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摘要:目的
结合长骨关节端的声像表现，初步探索采用超声定量评估骺软骨的发育情况，并分析其与骨龄的相关性。
方法对2023年3—6月就读于济宁市某体校的青少年进行研究，记录年龄、身高等信息，于1周内行X线骨龄检查，并由1名内分泌科医师使用Greulich-Pyle图谱法评估骨龄。由2名超声医学科医师针对非优势侧手及腕部、膝关节共7个部位(包括第三掌骨头部背侧、尺骨茎突、桡骨茎突、股骨内上髁、股骨外上髁、胫骨背侧、胫骨内侧髁)进行超声检查，测量超声骺软骨厚度(ultrasonic epiphysis cartilage thickness，UECT)，并分析其与骨龄的相关性。采用组内相关系数(intraclass correlation coefficient, ICC)评估UECT测量的信度与可重复性。
结果共纳入141名青少年，其中男性80名，女性61名。中位年龄为13(12，14)岁，男性中位骨龄为15(13，17)岁，女性中位骨龄16(14，17)岁，男、女骨龄与年龄差值＞1岁者分别占比60%、67%，男性身高显著高于女性。男、女7个部位UECT均随骨龄增长而减小，各部位UECT与骨龄均呈负相关。男性单部位UECT与骨龄均呈高度负相关(|r|≥0.80)，女性则表现出中高度负相关(0.65≤|r|≤0.75)。男、女7个部位UECT总和与骨龄的负相关性均达到较高水平(|r|=0.93，|r|=0.80)，单独选取手和腕部3个部位或膝关节4个部位时，女性UECT总和与骨龄呈高度负相关(|r|≥0.76)，而男性则表现出非常高度负相关性(|r|≥0.90)。7个部位UECT的测量一致性均较好(ICC≥0.75)。
结论超声可观察描述长骨关节端的生长发育变化，UECT与骨龄表现出中至高度负相关，具有用于骨成熟度定量评估的潜在价值。
Abstract:ObjectivePreliminary exploration of using ultrasound to quantitatively evaluate the development of epiphyseal cartilage and analyze its correlation with bone age, based on the ultrasound findings of the long bone joint end.
MethodsA study was conducted on adolescents studying at a sports school in Jining from March to June 2023. Age, height and other information were recorded. Bone age assessment by X ray were performed within 1 week with an endocrinologist interpreted the bone age using the Greulich-Pyle atlas. Two sonographers scanned a total of 7 sites in the hand, wrist and knee joint of the non-dominant side (including the dorsal side of the third metacarpal head, the ulnar styloid process, the radial styloid process, the medial and the lateral femoral epicondyle, dorsal tibia, and medial tibial condyle). The ultrasonic epiphyseal cartilage thickness (UECT) was measured and its correlation with bone age was analyzed. Intraclass correlation coefficient (ICC) was used to evaluate the reliability and repeatability of UECT measurement.
ResultsA total of 141 adolescents were included, with 80 males and 61 females. The average age was 13 (12-14) years old. The average bone age was 15(13-17) years in males and 16 (14-17) years in females. The proportion of the males and females whose bone age was 1 year older than chronological age was 60% and 67%, respectively, and the height of the males was significantly higher than that of the females(P < 0.001). The UECT of 7 sites in the males and females decreased with the increase of bone age, and there was a significant negative correlation between UECT and bone age. In males, UECT was highly and negatively correlated with bone age (|r|≥0.80), while in females, it was moderately and negatively correlated (0.65≤|r|≤0.75). The correlation between the sum of UECT at seven sites and bone age reached high levels in both sexes(|r|=0.93, |r|=0.80).When 3 sites of hand and wrist or 4 sites of knee joint were selected separately, the UECT of the females was highly negatively correlated with bone age (|r| ≥0.76), while that of the males showed a very high correlation (|r| ≥0.90). The measurement consistency of UECT in all seven sites was good (ICC≥0.75).
ConclusionUltrasound can observe and describe the developmental change of long bone, and UECT has potential value in quantitative evaluation of bone maturity.
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Keywords:
- ultrasound /
- bone age /
- epiphysis /
- adolescent /
- growth and development
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经过一天烈日的炙烤，住院部外面的地表温度已经高达40 ℃，进进出出需要加强监护的患者还在不断增加，面对监护室内堆积如山的病患，大家的心情已经烦躁不安。高速周转的病房似乎又经历了一波“大洗牌”，病床上躺着不同的面孔，交班正仔细且有序地进行着。“号外……又有新病人要从急诊科转入，目前鼻导管10 L/min吸氧中，呼吸困难，需要重新评估插管指征......”值班护士小罗一边接听着电话，一边冲大家喊道。此刻空气仿佛凝住了一般，最尴尬的事情莫过如此——在交班时要来病人。“大家先交班，速战速决，准备收病人......”作为今天当值的高年资主治医师，我立刻说道。
伴随着转运车的声音，病人送来了，大家立刻围了上去，按照平时标准动作过床、吸氧、完成心电监护连接。我走到病床边，那是一位白发苍苍、胸前皮下还隐约有一枚“勋章”的爷爷，一看心电监护，我本能地反应那枚东西应该是心脏永久起搏器。为了判断病人意识及症状，我拍了拍老人肩膀，问道：“爷爷，您知道这是在哪儿吗？”老人没有回答，但是眼睛在不停地转动，嘴巴似乎要表达什么，带着一点儿北方口音，但听得不太清楚。我瞬时像明白了什么，于是俯下身去对着他的耳朵大声喊道：“爷爷，您知道这是在哪儿吗？您是不是听得不太清楚？”老人摇了摇头，又点了点头。
此时，我身旁一位经验丰富的“老医生”冲我扬了扬手中的听诊器听筒，我第一反应是她要听诊，于是连忙说道：“我来吧。”但她却直接把听头给爷爷戴上了，并对着听筒大声说道：“老爷子，这样能听清吗？”老人喃喃地回答：“听清了，听清了……”慢慢地，他紧崩的神情似乎也逐渐舒展开来。经过一系列问诊和针对性的处理后，爷爷慢慢睡着了。
病人急性呼吸窘迫的病因尚未完全明确，依然有病情随时加重的危险，依照惯例，我们立即联系家属了解老人的病史并进行谈话签字。通过与家属充分沟通，我们了解到了爷爷的慢性病史以及本次发病的诱因，还得知爷爷听力不好，这几天辗转各大医院，一直没休息好，病情也越来越重了。好在经过我们悉心的治疗和照顾，两周后爷爷终于出院了！
门诊复诊时，我看到爷爷耳朵上多了一副助听器，便打趣道：“爷爷，现在声音清楚多了吧？”爷爷笑着回答：“这玩意儿还是没有你们给我戴的东西听得清楚。”我和家属听完都哈哈大笑起来……
后记
听诊器的发明已有近200年的历史，其除了可以帮助医生完成重要的听诊检查外，在某些情况下还可以成为与病人沟通的桥梁。从法国医生雷奈克为了诊治患者，第一次提出“听诊器”的概念，到吴孟超院士在冬天查房时先用双手捂热听诊器再为患者听诊，再到为了能让患者听清楚，发现听诊器的新用途……不同听诊器的故事中，有不同的主人公以及不同的场景，但伴随的都是那份来自医生的爱，那份给予患者温暖的爱。病人与医生之间的第一步，是沟通，是了解，但病人在任何时候和任何状态下，都一定是需要帮助的那个人。任何人在面对身体的病痛时，或是因为没有足够专业的知识，或是因为疾病带来的切肤之痛，无论是酸胀、麻木、疼痛、无力，还是其他任何一种异样的感觉，都会让其内心产生对于异常表现的无限猜测以及随之而来的焦虑、恐慌。初入医学院时的我，心里想的只是如何掌握高精尖的各种医学技术，如何把病看好。进入医院工作多年以后，特别是在经历新型冠状病毒感染疫情后，我深切地体会到，不管医生的技术有多精湛，医疗水平有多高超，医生的关怀和援助永远都是病人最坚实的情感堡垒。治病一定是依靠科学，但让病人感觉到舒服却更需要医生对于患者那颗帮助的心。从医和患这层关系构建起来的那一刻起，他们就不该是对立的，而是共生的，更是共情的，感同身受、同气连枝才是医治疾病的起点，更是每一个合格医生毕生追求的终点。
临床医生正如其名字一样，需要站在床边仔细观察病人。观察的目的除正确诊断病情外，更重要的是察觉病人最需要的帮助是什么。故事中的老人一直处于听不清周围声音的状态，这时候病人可能会感到恐惧与烦躁，甚至会导致病情恶化，而一次仔细的观察就能够使问题迎刃而解。一个小小的听诊器，以及听诊器带来的这份“逆向思维”，彰显的不仅是一种临床采集病史的技巧，更是医生把心打开，试图去侧耳倾听病人诉说的耐心，以及尽其所能去关爱病人的慈悲。
因此，听诊器的故事，讲述的不是一种疾病的诊断，更不是一个病例的转归，听诊器联通的亦非症状与诊断，心跳与鼓膜，而是受伤的心和呵护的手，告诉我你哪里不舒服，我一定会想办法听到你的诉说，也一定会陪着你直到疾病消散。把痛苦告诉我，把希望传给你，这才是听诊器的真正意义所在，才是医生和病人最正确的相处方式。一如美国医生特鲁多对医生这个职业的经典描述——有时是治愈，常常是帮助，总是去安慰！
作者贡献：赵泽庆负责数据分析、论文初稿撰写；张莉、张怡璇、杨亚梅负责数据收集及论文写作指导；谷怡琳协助数据分析；陈适、王凤丹、潘慧负责论文指导、审核; 杨筱、李建初负责论文选题设计及写作指导。利益冲突：所有作者均声明不存在利益冲突 -
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图 1 次级骨化中心呈从骨干向关节端下降的抛物线形(A)和半圆形(B)强回声带(UECT勾画示意图)
Dia(diaphysis)：骨干；Soc(secondary ossification center)：次级骨化中心；UECT(ultrasonic epiphyseal cartilage thickness)：超声骺软骨厚度
Figure 1. The schematic diagram depicts the way to measure UECT when secondary ossification center shows a parabolic strong echo zone descending from the diaphysis to the joint end (A) and a semicircular strong echo band(B)
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图 2 次级骨化中心呈从骨干向关节端下降的抛物线形(A~G)和半圆形(a~g)强回声带(7个部位UECT超声图示)
A.第三掌骨头部背侧正中矢状面；B.尺骨茎突冠状面；C.桡骨茎突冠状面；D.股骨内上髁冠状面；E.股骨外上髁冠状面；F.胫骨背侧正中矢状面；G.胫骨内侧髁冠状面
Figure 2. Ultrasound diagram of UECT at 7 sites when the secondary ossification center shows a parabolic strong echo zone descending from the diaphysis to the joint end(A-G) and a semicircular strong echo band(a-g)
A.dorsal median sagittal plane of the third metacarpal head(MCP3); B.coronal plane of ulnar styloid process(Ulna); C.coronal plane of radial styloid process(Radius); D.coronal plane of medial epicondyle of femur(FM); E.coronal plane of lateral epicondyle of femur(FL); F.median sagittal plane of dorsal tibia(TD); G.coronal plane of medial condyle of tibia(TM)
UECT: 同图 1![]()
图 3 141名青少年年龄、身高及骨龄分布
A.年龄；B.身高；C.骨龄
Figure 3. Age, height and bone age distribution of 141 adolescents
A.age; B.height; C.bone age
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图 4 不同骨龄男性青少年长骨关节端声像图(以尺骨茎突、桡骨茎突、股骨外上髁、胫骨内上髁为例)
Figure 4. Sonograms of the joint ends of different long bones in male adolescents of different bone ages (taking the ulnar styloid process, radial styloid process, femoral lateral epicondyle, and tibial medial epicondyle as examples)
表 1 男性与女性一般资料比较
Table 1 General information between male and female
项目 男性(n=80) 女性(n=61) P值 年龄[M(P25, P75)，岁] 13(12, 14) 13(12, 14) 0.52 骨龄[M(P25, P75)，岁] 15(13, 17) 16(14, 17) 0.40 骨龄-年龄＞1岁[n(%)] 48(60) 41(67) 0.48 身高[M(P25, P75)，cm] 175.3 (167.8, 181.4) 167.1 (161.4, 173.2) ＜0.001 
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表 2 不同骨龄男性青少年7个部位的UECT测值[M(P25, P75)，mm]
Table 2 Measured values of UECT at 7 sites in male adolescents of different bone ages[M(P25, P75), mm]
骨龄(岁) MCP3 Ulna Radius FM FL TD TM 8(n=1) 1.4 4.2 5.4 5.0 2.6 3.0 4.7 9(n=1) 1.4 3.0 4.8 5.7 3.7 3.4 3.5 11(n=6) 1.7(1.3, 2.2) 3.2(2.7, 3.5) 4.2(4.0, 4.9) 3.5(2.4, 4.2) 2.5(2.2, 2.7) 3.6(2.8, 4.1) 4.0(3.5, 4.8) 12(n=3) 1.3(1.2, 1.9) 4.4(3.6, 5.2) 4.9(3.7, 5.5) 2.4(2.15, 3) 3.1(2.7, 3.8) 1.6(1.5, 2.1) 4.5(4.5, 4.8) 12.5(n=1) 1.0 2.6 3.1 2.1 2.4 2.3 2.8 13(n=11) 1.4(0.9, 1.5) 2.5(2.1, 2.9) 3.0(2.6, 3.3) 2.0(1.3, 2.6) 2.9(2.3, 3.0) 1.8(1.7, 2.0) 3.0(2.6, 3.2) 13.5(n=2) 1.5(1.2, 1.9) 3.0(2.9, 3.0) 3.1(3.0, 3.2) 1.9(1.9, 1.9) 1.7(1.6, 1.9) 3.0(2.4, 3.5) 2.7(2.5, 2.8) 14(n=7) 0.8(0.7, 0.9) 2.0(1.5, 2.1) 2.2(1.9, 2.9) 1.8(1.4, 2.0) 2.0(1.3, 2.3) 1.6(1.2, 2.2) 2.1(2.0, 3.3) 15(n=11) 0.6(0.6, 0.7) 1.9(1.5, 2.2) 2.2(1.6, 2.3) 1.5(1.1, 1.9) 1.7(0.9, 2.7) 1.2(0.7, 1.8) 2.2(1.3, 2.5) 16(n=4) 0.4(0.2, 0.4) 1.1(0.9, 1.4) 1.2(0.8, 1.7) 0.8(0.6, 1.0) 1.2(1.0, 1.3) 0.7(0.5, 0.8) 1.3(1.1, 1.4) 17(n=19) 0.1(0, 0.4) 1.3(0.7, 1.7) 1.3(1.1, 1.5) 0(0, 0.8) 0.9(0.6, 1.4) 0(0, 0.7) 0.6(0, 1.3) 18(n=14) 0(0, 0) 0.6(0.4, 1.0) 0.6(0.4, 0.9) 0(0, 0) 0(0, 0.4) 0(0, 0) 0(0, 0)
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表 3 不同骨龄女性青少年7个部位的UECT测值[M(P25, P75)，mm]
Table 3 Measured values of UECT at 7 sites in female adolescents of different bone ages [M(P25, P75), mm]
骨龄(岁) MCP3 Ulna Radius FM FL TD TM 7(n=1) 1.7 4.7 6.4 3.1 3.8 1.5 2.3 8(n=1) 2.0 5.4 4.9 1.8 4.0 3.8 3.0 11(n=2) 1.1(1.0, 1.2) 2.4(2.0, 2.7) 3.4(2.6, 4.3) 2.5(2.2, 2.7) 2.2(1.7, 2.6) 1.9(1.8, 1.9) 1.7(1.4, 1.9) 11.5(n=1) 0.7 1.5 2.6 2.9 1.9 1.4 2.4 12(n=2) 0.9(0.8, 0.9) 1.9(1.9, 2.0) 2.1(2.0, 2.3) 1.5(1.4, 1.6) 1.7(1.7, 1.8) 0.9(0.9, 1.0) 4.4(4.0, 4.7) 13(n=7) 0.5(0.4, 0.6) 1.7(1.1, 1.8) 1.7(1.5, 1.9) 1.3(1.1, 2.0) 1.1(1.0, 1.3) 1.1(0.8, 1.4) 1.9(1.0, 2.7) 14(n=3) 0.3(0.3, 0.7) 1.3(1.3, 1.8) 1.3(1.2, 1.8) 1.4(0.7, 2.1) 1.0(1.0, 1.3) 0.6(0.3, 0.7) 1.3(1.2, 1.3) 15(n=4) 0.5(0.3, 0.5) 1.9(1.5, 2.1) 1.6(1.5, 1.7) 1.1(0.6, 1.6) 0.9(0.7, 1.4) 0.9(0.6, 1.3) 0.8(0.3, 1.5) 16(n=13) 0(0, 0) 0.9(0.9, 1.1) 0.8(0.6, 1.2) 0(0, 0.6) 0.9(0.5, 1.5) 0(0, 0) 0(0, 0.5) 17(n=19) 0(0, 0.2) 0.8(0.6, 1.1) 1.1(1.0, 1.4) 0(0, 0.7) 0.5(0, 1.0) 0(0, 0.2) 0(0, 0.2) 18(n=8) 0(0, 0) 0.4(0.2, 0.7) 0.6(0.4, 0.8) 0(0, 0) 0(0, 0.1) 0(0, 0) 0(0, 0)
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表 4 单部位UECT与骨龄的相关系数(r)
Table 4 Correlation coefficient between single-site UECT and bone age
性别 MCP3 Ulna Radius FM FL TM TD 男 -0.84 -0.85 -0.90 -0.83 -0.80 -0.87 -0.86 女 -0.74 -0.71 -0.69 -0.67 -0.65 -0.75 -0.71 MCP3、Ulna、Radius、FM、FL、TD、TM：同图 2
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表 5 7个部位UECT总和与骨龄及年龄的相关系数(r)
Table 5 Correlation between the sum of UECT at 7 sites and bone age or chronological age
性别 骨龄 年龄 男 -0.93 -0.79 女 -0.80 -0.64
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表 6 多部位UECT总和与骨龄的相关系数
Table 6 Correlation coefficient between UECT sum of different sites and bone age
性别 FL+TM+TD FM+TM+TD knee joint hand and wrist all 男 -0.91 -0.92 -0.93 -0.90 -0.93 女 -0.80 -0.76 -0.79 -0.77 -0.80 FL、FM、TM、TD：同图 2；knee joint：膝关节4个部位UECT总和；hand and wrist：手和腕部3个部位UECT总和；all：7个部位UECT总和
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表 7 UECT测量的一致性分析
Table 7 Consistency analysis of UECT measurements
部位 ICC 95% CI MCP3 0.91 0.79~0.96 Ulna 0.95 0.84~0.98 Radius 0.91 0.78~0.97 FM 0.98 0.95~0.99 FL 0.93 0.83~0.97 TD 0.93 0.83~0.97 TM 0.95 0.89~0.98 MCP3、Ulna、Radius、FM、FL、TD、TM：同图 2；ICC(intraclass correlation coefficient): 组内相关系数
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[1] Gaudino R, De Filippo G, Bozzola E, et al. Current clinical management of constitutional delay of growth and puberty[J]. Ital J Pediatr, 2022, 48(1): 45. DOI: 10.1186/s13052-022-01242-5
[2] 王凤丹, 次旦旺久, 焦洋, 等. 人工智能在骨龄评估中的应用[J]. 基础医学与临床, 2022, 42(11): 1776-1780. Wang F D, Cidanwangjiu, Jiao Y, et al. Use of artificial intelligence in bone age assessment[J]. Basic Clin Med, 2022, 42(11): 1776-1780.
[3] 袁新宇, 潘诗农, 程晓光. 构建儿童骨龄核心数据建立中国儿童骨龄标准体系[J]. 中华放射学杂志, 2023, 57(4): 341-343. DOI: 10.3760/cma.j.cn112149-20230219-00114 Yuan X Y, Pan S N, Cheng X G. Establishing bone age database of contemporary healthy children and building the standard for assessment in China[J]. Chin J Radiol, 2023, 57(4): 341-343. DOI: 10.3760/cma.j.cn112149-20230219-00114
[4] 赵泽庆, 潘慧, 张莉, 等. 超声评估骨龄研究现状及临床应用前景[J]. 协和医学杂志, 2024, 15(2): 400-405. DOI: 10.12290/xhyxzz.2023-0270 Zhao Z Q, Pan H, Zhang L, et al. Research status and application prospect of bone age assessment by ultrasonography[J]. Med J PUMCH, 2024, 15(2): 400-405. DOI: 10.12290/xhyxzz.2023-0270
[5] Pazzaglia U E, Beluffi G, Benetti A, et al. A review of the actual knowledge of the processes governing growth and development of long bones[J]. Fetal Pediatr Pathol, 2011, 30(3): 199-208. DOI: 10.3109/15513815.2010.524693
[6] Rivas R, Shapiro F. Structural stages in the development of the long bones and epiphyses: a study in the New Zealand white rabbit[J]. J Bone Joint Surg Am, 2002, 84(1): 85-100. DOI: 10.2106/00004623-200201000-00013
[7] Mukaka M M. Statistics corner: a guide to appropriate use of correlation coefficient in medical research[J]. Malawi Med J, 2012, 24(3): 69-71.
[8] Ekizoglu O, Er A, Buyuktoka A D, et al. Ultrasonographic assessment of ossification of the distal radial epiphysis for estimating forensic age[J]. Int J Legal Med, 2021, 135(4): 1573-1580. DOI: 10.1007/s00414-021-02521-2
[9] Benito M, Muñoz A, Beltrán I, et al. Assessment of adulthood in the living Spanish population based on ossification of the medial clavicle epiphysis using ultrasound methods[J]. Forensic Sci Int, 2018, 284: 161-166. DOI: 10.1016/j.forsciint.2018.01.007
[10] Torenek Ağirman K, Bilge O M, Miloğlu Ö. Ultrasono-graphy in determining pubertal growth and bone age[J]. Dentomaxillofac Radiol, 2018, 47(7): 20170398. DOI: 10.1259/dmfr.20170398
[11] Castriota-Scanderbeg A, De Micheli V. Ultrasound of femoral head cartilage: a new method of assessing bone age[J]. Skeletal Radiol, 1995, 24(3): 197-200. DOI: 10.1007/BF00228922
[12] Castriota-Scanderbeg A, Sacco M C, Emberti-Gialloreti L, et al. Skeletal age assessment in children and young adults: comparison between a newly developed sonographic method and conventional methods[J]. Skeletal Radiol, 1998, 27(5): 271-277. DOI: 10.1007/s002560050380
[13] Sherif H, Noureldin M, Bakr A F, et al. Sonographic measurement of calcaneal volume for determination of skeletal age in children[J]. J Clin Ultrasound, 2003, 31(9): 457-460. DOI: 10.1002/jcu.10213
[14] Windschall D, Pommerenke M, Haase R. Ultrasound assessment of the skeletal development of the proximal tibial, proximal femoral, and distal femoral epiphyses in premature and mature newborns[J]. Ultrasound Med Biol, 2016, 42(2): 451-458. DOI: 10.1016/j.ultrasmedbio.2015.10.020
[15] Wan J, Zhao Y, Feng Q Q, et al. Statistical confirmation of a method of US determination of bone age[J]. Radiology, 2021, 300(1): 176-183. DOI: 10.1148/radiol.2021204353
[16] Wan J, Zhao Y, Feng Q Q, et al. Potential value of conventional ultrasound in estimation of bone age in patients from birth to near adulthood[J]. Ultrasound Med Biol, 2019, 45(11): 2878-2886. DOI: 10.1016/j.ultrasmedbio.2019.07.681
[17] Wan J, Zhao Y, Feng Q Q, et al. Summation of ossification ratios of radius, ulna and femur: a new parameter to evaluate bone age by ultrasound[J]. Ultrasound Med Biol, 2020, 46(7): 1761-1768. DOI: 10.1016/j.ultrasmedbio.2020.03.021
[18] Roth J, Jousse-Joulin S, Magni-Manzoni S, et al. Definitions for the sonographic features of joints in healthy children[J]. Arthritis Care Res (Hoboken), 2015, 67(1): 136-142. DOI: 10.1002/acr.22410
[19] Benedick A J, Hogue B, Furdock R J, et al. Estimating skeletal maturity using knee radiographs during preadolescence: the epiphyseal: metaphyseal ratio[J]. J Pediatr Orthop, 2021, 41(9): 566-570. DOI: 10.1097/BPO.0000000000001921
[20] Huang L F, Furdock R J, Uli N, et al. Estimating skeletal maturity using wrist radiographs during preadolescence: the epiphyseal: metaphyseal ratio[J]. J Pediatr Orthop, 2022, 42(7): e801-e805. DOI: 10.1097/BPO.0000000000002174
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