中国人手腕骨发育标准-中华05.Ⅲ.中国儿童骨发育的长期趋势

目的观察中国儿童骨发育的长期趋势,为合理应用我国不同时期的骨发育标准提供参考.方法以1988年、2005年骨发育调查样本为对象.以概率单位回归方法计算各样本儿童的手腕骨化中心出现年龄和融合年龄.以CHN法评价2005年样本儿童各年龄组的骨龄,并与生活年龄比较.结果与1964年的儿童相比,1988年儿童手腕骨化中心出现年龄和融合年龄均提前;而与1988年样本比较,2005年男女儿童掌指骨骨化中心出现年龄均提前0.5岁～1.0岁,掌指骨的骺干融合年龄分别提前1.0岁和1.0～1.5岁;2005年不同年龄组男女儿童的CHN骨龄分别提前0.3岁～1.1岁和0.2岁～1.0岁.结论近40年来,中国儿童骨发育表现出加速的长期趋势,应当慎用1964年和1988年骨龄标准评价当代中国儿童的骨发育状况.     

中国人手腕骨发育标准——中华05.IV.中国儿童手腕骨发育特征

目的:观察中国儿童手腕骨发育特征,为应用国外研究成果提供参考。方法:受试者为2005年骨发育调查样本2~18岁的16035名儿童。使用TW3方法评价手腕骨成熟度,与文献中的日本、欧美儿童的数据相比较。结果:中国和日本儿童的手腕骨发育特征相似。在儿童期,中国男儿童TW3-RUS和TW-腕骨成熟度延迟于欧美儿童0.3~0.6岁,女儿童在5~10岁TW3-RUS骨发育与欧美儿童非常接近;但在男12岁、女10岁以后,中国男女儿童TW-RUS骨成熟度加速而分别提前1.1~1.6岁和1.2岁。与欧美儿童相比,中国男儿童在3~10岁、女儿童在2~5岁,TW-腕骨成熟度分别延迟0.3~0.6岁和0.2~0.4岁;在男10岁和女5岁后,中国儿童TW-腕骨成熟度加速而提前,腕骨发育成熟的年龄均提前1.4岁。结论:与1970s~1990s的欧美儿童相比,中国儿童骨发育的延迟已不明显,但是青春期TW3-RUS骨发育加速提前的程度以及腕骨发育成熟年龄的提前则更加显著。     

中国人手腕骨发育标准-中华05.Ⅳ.中国儿童手腕骨发育特征

目的观察中国儿童手腕骨发育特征,为应用国外研究成果提供参考.方法受试者为2005年骨发育调查样本2～18岁的16035名儿童.使用TW3方法评价手腕骨成熟度,与文献中的日本、欧美儿童的数据相比较.结果中国和日本儿童的手腕骨发育特征相似.在儿童期,中国男儿童TW3-RUS和TW-腕骨成熟度延迟于欧美儿童0.3～0.6岁,女儿童在5～10岁TW3-RUS骨发育与欧美儿童非常接近;但在男12岁、女10岁以后,中国男女儿童TW-RUS骨成熟度加速而分别提前1.1～1.6岁和1.2岁.与欧美儿童相比,中国男儿童在3～10岁、女儿童在2～5岁,TW-腕骨成熟度分别延迟0.3～0.6岁和0.2～0.4岁;在男10岁和女5岁后,中国儿童TW-腕骨成熟度加速而提前,腕骨发育成熟的年龄均提前1.4岁.结论与1970s～1990s的欧美儿童相比,中国儿童骨发育的延迟已不明显,但是青春期TW3-RUS骨发育加速提前的程度以及腕骨发育成熟年龄的提前则更加显著.     

中国人手腕骨发育标准-中华05 I.TW3-C RUS、TW3-C腕骨和RUS-CHN方法

目的适应20年来中国儿童出现的长期快速的生长发育趋势,修订中国人手腕骨发育标准.方法标准化样本为0～20岁的17401名(男8685名,女8716名)城市汉族正常青少儿.由一名评价者使用TW3方法阅读所有X线片.另外,在第一掌骨、近节指骨和中节指骨的第4、5、6、7等级,远节指骨的5、6、7等级,以及桡骨的第5、6等级和尺骨第5等级内选择新的骨成熟度指征,将每个等级分为两个骨发育等级;同时,根据桡骨、尺骨的融合程度将融合过程划分为4个阶段.使用分类特征计分算法计算骨发育等级得分.这种新的骨龄评价方法称为RUS-CHN法.结果以百分位数法分别制订了TW3-C RUS、TW3-C腕骨、RUS-CHN骨龄标准,称为<中国人手腕骨发育标准-中华05>.经在1～19岁2438名(男1301名,女1137名)对象中应用检验,各年龄组TW3-C RUS、TW3-C腕骨、RUS-CHN骨龄与生活年龄的差值大都在0.0～0.3岁之间.结论<中国人手腕骨发育标准-中华05>适用于我国当代儿童.     

《中国人手腕骨发育标准—中华05》RUS-CHN法在当代少年运动员中的应用

目的探讨《中国人手腕骨发育标准-中华05》RUS-CHN法在当代少年运动员中的应用效果。方法分别采用RUS-CHN法和原骨龄标准CHN法,评价245名8~18岁不同项目少年运动员的左手腕骨骨龄。结果不同运动项目的少年运动员,RUS-CHN骨龄与生活年龄间的差异无显著性,但原标准CHN法骨龄与生活年龄之间的差值为正数(0.71~0.91岁),且差异显著(P<0.01)。与原标准CHN方法相比,新标准RUS-CHN法骨龄读数组距更细,频数分布更均匀,并减少了骨龄与生活年龄差值等于或大于2岁的少年运动员的例数。结论当代少年运动员表现出了生长发育加速的长期趋势,《中国人手腕骨发育标准-中华05》RUS-CHN法更适用于当代少年运动员。     

学龄前儿童X线骨龄测评

目的 通过X线对健康学龄前儿童手腕部骨龄测评,了解其生长发育的特点和变化趋势,制定新的学龄前儿童骨龄标准.资料与方法 采用横断面调查方法,于2006年3月至2009年3月随机抽取贵州省贵阳市中心城区0～6岁学龄前儿童4404例,摄左侧手腕部正位X线平片,用TW3法测评骨成熟分(SMS).绘制SMS趋势图,制定学龄前儿童骨龄百分位表,统计各观察骨骨化中心萌出率.结果 低龄组儿童(＜1岁)各组SMS差异不大.按TW3标准测评R、C系列骨龄较实际年龄大;按TW2CH标准测评C系列与实际年龄基本相符.得到R、C系列SMS百分位表.得到各观察骨骨化中心萌出率表.结论 低龄组儿童进一步分组已无必要.TW3标准与国人出入较大,需要制定符合本国国情的骨龄评测标准.各观察骨骨化中心萌出情况与既往一致.     

跟骨骨骺发育X线研究

目的探讨跟骨骨骺从出现到闭合阶段发育的形态特征。方法 2012年5月~2016年2月期间,连续搜集1177例在日照市人民医院就诊的儿童青少年单踝X线正侧位片,其中男673例,女504例,年龄范围4个月~18.99岁,每岁为一组,每组男女各20~50例,观察分析每组跟骨骨骺出现及闭合例数、骨骺形态(结节状、弧形、不规则形)、密度(致密型、松质骨型)、透亮线随年龄变化特点及男女性别差异。结果女性跟骨骨骺最早于3~岁年龄组出现1例,9~岁及以后年龄组全部出现,完全闭合年龄最早于11~岁年龄组出现1例,16~岁及以后年龄组全部闭合;男性跟骨骨骺最早于5~岁年龄组出现1例,11~岁及以后年龄组全部出现,完全闭合年龄最早于12~岁年龄组出现1例,18~岁年龄组全部闭合。54例儿童在骨骺出现前有暂时性发育性跟骨骨刺(假性骨刺)出现。骨骺密度(致密型、松质骨型)、透亮线、假性骨刺性别差异均无显著统计学意义(χ~2=1.22、0.52、2.45,均P0.05)。跟骨骨骺最后闭合部位,上部29例,下部13例,差异有统计学意义(χ~2=6.40,P0.05)。结论认识跟骨骨骺发育规律,有助于跟骨骨骺疾病的X线诊断和鉴别。     

高原藏族和汉族青少年手和腕部骨发育异同的探讨

本文通过对世居青藏高原(海拔3000～4000m)藏族和汉族7～18岁健康学生1460人手腕部X光片的分析,研究两民族在高原环境下骨发育的规律和异同。本文资料表明:高原藏族青少年手和腕部骨的发育,骨化中心出现顺序及长骨干骺愈合顺序均与汉族青少年相同,在时间上一般提前于汉族1～2年。籽骨的出现或手末节指骨的干骺愈合,两族基本一致,可作为预测月经初潮的指标。本文讨论了其差异的原因。     

计算机辅助评估骨龄(中国人手腕骨发育标准CHN法的计算机化)

目的:把中国人手腕骨发育标准CHN骨龄评估法计算机化,以期提高骨龄评估的快速易用性及准确性。方法:笔者将CHN骨龄评估法计算机化,并配以计算机化的标准图谱编制成骨龄辅助评估应用软件,并对39 份2～17岁儿童手腕骨,共546 块骨的X片进行计算机辅助骨龄评估法与人工骨龄评估法的骨发育分级的一致性和所用时间进行对照。结果:计算机辅助法骨发育分级的一致性明显高于人工法(P< 0.01),并且骨龄评估所需的时间亦明显少于人工法。结论:本系统骨龄评估的快速易用性、准确性及重复性明显优于人工法,值得推广应用     

特发性侏儒症的骨龄观察

目的：分析骨龄，为在矮身材防治研究工作中提供依据。材料与方法：回顾性分析以矮身材就诊患者９８例的Ｘ线片，９岁以前照左腕关节正位片，９～１４岁照在腕关节和左肘关节正位片，１５岁以上者照左腕关节及左膝关节正位片，观察骨骺、骨化中心出现的年龄，以及骨干与骨骺融合的年龄。结果：骨骼年龄较实际年龄延迟平均５．８岁。结论：观察骨龄对特发性侏儒症十分重要，不仅可预测身高，而且能根据骨龄的提前、同步、落后、提示病因，鉴别其他疾病。     

Secular trends in physical growth indicators in infants and young children

There have been no analyses in Japan that have used mathematical functions to investigate changes over time in physical growth records of infants and young children. In this study, we investigated secular changes in physical growth velocity of infants and young children using the wavelet interpolation method, and examined secular changes in physical growth indicators. The subject data were physical growth survey records for young boys and girls published by the Ministry of Health, Labor and Welfare in 1960 and 2000. The physical growth indicators used in the study were height, weight, chest circumference and head circumference. The wavelet interpolation method was applied to these indicators for the period from age 0 to 6 years, and the derived growth distance curves and growth velocity curves were analyzed. The values at birth were higher in 1960 than in 2000 for both boys and girls, but after 6 months of age the values for 2000 exceeded those for 1960. The largest peak velocity soon after birth, obtained from the analysis of the growth velocity curve, did not show clear secular changes in either boys or girls. However, a clear increasing trend was seen in the largest peak velocity for all indicators in both boys and girls in 2000, compared with 1960. The age at first local peak velocity remained unchanged in boys in 2000 compared with 1960, but in girls slightly earlier trends were seen in all indicators in 2000. Thus, this investigation of the secular changes in physical growth indicators in infants and young children indicated that in 2000 children were slightly smaller at birth, but then matured more quickly, and grew larger than children in 1960.     

Radiology of Postnatal Skeletal development: The proximal humerus

Twenty-three pairs of proximal humeri obtained from human cadavers ranging in age from fullterm stillborn to fourteen years were studied morphologically and radiographically. Roentgenograms of the specimens demonstrated the osseous and cartilaginous portions of the epiphyses, using air/cartilage interfacing. Comparable clinical simulations were obtained by using water immersion of the specimens. The metaphyseal cortex remained thin and trabecular near the physis. Histologically this area had multiple fenestrations, which provide a potential pathway for childhood osteomyelitis into the subperiosteal space, and may also affect the biomechanics of this region (i.e., susceptibility to Salter epiphyseal fractures). As skeletal maturity was reached, thicker cortical (osteonal) bone extended toward the physis. The epiphyseal secondary ossification centers form an osseous connection shortly after the appearance of greater tuberosity ossification center, although this may not be radiologically evident until the child is older. The major intent of this roentgenographic survey is to provide a reference index of proximal humeral development for the adequate interpretation of shoulder radiography in children who have not yet attained skeletal maturity.     

Skeletal development of the glenoid and glenoid–coracoid interface in the pediatric population: MRI features

Objective

To assess the MRI appearance of normal skeletal development of the glenoid and glenoid–coracoid interface in the pediatric population. To the best of our knowledge, this has not yet been studied in detail in the literature.

Materials and methods

An IRB-approved, HIPAA-compliant retrospective review of 105 consecutive shoulder MRI studies in children, ages 2 months to 18 years was performed. The morphology, MR signal, and development of the following were assessed: (1) scapular-coracoid bipolar growth plate, (2) glenoid and glenoid–coracoid interface secondary ossification centers, (3) glenoid advancing osseous surface.

Results

The glenoid and glenoid–coracoid interface were identified in infancy as a contiguous, cartilaginous mass. A subcoracoid secondary ossification center in the superior glenoid was identified and fused in all by age 12 and 16, respectively. In ten studies, additional secondary ossification centers were identified in the inferior two-thirds of the glenoid. The initial concavity of the glenoid osseous surface gradually transformed to convexity, matching the convex glenoid articular surface. The glenoid growth plate fused by 16 years of age. Our study, based on MRI, demonstrated a similar pattern of development of the glenoid and glenoid coracoid interface to previously reported anatomic and radiographic studies, except for an earlier development and fusion of the secondary ossification centers of the inferior glenoid.

Conclusions

The pattern of skeletal development of the glenoid and glenoid–coracoid interface follows a chronological order, which can serve as a guideline when interpreting MRI studies in children.     

High-resolution CT findings in the development of the sphenooccipital synchondrosis.

PURPOSETo evaluate the development of the sphenooccipital sychondrosis as seen on high-resolution thin-section CT scans.METHODSWe retrospectively reviewed the records of 253 patients, ages 1 to 77 years old, who had had thin-section CT examination of the skull base.RESULTSAn ossification center appeared midline in the patients who were 8 to 13 years old. Six of 12 girls showed additional symmetric ossification centers on either side of the midline; however, this pattern was not seen in boys. No sphenooccipital synchondrosis persisted in any patient past the age of 13 years.CONCLUSIONHigh-resolution CT scans of the skull base can show a pattern of progressive ossification of the sphenooccipital synchondrosis, which can be readily recognized and predicted.     

Confirmation of physical growth pattern in children with a slim body type: analysis of longitudinal data in Korean youth

There is little research carried into physical growth in obesity, and there is even less carried out into physical growth in slimness. In this study, using data on Koreans, who are racially similar to Japanese, we classified subjects into slim and medium types, and analyzed longitudinal growth data for height and weight in these two groups. The study groups comprised 600 boys and 501 girls in the final year of high school selected from schools in Busan, South Korea, and in a suburb of Busan. We identified the age at maximum peak velocity (MPV) in growth during puberty derived from the growth velocity curves for height using the wavelet interpolation method, and determined the levels of maturity. We also retrospectively analyzed the rate of appearance of the slim and moderate types back to the first year of elementary school, and investigated genetic elements by examining the proportion of slim children who remained slim. The proportions of boys and girls classified as slim in grade 1 were 26% and 38%, respectively, in relation to those classified as slim in the final year. The ages at MPV for height were 14.11 years (SD 1.07) among medium-type boys and 14.68 years (SD 1.01) among slim boys. The ages at MPV for height were 12.05 years (SD 1.30) among medium-type girls and 12.18 years (SD 1.36) among slim girls. The ages at MPV for height were significantly different (P < 0.05) between slim and medium-type boys, but were not significantly different in girls.     

Dental maturity of children in Perth, Western Australia, and its application in forensic age estimation

The dental maturity of 1450 healthy children from Perth, Western Australia, was determined in a cross-sectional study. Orthopantomographs of 690 males and 760 females aged 4-16 years old, were randomly selected from various dental practices and hospitals in the Perth metropolitan area. Dental maturity was determined by the method of Demirjian and Goldstein based on the development of four permanent mandibular teeth. Curves were constructed for the Perth children and then compared to that of Demirjian and other studies using the same method. Girls were more advanced dentally than boys. Perth boys showed more advanced dental maturation than French-Canadian boys for ages 6-10 years. Perth girls showed advancement over French-Canadian girls for ages 5-11 years. The same pattern was seen with Hong Kong Chinese children. London and Finnish children, however, were more advanced for the older age groups, 10-16 years, compared to Perth children. Dental age as determined from maturity scores using this method revealed a highly significant correlation with chronological age. From our results we conclude that the method devised by Demirjian and Goldstein is accurate and reliable for forensic age determination within the Perth population, but variations do exist between different population groups.     

Sport accidents in childhood.

Injuries among children during sporting activities are common. This study is a one year study including children between five and fourteen years of age who sustained their injuries during sporting activities and were treated at Trondheim Regional and University Hospital. Sport accidents account for 27 per cent of all childhood accidents in this age group. Fifty-three per cent of the injured were boys, and 47 per cent were girls. The boys sustained more severe injuries than the girls. Soccer caused the greatest number of injuries. Horse riding and alpine skiing were the cause of the most severe injuries. A more widespread use of protective guards, better technique and body control, better coaching and not allowing the younger children to take part in technically advanced sporting activities might reduce the number and the severity of the sport injuries in children.     

Características radiológicas del desarrollo de la tuberosidad tibial anterior

ObjectiveFew studies have evaluated the radiologic characteristics of the development of the anterior tibial tuberosity. This study aimed to evaluate the radiologic characteristics of the anterior tibial tuberosity in a pediatric population broken down into age groups.Material and methodsWe assessed 210 plain-film X-rays of the knee from patients aged from 10 to 17 years, divided into groups according to age and sex, for the presence of ossification of the anterior tibial tuberosity, the distance between the anterior tibial tuberosity and the metaphysis, and fusion with the epiphysis.ResultsAt 10 years of age, the anterior tibial tuberosity was ossified in 50% of the girls but in only 25% of the boys. In all the girls, the anterior tibial tuberosity was ossified at 11 years, fusion of the anterior tibial tuberosity with the epiphysis had started at 12 years, and fusion was complete by 17 years. In boys, the process is delayed by one year compared to girls. A single center of ossification was found in all cases.ConclusionThe ossification of the anterior tibial tuberosity starts distally, then the proximal part fuses with the rest of the epiphysis, and finally the distal part fuses with the tibia. The results of this study help enable a better analysis of the anterior tibial tuberosity in cases of knee pain.     

自填式青春期发育量表(中译版)的检验

目的:验证自填式青春期发育量表(中译版)的可靠性和有效性。方法:选取153名11～14岁健康中学生(男79人,女74人)填写量表,通过量表的总分相关系数和内部一致性检验反映量表的信度。量表的效度检验方法为,选取32名11～14岁健康受试者(男20名,女12名),使其同时完成量表填写和骨龄片的拍摄,运用Pearson相关分析确定效标系数,说明量表得分与骨龄的相关一致性,P<0.05具有统计学意义。结果:自填式青春期发育量表(中译版)三个记分条目的总分相关系数,男性分别为0.49、0.51和0.40,女性分别为0.55、0.63和0.65;男、女生量表的克朗巴哈α系数分别是0.63和0.72。男、女生量表得分与骨龄呈高度相关,相关系数分别为0.614(P<0.01)、0.798(P<0.01)。结论:自填式青春期发育量表(中译版)具有较高的内部一致性,可以有效评估中国学生青春期的发育阶段。