Bone age is less than biological age. Bone age, or skeletal maturity

Paths of education bone tissue

The future skeleton is formed in certain areas of the embryo's body from an accumulation of mesenchymal cells, which in the second month intrauterine development(5-8 weeks) turn into a membrane (membrane). In the process of ontogenesis, there are two ways of bone tissue formation:

1) desmal (connective tissue), along which the development of the bones of the cranial vault occurs, facial bones, lower jaw– directly from mesenchyme without prior formation into cartilage;

2) chondral (cartilaginous) osteogenesis. All other bones of the skeleton arise through the stage of cartilage, formed from an accumulation of mesenchyme.

Stages of bone formation

There are three stages in the process of bone formation:

The first stage is the creation of a matrix - the protein basis of bone tissue. This process is regulated hormones thyroxine, somatomedins, insulin, parathyroid hormone.

The second stage is the formation of hydroxyapatite crystallization centers followed by osteoid mineralization. For this stage, a sufficient supply of the body with calcium, phosphorus, vitamin D, and microelements (fluorine, manganese, magnesium, zinc, copper) is decisive.

The third stage of osteogenesis is the processes of remodeling and constant self-renewal of bone. This process is regulated by parathyroid hormone and vitamin D.

Information block on the topic "Anatomical and physiological features, semiotics of lesions of the musculoskeletal and muscular systems in children" Bone age

By birth, only points of ossification are visible. The totality of ossification points present in a child characterizes the biological development of the child and is called bone age.

Bone age is usually assessed using x-rays of the wrist bones. At the age of 1 year, 2 ossification points are determined, at 3 years - 4, and so on until 5-6 years.

Formula for determining bone age:

Bone age equal to = number of ossification points – 1

Skeleton of the hand and distal forearm (diagrams from radiographs, according to D. G. Rokhliiu): 1 - a four-month-old boy; 2 - one and a half year old boy; 3 - a three and a half year old boy; 4 - four-year-old girl; 5 - six year old boy; 6 - eight-year-old boy; 7 - ten year old girl. The emerging foci of ossification are outlined

fontanelles

After birth, sagittal, coronal and occipital sutures open and begin to close only from 3-4 months. Lateral fontanelles in full-term babies they are closed. Posterior (small) fontanel located between the occipital and parietal bones, has a triangular shape and can be open in 25% of newborns. In this case, it closes by 4-8 months.

Anterior (large) fontanel located between the two parietal and two frontal bones, has a diamond shape. Immediately after birth, the size of the large fontanelle ranges from 3x3 to 1.5x2 cm. In healthy children, the large fontanel closes by 12 - 18 months.

Palpation of the fontanel

Spine

Spine a newborn is deprived of physiological curves. Forward bend of the spine - lordosis , back - kyphosis .

Cervical lordosis forms after the child begins to hold his head - 2-3 months. Thoracic kyphosis develops after the child begins to sit independently - 6-7 months. Lumbar lordosis becomes noticeable after 9-12 months - after the start of standing and walking.

Milk and permanent teeth, bite

Baby teeth erupt in a certain sequence. The lower incisors appear first at 6-7 months, then, every 2 months, teeth erupt in the following sequence: upper - upper - lower - lower and so on. All baby teeth (20) erupt by age 2 (24 months). Approximate formula to determine the quantity dairy teeth:

n – 4, where n is the child’s age in months.

First permanent teeth erupt at the age of 5 years. These are usually the first molars. Then permanent teeth appear in approximately the same sequence as baby teeth.

Approximate formula to determine the quantity permanent teeth: 4n – 20, where n is the child’s age in years.

Bite – tooth ratio upper jaw and lower jaw. Normally, the teeth of the upper jaw are located slightly in front of the teeth of the lower jaw. Distinguish prognathism (bite disorder) front (teeth of the lower jaw protrude forward) and rear (the teeth of the lower jaw protrude significantly back).

Posterior prognathism, jaw without prognathism, anterior prognathism

Determination of bone age. Bone age characterizes the biological maturity of the body. The main indicators of age-related differentiation of skeletal bones are ossification nuclei and the formation of synostoses.

According to researchers, bone age, more than any other indicator, correlates with parameters of the body's maturity (body length, growth rate, stage of puberty). Based on bone age, it is possible to predict the final height of boys and girls relatively accurately (probability of error ± 1.5-2 cm).

There are several methods for determining bone age by differentiation and maturity of the skeleton (the time of appearance of the epiphyses, the phase of their development, the time of fusion of the epiphyses with the metaphyses - synostosis). These processes are most indicative in the bones of the hands due to quite large number ossification nuclei and epiphyseal zones. Bone age is easily determined by X-ray examination. To determine the child’s bone age, the obtained radiographs are compared with bone maturation standards using special radiological tables (see Appendix) (Fig. 26).

Skeletal differentiation has not only age, but also gender characteristics: girls are ahead of boys, and sexual difference the rate of ossification is evident already from the first year of life.

Subsequently, the bone age of girls is also ahead of the bone age of boys by 12-18 months. At puberty, the gender difference in this indicator reaches an average of 18-24 months.

Bone age can be used to assess the dynamics of puberty. The beginning of the active functioning of the gonads corresponds to the appearance of the sesamoid bone in the first metacarpophalangeal joint. At the same time, girls have initial development mammary glands and pubic hair I-II degrees, and in boys - an initial enlargement of the testicles and external genitalia with possible appearance pubic hair. By the time of synostosis of the first metacarpal bone, girls have their first menstruation, and boys have regular emissions. In the period from the beginning of the formation of the sesamoid bone in the first metacarpophalangeal joint until the end of synostosis in the first metacarpal bone, the body length increases most rapidly: this is the so-called pubertal growth spurt, it lasts 1 1/2 -2 years.

The Institute of Economics and Chemistry of the USSR Academy of Medical Sciences has developed an x-ray bone age table for healthy children and adolescents middle zone RSFSR [Zhukovsky M. A. et al., 1980]. Body length and weight, circumference were taken into account chest And sexual development surveyed. The “average”, “earliest” and “latest” dates for the appearance of ossification and synostosis points were established depending on the age and gender of the children.

In cases of disorders of sexual development, the dynamics of ossification is disrupted, which is taken into account both in diagnosis and when determining the stage of sexual development. At the same time, the degree of advance (or lag) of bone maturation is one of the criteria for feasibility and prospects drug treatment. Acceleration of bone maturation is observed with various forms PPR, lag - with hypogonadism.

Pneumopelviography represents the introduction of gas into the pelvic cavity followed by an x-ray examination of this area and is carried out if there is a suspicion of pathological abnormalities in the state of the internal genital organs. This procedure requires thorough preliminary bowel cleansing and emptying bladder. A puncture is made to introduce gas (usually oxygen, less commonly carbon dioxide) abdominal wall 5-6 cm lower umbilical ring. For children under 10 years of age, the procedure is performed under anesthesia.

This method is currently used for differential diagnosis anorchism and abdominal cryptorchidism in boys, with suspected Shereshevsky-Turner syndrome, Stein-Leventhal syndrome, ovarian tumor in girls, as well as with some forms of intersexism.

Among other radiological studies for the differential diagnosis of disorders of sexual development, we can mention X-ray skull examination in the lateral projection (mainly the condition of the sella turcica is assessed). In some cases it is used pneumoretroperitoneum- injection of gas into the retroperitoneal space for x-ray visualization of the adrenal glands (if suspected adrenogenital syndrome, androsteroma or other disease of adrenal origin).

Genitography. The purpose of the study is to X-ray visualization of the genital and urinary tract. Genitography allows you to clarify the anatomical anomaly genitourinary system. Contrasting the urogenital sinus in some forms of intersexism allows us to establish the relationship between the outer part of the urethra and the vaginal process. This type The study is of undoubted importance for planning intervention and determining the scope of corrective (feminization or masculinization of the external genitalia) plastic surgery.

My feet are sweating! Horror! What to do? And the solution is very simple. All the recipes we give are tested primarily on ourselves and have a 100% guarantee of effectiveness. So, let’s get rid of sweaty feet.

There is much more useful information in a patient's life story than in all the encyclopedias in the world. People need your experience - “the son of difficult mistakes.” I ask everyone, send recipes, don’t be sorry for advice, they are a ray of light for a patient!

ABOUT medicinal properties pumpkins Ingrown toenail I am 73 years old. Sores appear that I didn’t even know existed. For example, a nail suddenly began to grow in on your big toe. The pain prevented me from walking. They suggested surgery. In “Healthy Lifestyle” I read about pumpkin ointment. I peeled the pulp from the seeds, applied it to my nail and bandaged it with plastic so that the juice […]

Fungus on the feet Fungus on the feet Pour into a basin hot water(the hotter the better) and scrub with a washcloth in water laundry soap. Keep your feet in it for 10-15 minutes to steam them properly. Then clean your soles and heels with a pumice stone, and be sure to trim your nails. Wipe your feet dry, dry and lubricate them nourishing cream. Now take the pharmaceutical birch […]

My foot hasn't bothered me for 15 years. Corns on my foot. For a long time I was bothered by a corn on my left foot. I cured it in 7 nights, got rid of the pain and began to walk normally. You need to grate a piece of black radish, put the pulp on a cloth, tie it tightly to the sore spot, wrap it in cellophane and put on a sock. It is advisable to do the compress at night. To me […]

The young doctor prescribed his grandmother's recipe for Gout, heel spurs I am sending you a recipe for the treatment of heel spurs and bumps near the big toe. A young doctor gave it to me about 15 years ago. He said: “I can’t write out a sick leave for this, it’s not allowed. But my grandmother was treated for these troubles like this...” I took the advice […]

Let's start with gout, which is mainly caused by a disorder metabolic processes. Let's listen to what Vinnitsa doctor D.V. NAUMOV says about padagre. We treat gout according to Naumov Gout “Healthy lifestyle”: There are a lot of questions about the dissolution of salts in the joints. You claim that table salt, which we consume internally, has nothing to do with insoluble salts such as urates, phosphates and oxalates. And what has […]

On the advice of Antonina Khlobystina Osteomyelitis At the age of 12, I fell ill with osteomyelitis and almost lost a leg. I was admitted to hospital in in serious condition and was operated on the same day. Whole month treated, but deregistered only after 12 years. I was cured with a simple folk remedy, which was suggested to me by Antonina Khlobystina from Chelyabinsk-70 (now [...]

Fell, woke up - plaster Over the years, bones become very fragile, osteoporosis develops - women especially suffer from this. What to do if you have a fracture? In addition to plaster and bed rest can you help yourself? We addressed these questions to Doctor of Biological Sciences, Professor Dmitry Dmitrievich SUMAROKOV, a specialist in bone tissue restoration. “HLS”: You are 25 years old […]

Onion soup against osteoporosis Osteoporosis Doctors call osteoporosis “ silent thief" Calcium leaves the bones quietly and without pain. A person has osteoporosis and knows nothing about it! And then unexpected bone fractures begin. A 74-year-old man was admitted to our hospital with a hip fracture. He fell in the apartment out of the blue - the bone could not support his body and [...]

A person stretches upward only until his growth zones are open - the cartilaginous parts at the ends tubular bones. As the body matures, cartilage is replaced by dense bone tissue. It is by the degree of ossification that the endocrinologist, using special atlases, determines bone age- the one that matches the child’s bone structure. For example, the true age of a toddler is 4 years, but according to the bones it is two. This means he has time to grow, like two year old child. His peers will finish growing, but he has 2 more years left to stretch out. How else is a child’s growth rate determined?

Let's ask for blood. In addition to determining the child’s bone age, a hormone test is performed. thyroid gland and insulin-like growth factor is a conductor between somatotropin and the cells of the body. When the indicator is normal, a wait-and-see tactic is chosen: the doctor observes the growth rate over time.

If the level of the conductor is low, we conclude that the level of growth hormone may be low. In this case, the child will have a special test to determine the level of growth hormone in the blood. These are so-called stimulation tests, and they are carried out only in a hospital, under hard medical supervision. By the way, if hormone therapy is necessary, the doctor will certainly calculate the predicted growth: what it will be at the time of completion of treatment.

I would prescribe myself a hormone. We remember that growth retardation can be associated not only with a deficiency of somatotropin, which is effective only when it is truly lacking in the body.

But doctors have to deal with a situation where a short mother and father ask specialists to help their miniature child grow taller with the help of “growth medicine.” But what will happen if this option is allowed?

Endocrinologist's opinion: Of course, the hormone will have an effect, and the child will begin to grow much faster. The trouble is that the growth zones will close even faster, especially considering that with familial short stature, the bone age coincides with the passport age. As a result, the child's final height will be even less than what you genetically intended for him. Imagine this situation. A person whose growth zones have already closed takes somatotropin in the hope of growing. But this also happens! What will this drug do? On cartilage tissue and distal limbs. As a result, the unfortunate person’s nose and ears will grow, and their feet and palms will increase in size.

Useful and safe. But how can you give yourself, your loved ones, a chance to stretch out a little? Growth hormone is produced at moderate physical activity (professional sports doesn't count). So you shouldn’t ignore physical education, and, by the way, it’s even available in nurseries.

It is useful for children and teenagers to hang on the horizontal bar. This activity, which, by the way, is very popular with children, “stretches” growth zones.

Plays a big role proper nutrition. It is also very important to get enough sleep: growth hormone is produced during sleep, the peak release occurs at 4-5 o'clock in the morning. Moreover, the body needs to prepare for this meeting. If you go to bed at 3 am, the effect will be minimal.

And for the future, advice to parents of boys: explain to your son that smoking, active and passive, leads to the fact that growth hormone simply does not act on cells.

X-ray examination is the most reliable way to detect pathological conditions in the body, which makes x-rays of the hand indispensable in general diagnostics injuries and damage, including degenerative-destructive ones.

Indications and contraindications for implementation

X-ray diagnostics makes it possible to detect disease on initial stage its development and more accurately identify possible complications. Based on X-ray diagnostics, the doctor prescribes adequate therapy aimed at eliminating the symptoms of the disease.

The main indications for performing x-rays of the hands are injuries, as well as pathological processes, during which the left or right hand may be subject to serious deformation. Besides this, X-ray examination recommended in the following cases:

the presence of pain symptoms in the arms;
swelling and redness of the joints;
various joint deformities;
suspected bone fracture;
inflammatory process in the wrist joints (arthritis and arthrosis);
destructive disorders of bone tissue (osteomyelitis);
benign and malignant neoplasms;
hereditary joint abnormalities.

X-rays of the hands are not recommended for pregnant women and children under 15 years of age. However, in extreme cases, if there is a real threat to the patient’s life, the doctor may prescribe such an examination, making an exception. In other cases, an MRI is prescribed.

Main pathologies of the hands

On x-ray The following signs are revealed:

synovitis is an accumulation of fluid in the wrist joints, which appears on the image in the form of a slight expansion of the joint space;
calcifications – early radiological sign arthritis;
tendinitis and tenosynovitis– the result of the x-ray image appears in the form of compactions and thickening of the wrist, which is due to the involvement of the ligamentous apparatus in the inflammatory process;
osteoporosis – early, but not specific, radiological symptom development of polyarthritis. The image shows thinning of the cortical layer of the diaphysis of the short tubular bones;
cysts – radiologically defined as multiple formations round shape located in the central or subchondral parts of the bone epiphysis;
osteophytes – defined in the image as bony growth of the edge of the joint surface in the form of a sharp spike;
– this radiological sign is detected during advanced processes and is characterized by a narrowing of the joint space caused by friction of the bone joints;
joint erosion - this symptom can be detected in chronic polyarthritis.

Osteophytes on the fingers

It's important to remember that small joints, including the hands, are the main targets for quite a lot of inflammatory systemic diseases, when X-ray examination makes it possible to detect pathology on initial stage its occurrence.

In addition, radiography of the hand is necessary for an adequate assessment of damage not only bone structure, but also soft tissues (calcification). In this case, a standard x-ray shows their compaction and thickening.

Calcification of soft tissues of the hand

Preparation for the procedure

Most often, radiography is a norm included in the diagnostic standard and is mandatory for any bone injuries. It allows you to determine the severity of damage to the bone and muscle tissue regardless of which area is damaged, including the right or left hand, foot, knee or elbow joint.

Before performing the examination, it is necessary preliminary preparation patient:

Before starting the procedure, it is necessary to remove all jewelry (watches, bracelets, rings), the presence of which negatively affects the quality of the image and the determination of the subsequent result;
you need to remove the bandage and iodine residues from the area being examined, as well as traces of the adhesive plaster;
the question of the need to remove the plaster before X-ray diagnostics is decided by the attending physician, who will give all the necessary consultations on further immobilization of the limb.

Important! During a woman's pregnancy, fluoroscopy is performed under the supervision of a doctor and only when the risk to the mother's health outweighs the danger to the baby.

Tactics for performing the examination

In all cases of X-ray examination, the patient is wearing a special apron with lead coating, which reduces ionizing radiation.

When photographing the hand of small children, only the area of the body being examined is left open. The result of X-ray diagnostics in a child is compared with the bone age standard, which is indicated in a special table.

The brush shot is completed within 3-5 minutes. In this case, the patient is asked to straighten the fingers so that they are located on a special surface (cassette). The radiologist must take into account that the position of the hand must coincide with the axis connecting the forearm and wrist.

Scanning of the hand is performed in a sitting position, and the arm should be bent in elbow joint, and place the hand itself on the cassette of the X-ray machine. Its accuracy and information content depends on how correctly the brush is positioned when taking a photo.

The image can be taken in several projections (frontal and lateral), which allows you to obtain more reliable information. If necessary, the doctor can change the methods of laying the brush, which differ from each other.

If it is necessary to make an X-ray examination of the wrist more accurate, the following positions for placing the hands are used:

Direct projection

This position can be performed in 2 versions (palm and dorsal). With a direct projection, the palm should be placed horizontally on the cassette so that x-ray passed strictly through the middle of the hand, perpendicular to the cassette.

Lateral projection

In this case, the brush is placed on the cassette with its ulnar edge (edge), and thumb the person is slightly pulled forward. When photographed in a lateral projection, the contour of the wrist, phalanx and metacarpal bones is most clearly defined. Most often, this projection is used in traumatology practice, which makes it possible to identify displacement of the bones in this area.

A - location of the hand with a direct palmar projection for the X-ray, B - location of the hand with a lateral projection of the 2nd finger X-ray

Oblique palmar projection

This method of placing the hand best visualizes the trapezius and scaphoid bones. The oblique palmar projection involves positioning the hand on the cassette with the palmar surface so that an angle of at least 45 degrees is formed.

Oblique dorsal projection

In this case, the hand should be positioned so that its back side forms an angle of 45 degrees with respect to the cassette. The x-ray clearly shows damage to the pisiform, triquetral, hamate, as well as the 1st and 5th metacarpal bones.

Additional styling

In addition, there are several additional styling for better visualization individual bones, for example, scaphoid or pisiform. The panaritium is visualized in isolation, joint damage inflammatory in nature(arthritis and arthrosis). In this case, the area for the image is separated from healthy tissue by a special protective apron that does not transmit x-rays.

Additional layups can be used to identify the following damage:

the first finger of the hand - this picture is taken in the lateral and direct projection. To obtain a direct projection image, you need to place your thumb on the cassette back side. For a lateral projection, the finger is placed on the cassette with the radial edge. The image reveals damage to the wrist, phalanx of the finger and 1 metacarpal bone;
second - fifth finger - in this case, lateral and direct projections are also used. With a direct projection, the damaged finger is placed on the cassette with the palm side for the image, and with a lateral projection, with the side side. The picture clearly shows the phalanges of the fingers and the condition of the joint space of the interphalangeal joint.

X-ray radiation is one of the most accurate and necessary ways diagnosis of joint diseases. The effectiveness of such a study is confirmed by doctors, and modern equipment used in diagnostics provides the opportunity to examine the hands in more detail, which allows you to select the most suitable suitable way treatment.