背景：目前在国内医学和体育领域有3种骨龄评估方法较为广泛应用，分别为Greulich-Pyle图谱法(GP法)、CHN计分法(CHN法)、中华05法，哪种方法更适合本地区的儿童青少年评估，需要进行大样本研究实证。

目的：以上海市健康儿童为样本，比较GP法、CHN法、中华05法骨龄，为经济发达东部地区儿童青少年选用合适的骨龄评估方法提供参考。

方法：受试者为上海市市区4 152名(男2 185，女1 967)儿童青少年，分别以GP法、CHN法、中华05法骨龄标准评价所有受试者左手腕部X射线片骨龄，以骨龄与生活年龄之间的差值评价不同骨龄标准的适用性。项目经上海体育科学研究所伦理委员会通过，受试学生放家长均知情同意。

结果与结论：①GP法，6-8岁男女骨龄与生活年龄差值为-0.12至-0.65岁，其中女子8岁差异无显著性，其他组均有差异具有显著性，≥9岁差值为岁，除9岁年龄段外，其他组差异均具有显著性；②CHN法，男6-17岁和女6-16岁，骨龄与生活年龄差值为岁(P＜ 0.01)；③中华05法，男子6-16岁，骨龄与生活年龄差值在(P＜ 0.01)，17岁差值为0.08(P＞ 0.05)，18岁组为-0.60(P＜ 0.01)；女6-17岁，骨龄与生活年龄差值在-，大部分年龄组差异无显著性意义；④在3种评估方法中，中华05法评估结果相对来说较好，最为符合当前上海市青少年发育状态，提示中华05法更适合于经济水平类似于上海东部发达地区。3种评估方法都有一定的局限性，由于青少年生长长期趋势影响，也有必要再次修订目前使用的各种骨龄评估标准。

BACKGROUND:In China, three bone age assessment methods have been widely used in the medical and sports fields, including the Greulich-Pyle atlas method (GP method), CHN scoring method (CHN method), and China 05 method. A large-sample empirical study is required to determine which method is more suitable for assessing bone age of children and adolescents.

OBJECTIVE:To provide a scientific evidence for appropriate bone age evaluation standards for children and adolescents in the eastern developed areas, by comparing the GGP method, CHN method and China 05 method based on samples of healthy children from Shanghai.

METHODS:A total of 4 152 healthy children and adolescents (2 185 boys and 1 967 girls) from the urban area of Shanghai were selected for the study. Their digital X-ray of the left hand and wrist were collected and evaluated by the GGP method, CHN method and China 05 method. The difference between the bone age and the chronological age was used to assess the applicability of different bone age standards. The study was approved by the Ethics Committee of Shanghai Research Institute of Sports Science, and informed consent was given by all parents of the enrolled students.

RESULTS AND CONCLUSION:For the GP method, the difference between bone age and chronological age in both genders at the age of ≥ 8 years was -0.12 to -0.65 year with significant difference, except for 8-year-old girls. The significant age difference at the age of ≥ 9 years was 0.18 to 1.62 year, except for the 9-year-old age group. For the CHN method, the difference between bone age and chronological age among 6-17-year-old boys and 6-16-year-old girls was 0.42 to 1.56 years (P＜ 0.01). For the China 05 method, the difference between bone age and chronological age was 0.20 to 0.53 in 6-16-year-old boys (P＜ 0.01), 0.08 in 17-year-old boys (P＞ 0.05), and -0.60 in 18-year-old boys (P＜ 0.01); the age difference among 6-17-year-old girls was -0.01 to 0.56 year, and the difference was not significant in most age groups. Among the three methods, the result of China 05 method is relatively better, which is the best method that matches the current development of teenagers in Shanghai, suggesting that the China 05 method is more suitable for the eastern developed areas with economic level similar to Shanghai. All the three methods have some limitations. Considering the long-term growth trend of adolescents, it is necessary to revise the current bone age evaluation standards.

0 引言 Introduction

骨龄评估是最经典的生物学年龄鉴定的方法[1-2]，在儿童保健学、儿童内分泌疾病诊断、青少年运动员选材学、青少年司法犯罪鉴定中得到广泛的应用。骨龄评估方法自20世纪初发展至今，已经有100多年的历史，其评估方法发展经历3个阶段：计数法、图谱法到计分法[3-4]。目前在国内医学和体育领域有3种骨龄评估方法较为广泛应用，分别为Greulich-Pyle图谱法(GP法)、CHN计分法(CHN法)、中华05法。GP法是上世纪初以美国上层富人儿童为样本，纵向追踪方法定的骨龄评价方法[5]，CHN法和中华05方法是以国内青少年儿童为样本量[6-7]，横断面采样，制定于不同的时代的两种方法，当这3种方法在某一地区应用时，由于制定标准时样本差异(种族差异、时代差异、样本量差异)，3种方法评估同一个人骨龄时，结果会产生较大的差异[8]，因此，这3种骨发育评估方法中，到底哪种方法更适合该地区的儿童青少年评估，需要进行大样本实证研究，为此研究比较GP法、CHN法和中华05法这3种骨发育方法评价上海市当代健康儿童青少年骨龄的差异，以确定哪种方法更适用于上海市当代儿童的生长发育评估，同时也可以为经济发展水平与上海类似的东部地区儿童青少年生长发育评估方法的选择提供参考。

文章来源：《青少年体育》 网址: http://www.qsntyzz.cn/qikandaodu/2021/0302/1136.html