Value Of Thumb Ossification Composite Index For Predicting Growth Potential In Patients With Adolescent Idiopathic Scoliosis

PartⅠ Value of thumb ossification composite index for predicting growth potential in patients with adolescent idiopathic scoliosisObjective To evaluate the predictive value of thumb ossification composite index(TOCI)for growth potential in adolescent idiopathic scoliosis(AIS)patients and to analyze its correlation with several other indicators of growth potential.Methods A retrospective review was conducted on 45 girls with AIS who underwent standard bracing treatment between October 2006 and August 2013 in Nanjing DrumTower Hospital.All patients were regularly followed up with an interval of 4-6 months until brace weaning.During follow up,the data,including age,menses,height,Cobb angle of main curve,TOCI score,digital skeletal age(DSA)score and radius,ulna and small bones(RUS)score,were recorded: chronologic age,stage of menses,standing height,Cobb angle of main curve,TOCI score,digital skeletal age(DSA)score and radius,ulna and small bones(RUS)score.The height velocity(HV)at each visit were calculated.The correlations analysis between TOCI and other indicators including DSA scores and RUS scores were studied.Results The average age at initial visit was(10.9±1.3)years.The average age of menarche was(12.6±1.3)years.The mean peak height velocity(PHV)was(7.5±1.5)cm/year and the mean age was(12.0±0.9)years.A total of 71.8% AIS girls attained their PHV at TOCI 5.The Spearman correlation analysis showed that TOCI was highly correlated with the DSA and RUS scores(r=0.95 and 0.96,both P<0.001).Chi-square test showed that TOCI 5 accurately predicted the occurrence of PHV(Cramer V=0.531,P=0.007).Conclusion The TOCI 5 indicates high HV and high growth potential in AIS patients with bracing treatment.TOCI can thus serve as a good indicator for growth potential in braced AIS girls.Part Ⅱ Contrastive study of thumb ossification composite index and Risser sign in evaluating the growth potential of adolescent idiopathic scoliosisObjective To compare and analyze the correlations between thumb ossification composite index(TOCI),Risser sign and digital skeletal age(DSA)scores and to verify the possibility of TOCI as a supplementary to Risser sign in the evaluation of growth potential of adolescent idiopathic scoliosis(AIS)patients.Methods Forty-nine AIS patients undergoing bracing treatment between May 2006 and May 2014 were selected from Nanjing Drum Tower Hospital.The follow-up interval was 4-6 months.The following data at each visit were routinely collected,including TOCI and DSA scores,as well as chronologic age and standing height.The height velocity(HV)at each visit was calculated based on the above data.All results were analyzed by Spearman correlation with TOCI and Risser sign.Results There were strong correlations between TOCI and Risser sign and DSA scores(r=0.962,0.813,both P<0.01).In AIS patients whose Risser sign were 0-1,the correlation between TOCI and DSA scores was more pronounced,compared with the correlation between Risser sign and DSA scores(0.918 vs 0.792,P<0.01).The HV averaged 7.1 cm/year in TOCI 5,significantly larger than these in other TOCI scores(all P<0.01).Conclusions The TOCI 5 can be a sign of high height velocity and high growth potential in AIS patients.TOCI is a valid indicator of skeletal maturity evaluation and can be used as a helpful supplementary to Risser sign,whose predictive ability may be better than Risser sign.