【摘要】 目的:检验《中国人手腕骨发育标准-中华05》的RUS-CHN和TW3-C对腕骨骨龄评价的可靠性。方法:11名有不同骨龄评价经验的评价者以RUS-CHN法评价75名儿童左手腕后前位X线片(骨龄3-18岁),其中7名评价者以TW3-C腕骨方法评价46名儿童腕骨X线片(骨龄3~13.5岁);20天后重复阅读。结果:评价者内的RUS-CHN骨发育等级评价重复率为63.4%~82.2%,单一读数的95%置信区间为±0.40岁~±0.76岁;评价者内的TW3-C腕骨等级评价重复率为65.6%~83.2%,单一读数的95%置信区间为±0.38岁~±0.71岁。评价者间的RUS-CHN等级评价重复率为61.3%~77.3%,单一读数的95%置信区间为±0.42岁~±0.96岁;评价者间的TW3-C腕骨等级评价重复率为77.4%~88.0%,单一读数的95%置信区间为±0.42岁~±0.78岁。结论:具备不同经验的评价者,其评价骨龄的可靠性有显著性差异;有经验者读片可靠性水平较高,少数无经验者通过一次学习培训可以达到有经验者的水平,但大部分无经验者的评价可靠性较低,需进一步学习与实践。更多还原

【Abstract】 Objective The reliability of the RUS-CHN of The Standards of Skeletal Maturity of Hand and Wrist for Chinese-China 05 and the TW₃-C Carpal methods was studied and the effects of readers’ experience on the measured skeletal age were determined.Methods Under the conditions that readers were blinded to the age and sex of the children,the hand and wrist radiographs of 75 children（skeletal age from 3 to 18 years） were independently read by 11 readers using RUS-CHN method and the radiographs of 46 children（skeletal age from 3 to 13.5 years） were analyzed by 6 readers using TW₃-C Carpal method.The radiographs were re-read by the same readers 20 days later.The percentage agreement in the ratings and the differences of skeletal age in the rereading were used to evaluate the reliability.Results It was found that（a） intraobserver percentage agreement of ratings were 63.4% to 82.2% for RUS-CHN and 65.6% to 83.2% for TW₃-C Carpal respectively,the intraobserver 95% confidence limits for a single reading were ±0.40 year to ±0.76 year for RUS-CHN and ±0.38 year to（±0.71） year for TW₃-C Carpal respectively;（b） interobserver percentage agreement of ratings were 61.3% to 77.3% for RUS-CHN and 77.4% to 88.0% for TW₃-C Carpal respectively;interobserver 95% confidence limits for a single reading were ±0.42 year to ±0.96 year for RUS-CHN and ±0.42 year to ±0.78 year for TW₃-C Carpal respectively.Conclusion The present findings suggest that the reliability of skeletal age assessment between readers is significantly different and that the reliability levels of the experienced and relative experienced readers is higher,which can be obtained for few nonexperienced readers through training of assessment of skeletal age.The assessments of skeletal age are unreliability for the majority of non-experienced readers,so that the further training for them is needed.更多还原