儿童锌缺乏性身材矮小的治疗

目的探讨锌剂加干酵母片治疗儿童锌缺乏性身材矮小的疗效。方法将100例3～5岁身材矮小的学龄前儿童随机分为两组,一组只补充锌剂,另一组在补充锌剂的基础上加服干酵母片。每3个月进行一次血清微量元素的检测;每半年进行一次常规的健康体检,包括身高、体重的测量;1年后进行骨龄测定。结果锌剂加干酵母片治疗儿童锌缺乏性身材矮小明显优于只补充锌剂。锌剂治疗身材矮小不会引起骨龄提前。结论锌对身材矮小儿童的身高增长有促进作用。干酵母片和锌剂并用有很好的协同作用,干酵母片可提高锌剂和食物中锌的吸收率,提高患儿食欲,增加进食量,可加速身材矮小儿童身高的追赶生长。锌剂能促进身材矮小儿童的生长发育,增高而不加速骨龄发育。     

Turner综合征的临床与实验检查研究

目的探讨Turner综合征(TS)的染色体核型异常与躯体发育异常、卵巢发育不全、性激素激素异常以及矮小和骨龄落后的关系.方法对11例TS患儿进行染色体、性激素和促性腺激素、骨龄和子宫、卵巢B超影像学检查及身高评价.结果染色体核型各异,患儿矮小和各种躯体畸形.B超检查患儿或无子宫和/或卵巢声像,或其发育落后(P＜0.01或P＜0.05).血E2降低,血促性腺激素升高(P＜0.01).骨龄落后2.4±1.5岁,身高的标准差积分为-3.9±1.2.结论TS的染色体核型与患儿临床表现有关.矮小和骨龄(BA)落后可能与SHOX基因缺失、雌激素缺乏、生长激素缺乏及甲状腺功能低下等有关.X染色体异常致患儿卵巢发育不全,并使体内性激素水平异常.     

海拔高度对儿童及青少年骨龄发育的影响

目的 探索海拔对儿童青少年骨骼生长发育的影响规律。方法 选取3种不同海拔高度的地区进行观察：北京(北京协和医院)海拔43.5 m、拉萨(西藏自治区人民医院)海拔3 650 m和那曲(那曲市人民医院和那曲市尼玛县人民医院)平均海拔4 500 m以上。收集2013年9月至2021年12月正常发育或因外伤就诊儿童青少年的一般资料和左手腕X线片。由1名有10年骨龄判读经验的医生在人工智能(AI)骨龄软件辅助下依据Greulich-Pyle图谱法判读骨龄。计算不同海拔不同年龄段儿童青少年骨龄与日历年龄的差值，并进行统计学分析。结果 最终纳入北京407例、拉萨456例、那曲150例共1 013例左手腕X线片(男671例，女342例，北京病例均为汉族，拉萨和那曲病例均为藏族)。北京地区儿童青少年的骨龄基本符合日历年龄，拉萨及那曲地区儿童青少年的平均骨龄分别落后于日历年龄0.50岁及1.33岁，男女均如此。相对于北京汉族儿童青少年，藏族男孩、女孩大部分年龄组(7～18岁)的骨龄均随海拔升高而更滞后于日历年龄。结论 高原地区藏族儿童青少年骨龄落后于日历年龄，且随着海拔增加而更加明显。     

乌鲁木齐地区汉族及维吾尔族青少年和儿童手腕骨骨龄评价

背景：由于不同个体间,种族、性别、遗传、地理环境的不同而导致骨龄也会有所不同,因此有必要对新疆地区汉族,维吾尔族青少年儿童的手腕部骨发育状况作评价。 目的：评价乌鲁木齐地区汉族、维吾尔族青少年儿童手腕骨骨龄实际状况。 方法：选取乌鲁木齐地区汉族、维吾尔族760例4.0-14.0岁发育正常青少年儿童腕部X射线片,样本不区分左右手,以2岁为一个年龄段。采用《中国人手腕骨发育标准CHN法》对手腕部骨进行评分,确定参与研究的青少年儿童的骨龄情况。采用统计学方法分析骨龄和生活年龄的关系及两民族间骨龄与生活年龄的差异。 结果与结论：①乌鲁木齐地区汉族、维吾尔族青少年儿童骨龄与生活年龄明显相关(P值均< 0.05)。②骨龄和生活年龄的比较,有13组骨龄高于生活年龄,包括汉族女性4.0-11.9岁阶段4个年龄组,汉族男性4.0-9.9岁阶段3个年龄组,维族女性4.0-9.9岁阶段3个年龄组,维族男性4.0-9.9岁阶段3个年龄组。③两民族间青少年儿童骨龄与生活年龄差值比较,女性汉族女性10-11.9岁组骨龄与生活年龄差异高于维吾尔族;汉族男性12-13.9岁组骨龄与生活年龄差异高于维吾尔族。结果提示,两民族青少年儿童多个年龄组骨骼发育有提前成熟的趋势;两民族两性别骨龄与生活年龄的差值在部分年龄段存在差异。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

山东省沿海和内陆地区青少年骨龄的对比

背景：骨龄是反映青少年骨骺发育成熟程度的最佳指标。 目的：对比山东省沿海和内陆地区青少年的生长发育状况及变化趋势。 方法：随机选择山东省沿海地区(n=2 377)和内陆地区(n=3 235)9~19岁健康汉族青少年,测量其身高、体质量和胸围生长发育指标;拍摄膝踝部正位片,统计各长骨干骺融合时间。 结果与结论：沿海和内陆地区男、女青少年身高、体质量和胸围均无明显差异,但同一年龄组中沿海地区测量值均大于内陆地区测量均值;沿海地区男、女青少年各长骨干骺融合时间早于内陆地区。表明山东省沿海地区青少年生长发育较内陆地区有提前的趋势。     

基因重组人生长激素治疗特发性身材矮小儿童的临床观察

目的为了了解基因重组人生长激素(r-hGH)治疗特发性身材矮小儿童时其对身高、青春期的影响.方法我们对14例特发性身材矮小(ISS)儿童采用r-hGH治疗3～12月,比较其治疗前后的年生长速率和青春发育情况.结果经r-hGH治疗,特发性身材矮小儿童的年生长速率有显著提高,身高年龄的增长明显快于生活年龄和骨龄的增长,但没有明显青春期加速的现象.结论r-hGH可显著改善特发性身材矮小儿童的身高,且青春期、骨龄均不提前.     

学龄前先天性甲状腺功能减低症患儿生长发育及其影响因素的研究

目的分析甲状腺激素替代治疗后的学龄前先天性甲状腺功能减低症congenital hypothyroidism(CH)患儿体格、骨龄发育状况及其影响因素,以进一步完善治疗方案,提高治疗效果。方法选取青岛市经新生儿筛查确诊的持续性甲低患儿(病例组)47例(年龄4.92±0.79岁)及性别、年龄与之相匹配的正常儿童58例(年龄5.17±0.66岁)作为研究对象,采用自制的一般情况调查问卷、骨龄评定手册进行调查分析。结果①两组儿童的体重、身高、坐高和头围均在正常范围,但差异均有统计学意义(P<0.05,或P<0.01),②病例组儿童平均骨龄明显低于对照组,差别有统计学意义(P=0.006)。③病例组儿童骨龄与初始治疗剂量及治疗前FT4浓度呈显著正相关(P均<0.05)。结论经过新生儿筛查得到早期诊断和治疗的CH患儿,在学龄前期,身高、体重在正常范围之内,但仍落后于正常儿童;骨龄发育水平与初始治疗剂量、治疗前的甲状腺激素浓度(FT4)有关;在对CH患儿早期足量甲状腺激素替代治疗时,应重视骨龄、身高、体重的监测,及时调整治疗方案,以获得满意的治疗效果。     

基于卷积神经网络的X图像骨龄评估方法

针对传统方法中骨骺评估区域多、评估结果对医生的依赖性强、评估准确率低等问题,在TW3-C法基础上提出一种改进的骨龄评估方法。根据中国儿童骨骼发育特点,利用卷积神经网络对评估区域进行精减和分类,将传统的13个骨骼评估区域精减至10个,并改进等级计分法。试验结果显示,在1岁误差范围内,该方法将骨龄的预测值准确率提升至男性94.42%、女性93.64%,平均绝对误差为男性0.414 3岁、女性0.428 6岁,与典型的骨龄评估方法相比,准确率得到显著提高。     

RWT法评价拉萨藏族儿童青少年膝部骨龄

目的：探讨拉萨藏族儿童青少年膝部骨发育规律。方法：随机选取世居拉萨、父母为藏族的7～21岁儿童青少年1 496名为研究对象,拍摄膝部X线片,以RWT法评价膝部骨龄。结果：骨龄与日历年龄高度相关;各年龄组骨龄显著小于日历年龄;骨龄存在性别差异。结论：RWT法可以预测骨龄;托萨藏族儿童青少年膝部骨龄小于日历年龄,提示该地区骨发育存在延缓的特点。     

兰州地区61例Turner综合征核型及临床特征分析

目的探讨Turner综合征患者的染色体核型异常与内分泌激素异常、发育异常和骨龄落后的关系。方法对61例Turner综合征患者进行染色体核型分析、内分泌激素六项检测、B超检查及身高评价。选择同期健康体检人群作为对照组。结果 Turner综合征染色体核型各异,患者表现为身材矮小和躯体畸形,B超检查患者无子宫和/或卵巢,与正常对照组相比发育明显落后（P〈0.01）;患者血清FSH、LH明显高于对照组,E2、P低于对照组,PRL、T无明显差异;身高及骨龄明显落后。结论 Turner综合征的染色体核型与患者临床表现相关,骨龄落后和身材矮小可能与SHOX基因缺乏、雌激素缺乏有关。     

Estimation of stature from second metacarpal length in Japanese children.

A relationship between stature and second metacarpal length was examined by means of a linear regression for sex, skeletal age and locality in 2056 children aged 6-19 years in five districts of Japan. Significant differences (p less than 0.05) were found for the regression of two measurements between immature and mature groups according to the TW2 method. Few significant differences were found in the regression with sex and locality in both immature and mature groups. Stature could be estimated from second metacarpal length with standard errors of 44mm in the immature group and 40mm in the mature group. Furthermore, from the bone length and TW2 age, stature could be estimated with a standard error of 38mm for each sex in combined groups. These figures are similar to the variability in stature at a given age and comparable to reliability of estimates from long bones. The second metacarpal length may be a reliable and practical marker in children for the estimation of stature by means of a general formula regardless of sex and locality in a population.     

Growth failure in focal dermal hypoplasia

Focal dermal hypoplasia (FDH) is a rare genetic disorder caused by mutations in the PORCN gene located on the X chromosome. Short stature was previously noted to be a common finding in FDH, however the etiology of this is unclear. The present study sought to elucidate specific causes for short stature by assessing growth charts, determining bone ages and auxologic measurements, examining laboratory data for the common causes of growth failure, assessing dietary intake, and performing a growth hormone stimulation test. Sixteen patients with FDH between the ages of 3 and 18 years of age consented to the study. While 11 out of 16 patients had short stature based on height less than 2 standard deviations below mid‐parental target height percentile and bone age not suggestive of likely catch‐up growth, only four had a BMI less than the 5th percentile for age. Laboratory studies did not support a gastrointestinal, allergy or autoimmune cause of growth failure. Three patients had results suggestive of possible growth hormone deficiency. Although short stature is a common feature in FDH, our data suggests that severe undernutrition is not common in this group and that there may be underlying treatable causes for this short stature in some patients.     

潍坊地区学龄前儿童骨密度检测及其相关因素分析

目的了解学龄前儿童骨密度水平及影响因素,提出指导性意见。方法采用北京澳诺产BMD-1000C型超声骨质分析仪,随机抽取2010年5月～8月在我院儿童保健科门诊健康查体的780例6岁以下儿童进行检测,全部选择小儿左下肢胫骨中点处为测试点。Z值-1—1骨密度正常值,Z值<-1为骨密度异常。结果男女童比较无明显差异;>3岁儿童与≤3岁儿童有显著差异﹙P<0.05﹚。喂养情况分析混合喂养的儿童异常率明显高﹙P>0.05﹚,而纯母乳喂养及人工喂养的儿童无明显差异;骨矿含量与身高密切相关,生长过快及生长迟缓儿童的骨密度异常率明显增加。结论儿童骨密度峰值是由多种因素导致的,定期检查早防早治是减少缺钙发生的关键。而骨密度检测无创伤无放射,检查时间短,家长儿童都容易接受。把骨密度测定列入儿保常规性体检项目是非常有必要的。     

Stature and age as factors in the growth of second metacarpal cortical bone in moderately malnourished children.

The association of stature and age with measures of second metacarpal cortical bone growth is investigated in a sample of 1586 radiographs taken from Guatemalan Ladino children aged 1-7 years in a setting of endemic mild-to-moderate malnutrition. For given stature, chronological age is positively associated with cortical thickness and cortical area and negatively associated with periosteal and medullary diameter. These different partial correlations are seen as evidence of different kinds of growth. Correlations of cortical bone variables with body size within a chronological age are shown to derive from the overall relationship between age, stature, and measures of cortical bone.     

Metacarpophalangeal pattern profile and bone age in Rett syndrome: further radiological clues to the diagnosis

Hand radiographs of 100 girls representing 73% of the known Australian population of girls with Rett syndrome, age 20 years or less, were available for this study. Control radiographs were matched for age, sex, and laterality. Bone age was assessed against standard radiographs in Greulich and Pyle [1959: Radiographic Atlas of Skeletal Development of the Hands and Wrist, 2nd ed.]. A metacarpophalangeal pattern (MCPP) profile comparing the relative lengths of the hand bones with mean population norms by age was produced by converting the length of each of the 19 metacarpal and phalangeal bones into a Z score. In girls less than 15 years old, bone age was more advanced in Rett syndrome than in age-matched control girls (left hand P = 0.03, right hand 0.004), but was most advanced in the younger group and normalized with age. In Rett syndrome, the mean Z score for the 19 metacarpal and phalangeal bones was 1.0 in children under 5 years, -0.27 in those aged 5-11 years, and -1.7 in those aged 12 years and over. This variation between age groups was much greater than in the controls. The dips in the MCPP profile occurred at MC2 and D1, and the peaks at M5, P5, and M4. An MCPP profile may provide an additional aid to diagnosis in cases of Rett syndrome where all the criteria are not met, but in children under age 5 years, advanced bone age may be more helpful as a marker.     

Bone Age Assessment in Young Children Using Automatic Carpal Bone Feature Extraction and Support Vector Regression

Boundary extraction of carpal bone images is a critical operation of the automatic bone age assessment system, since the contrast between the bony structure and soft tissue are very poor. In this paper, we present an edge following technique for boundary extraction in carpal bone images and apply it to assess bone age in young children. Our proposed technique can detect the boundaries of carpal bones in X-ray images by using the information from the vector image model and the edge map. Feature analysis of the carpal bones can reveal the important information for bone age assessment. Five features for bone age assessment are calculated from the boundary extraction result of each carpal bone. All features are taken as input into the support vector regression (SVR) that assesses the bone age. We compare the SVR with the neural network regression (NNR). We use 180 images of carpal bone from a digital hand atlas to assess the bone age of young children from 0 to 6 years old. Leave-one-out cross validation is used for testing the efficiency of the techniques. The opinions of the skilled radiologists provided in the atlas are used as the ground truth in bone age assessment. The SVR is able to provide more accurate bone age assessment results than the NNR. The experimental results from SVR are very close to the bone age assessment by skilled radiologists.     

Bone age estimation based on phalanx information with fuzzy constrain of carpals

The proposed automatic bone age estimation system was based on the phalanx geometric characteristics and carpals fuzzy information. The system could do automatic calibration by analyzing the geometric properties of hand images. Physiological and morphological features are extracted from medius image in segmentation stage. Back-propagation, radial basis function, and support vector machine neural networks were applied to classify the phalanx bone age. In addition, the proposed fuzzy bone age (BA) assessment was based on normalized bone area ratio of carpals. The result reveals that the carpal features can effectively reduce classification errors when age is less than 9 years old. Meanwhile, carpal features will become less influential to assess BA when children grow up to 10 years old. On the other hand, phalanx features become the significant parameters to depict the bone maturity from 10 years old to adult stage. Owing to these properties, the proposed novel BA assessment system combined the phalanxes and carpals assessment. Furthermore, the system adopted not only neural network classifiers but fuzzy bone age confinement and got a result nearly to be practical clinically.     

Carpal bone maturation during childhood and adolescence: Assessment by quantitative computed tomography

The aim of our study was to measure the volume of each carpal bone during childhood and adolescence by image processing from computed tomography (CT) scans, and to analyze the relationship between the eight carpal bones. Thirteen CT scans were performed in nine normal prepubertal, peripubertal and post-pubertal children, six boys and three girls, aged 5-14 years. Each scan was processed in order to extract the carpal bones. The volume was computed for each bone. There was a significant correlation between carpal bone volume and age (0.55 < r < 0.79), and a very strong correlation between the volume of a given carpal bone and the volume of all the others, whatever the age (0.87 < r < 0.99, p < 0.01). Image processing is a potentially useful method for assessing bone maturation. The constant ratio between carpal bone volumes indicates that these bones interact with each other in wrist bone maturation