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目的通过观察7 个关节次级骨化中心的出现及骨骺闭合时间推断年龄,并进一步提高骨龄鉴定的准确性。方法选取华东、华中及华南地区1 709 名年龄在11.0～20.0 岁的汉族青少年双侧锁骨胸骨端以及左侧肩、肘、腕、髋、膝、踝7 个关节的数字X线片。在7 个关节中选取24 个能较好推断青少年年龄的骨骼发育指标。观察各次级骨化中心出现及骨骺闭合情况,据此推断平均年龄范围。结果 24 个骨骺发育指标有不同的骨骺闭合时间,闭合顺序依次为锁骨胸骨端,肩胛骨肩峰端,桡骨远端,尺骨远端,髂嵴,坐骨结节,胫、腓骨的上、下端。其中锁骨胸骨端、肩胛骨肩峰端、髂嵴、坐骨结节的骨骺在12 岁之后青少年中均已闭合,女性比男性要提早近一年完成此过程。结论为给法庭审判、定罪和量刑提供准确和客观的证据,骨龄鉴定的相关研究资料和数据应每隔10~15 年更新一次。
Objective To observe the appearance of secondary joint ossification center and epiphyseal closure time to infer the age and to further improve the accuracy of bone age identification. Methods A total of 1 709 digital X-ray films were collected from the sternum of the bilateral clavicles and the left shoulder, elbow, wrist, hip, knee and ankle of 1 709 aged 11.0-20.0 years in East China, Central China and South China. Twenty-four of the seven joints were selected to better predict skeletal development in adolescents. Observation of secondary ossification center and epiphyseal closure, infer the average age range. Results The indexes of epiphyseal development in 24 epiphyseal stages all had different epiphyseal closing time. The order of occlusion followed was the upper and lower ends of clavicle sternum, shoulder acromial end, distal radius, distal ulna, iliac crest, ischial tuberosity, tibia and fibula. In which the supraclavicular sternum, scapular acromion, iliac crest, ischial tuberosity epiphysis after 12-year-old adolescents have been closed, women than men to be completed nearly a year earlier this process. Conclusion In order to provide accurate and objective evidence for trial, conviction and sentencing in court, relevant research data and data on bone age identification should be updated every 10-15 years.