Abstract：
The proximal humeral epiphyses can be conveniently viewed in routine spine radiographs. This study aimed to investigate whether the proximal humeral epiphyseal ossification system (PHOS) can be used to determine the timing of brace weaning in adolescent idiopathic scoliosis (AIS), as assessed by the rate of curve progression after brace weaning.
A total of 107 patients with AIS who had weaned brace-wear at Risser Stage ≥ 4, no bodily growth and post-menarche ≥ 2 years between 7/2014 and 2/2016 were studied. Increase in major curve Cobb angle > 5° between weaning and 2-year follow-up was considered curve progression. Skeletal maturity was assessed using the PHOS, distal radius and ulna (DRU) classification, Risser and Sanders staging. Curve progression rate per maturity grading at weaning was examined.
After brace-wear weaning, 12.1% of the patients experienced curve progression. Curve progression rate for weaning at PHOS Stage 5 was 0% for curves < 40°, and 20.0% for curves ≥ 40°. No curve progression occurred when weaning at PHOS Stage 5 with radius grade of 10 for curves ≥ 40°. Factors associated with curve progression were: Months post-menarche (p = 0.021), weaning Cobb angle (p = 0.002), curves < 40° versus ≥ 40° (p = 0.009), radius (p = 0.006) and ulna (p = 0.025) grades, and Sanders stages (p = 0.025), but not PHOS stages (p = 0.454).
PHOS can be a useful maturity indicator for brace-wear weaning in AIS, with PHOS Stage 5 having no post-weaning curve progression in curves < 40°. For large curves ≥ 40°, PHOS Stage 5 is also effective in indicating the timing of weaning together with radius grade ≥ 10.
A total of 107 patients with AIS who had weaned brace-wear at Risser Stage ≥ 4, no bodily growth and post-menarche ≥ 2 years between 7/2014 and 2/2016 were studied. Increase in major curve Cobb angle > 5° between weaning and 2-year follow-up was considered curve progression. Skeletal maturity was assessed using the PHOS, distal radius and ulna (DRU) classification, Risser and Sanders staging. Curve progression rate per maturity grading at weaning was examined.
After brace-wear weaning, 12.1% of the patients experienced curve progression. Curve progression rate for weaning at PHOS Stage 5 was 0% for curves < 40°, and 20.0% for curves ≥ 40°. No curve progression occurred when weaning at PHOS Stage 5 with radius grade of 10 for curves ≥ 40°. Factors associated with curve progression were: Months post-menarche (p = 0.021), weaning Cobb angle (p = 0.002), curves < 40° versus ≥ 40° (p = 0.009), radius (p = 0.006) and ulna (p = 0.025) grades, and Sanders stages (p = 0.025), but not PHOS stages (p = 0.454).
PHOS can be a useful maturity indicator for brace-wear weaning in AIS, with PHOS Stage 5 having no post-weaning curve progression in curves < 40°. For large curves ≥ 40°, PHOS Stage 5 is also effective in indicating the timing of weaning together with radius grade ≥ 10.
摘要：
目的：在常规脊柱X线片中可以方便地观察肱骨近端骨phy。本研究旨在探讨肱骨近端骨骨化系统（PHOS）是否可用于确定青少年特发性脊柱侧凸（AIS）的支具断乳时机。通过断奶后的曲线进展率评估。
方法：在2014年7月至2016年2月期间，共107例AIS患者在Riser分期≥4，无身体生长和初潮后≥2年的断奶支具。断奶和2年随访之间的主要曲线Cobb角>5°的增加被认为是曲线进展。使用PHOS评估骨骼成熟度，桡骨远端和尺骨（DRU）分类，Risser和Sanders上演.检查了断奶时每个成熟度等级的曲线进展率。
结果：在断奶后，12.1%的患者出现曲线进展。对于<40°的曲线，PHOS第5阶段断奶的曲线进展率为0%，曲线≥40°为20.0%。对于≥40°的曲线，在PHOS第5阶段断奶时半径等级为10时，未发生曲线进展。与曲线进展相关的因素是：初潮后数月（p=0.021），断奶Cobb角(p=0.002),曲线<40°与≥40°（p=0.009），半径（p=0.006）和尺骨（p=0.025）等级，和桑德斯阶段(p=0.025)，但不是PHOS阶段（p=0.454）。
结论：PHOS可以成为AIS中断奶的有用成熟度指标，PHOS阶段5在曲线<40°中没有断奶后曲线进展。对于大曲线≥40°,PHOS第5阶段也可有效地指示断奶时间以及半径等级≥10。
方法：在2014年7月至2016年2月期间，共107例AIS患者在Riser分期≥4，无身体生长和初潮后≥2年的断奶支具。断奶和2年随访之间的主要曲线Cobb角>5°的增加被认为是曲线进展。使用PHOS评估骨骼成熟度，桡骨远端和尺骨（DRU）分类，Risser和Sanders上演.检查了断奶时每个成熟度等级的曲线进展率。
结果：在断奶后，12.1%的患者出现曲线进展。对于<40°的曲线，PHOS第5阶段断奶的曲线进展率为0%，曲线≥40°为20.0%。对于≥40°的曲线，在PHOS第5阶段断奶时半径等级为10时，未发生曲线进展。与曲线进展相关的因素是：初潮后数月（p=0.021），断奶Cobb角(p=0.002),曲线<40°与≥40°（p=0.009），半径（p=0.006）和尺骨（p=0.025）等级，和桑德斯阶段(p=0.025)，但不是PHOS阶段（p=0.454）。
结论：PHOS可以成为AIS中断奶的有用成熟度指标，PHOS阶段5在曲线<40°中没有断奶后曲线进展。对于大曲线≥40°,PHOS第5阶段也可有效地指示断奶时间以及半径等级≥10。
