Radiology bone age in children. Ossification points on x-rays of bones of people of different ages

Serves good indicator biological age for all periods of ontogenesis, from the uterine to the period of aging. During the process of growth, bones undergo a series of characteristic changes, which can be recorded on radiographs. The main indicators of age differentiation are ossification nuclei and the formation of synostoses.

The radiographic method makes it possible to determine at what stage in relation to the definitive (adult) state the child is based on one or another characteristic. The brush is usually chosen to determine skeletal maturity because it contains large number ossification centers. The method gives accurate indicators, and nothing threatens the child’s health, since the dosage x-rays is taken to be minimal: it approximately corresponds to the dose of natural radiation received by a person, for example, during a week’s stay in the mountains. To assess bone age, the time and sequence of appearance of foci of ossification are determined, as well as the degree of development and timing of the formation of synostoses using atlases of evaluation radiographs, standardized according to age.

One of the first such atlases was developed by the American T. Todd in 1937. Later, on the basis of this atlas, American researchers V. Greulich and S. Pyle created their atlas, which is still used by pediatricians (Greulich and Pyle, 1950). They collected and evaluated a large number of radiographs of the hand and wrist in children of different ages, derived on this basis the average assessment score for each individual bone(a total of 30 bones were used), and then selected x-rays for each age (separately for boys and girls), which corresponded as closely as possible to these estimates, as standard ones. (The atlas includes x-rays with “reference” standards both for individual bones and for each age stage generally. Moreover, although the creators of the method assumed that those who would use their method would have to go from “particular to general,” in practice, the determination is made immediately from the total radiographs, which inevitably leads to numerous errors).

Although, due to their convenience, atlases are still widely used in research on physical development children and adolescents, they contain a number of fundamental methodological shortcomings that limit their use. In addition to the fact that there is significant variation between children from different socioeconomic and racial groups, there is also significant genetic determination in the order in which ossification centers appear. Therefore, the failure of one or another ossification center to appear at the “right” (“standard”) time does not necessarily mean a lag in bone age, and the final assessment should take into account All without exception bones. The second significant drawback is that the series of radiographs in the atlas are organized by annual intervals, although the concept of a “skeletal year” is fundamentally different from a chronological year.

To avoid this drawback, methodological approaches have been developed that make greater use of quantitative methods. Thus, the outstanding British auxologist J. Tanner, together with his colleagues R. Whitehouse and M. Healy, proposed an assessment system called TU-1 (after the initial letters of the surnames of the first two authors - Tanner-Whitehouse), which was subsequently modified by them into the system TU-2 (Tanner et al., 1983). The essence of the method is that each of the bones (a total of 20 bones are used in the analysis) is given a score in accordance with 8 or 9 pre-identified standard stages of maturation. Subsequently, these scores are summed up and compared with the percentage distribution of total scores in the “standard” group of a particular chronological age. This method is often also called “percentage ripening.” The Tanner-Whitehouse method uses only one set of standards for both boys and girls. The latter always receive higher scores, which reflects a significant advance in the rate of ossification characteristic of female almost throughout the entire growth period: from the moment of birth (and even during prenatal period) and before maturity, the bone age of boys is 80% of that of girls.

Two other methods for quantifying bone age are associated with the name of another outstanding auxologist, A. Rocha, and with the famous center for the study of growth and development - the Fels Research Institute, located in Yellow Springs (Ohio, USA). Roche and co-authors developed two methods: the RUT method (Roche-Wainer-Tissen) - to determine bone age by kneecap, and the Felsian method, using traditional hand and wrist bones (Roche et al., 1975, 1988). Unlike the Tanner-Whitehouse method, the Fels method takes into account some size relationships in the form of indices between linear dimensions long bones hands and wrists, and also includes in the analysis more bones.

Age changes skeletal system, taking into account criteria other than those of a growing organism, are used to determine biological age throughout the entire period of postnatal ontogenesis. During the aging period, the criteria used are the timing of the manifestation of osteoporosis and osteosclerosis, various deformations in the joint area, etc. (We refer those interested to the fundamental work of O.M. Pavlovsky “Biological age in humans,” 1987).

Dental age or dental maturity

The traditional method of determining dental age is based on taking into account the number (on at the moment) and the sequence of erupted teeth (both primary and permanent) and comparison of these data with existing standards. It is used as an indicator of biological age only up to 13-14 years, since milk teeth erupt from 6 months to 2 years, and permanent teeth - on average from 6 to 13 years (with the exception of third molars).

Milk teeth begin to calcify from the 4th to the 6th month of intrauterine life and by the time of birth they are varying degrees development. Around the 6th month of the first year of life (there are significant intra- and intergroup variations in this and other indicators), the first primary teeth, usually the central lower incisors, erupt. By the age of 6, as the proverb says, “the mouth is full of teeth,” since at this time, as a rule, the milk teeth are still completely preserved, and permanent teeth almost completely formed and ready for teething. The first permanent molars (molars) emerge first. This occurs around the same time as the loss of primary incisors.

In Fig. VI. Figure 11 shows the average age of eruption of permanent teeth. Although there are significant variations in the time of eruption of individual categories of teeth and the sequence of their appearance, nevertheless, among individual categories of teeth, a number of “markers” can be identified that serve as a reflection of certain stages of development. Among them is the second permanent molar, which erupts at about 12 years of age (in Great Britain this tooth was called a “working tooth”, since, according to the “Regulations on Plants and Factories”, it was from this age that children could be hired. In those days, where documentation regarding the exact date of birth of a child was often lacking, this criterion proved very useful). The third permanent molar, the so-called “wisdom tooth,” can erupt at almost any age, starting from 18 years, and is of no interest in terms of maturity indicators.

There are practically no gender differences in the eruption of primary teeth, but in the eruption of permanent teeth, as well as in the achievement bone maturity, girls are ahead of boys, with the greatest differences noted in the timing of canine eruption (Fig. VI. 11).

Despite its apparent simplicity, the method of determining dental age can present some difficulties, since various authors adhere to different criteria when assessing a tooth as “erupted”. In Russian literature, it is generally accepted that a tooth has “erupted” when it first appears through the gum.

IN lately New methods for determining dental age have been proposed using the stages of tooth formation using X-rays of the jaws. The degree of calcification, the amount of secondary dentin and cement of the teeth are determined, and the number of annual annular deposits of cement is calculated using special techniques. These methods acquire particular importance in the period from 2 to 6 years, when new teeth practically do not erupt, and also after 13 years. It was at this time that the degree of dental calcification, determined from x-rays of the jaws, becomes particularly important. Criteria for assessing different stages of calcification were developed by Demircan et al, similar to the Tanner-Whitehouse bone maturity assessment system.

The work of many scientists, in particular S. Garn, has shown the presence of clear genetic control over the various stages of the formation and appearance of teeth. The relationship between indicators of bone and skeletal maturity is generally small, the correlation between bone and dental age does not exceed 0.4 (Tanner, 1978). * Determination of dental age finds wide application in forensic science, it is one of the main methods for estimating individual age in the study of fossil materials; serves as a reliable indicator of an individual’s age status in cases where for some reason it is unknown exact date birth of a child.

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Estimation of body proportions

Along with measuring height, it is advisable to determine the length of the upper body segment (sitting height). When measuring the length of the upper segment of the body, the head should be fixed in the same way as during normal height measurement. It is necessary to ensure that the back is tightly pressed against the vertical bar of the stadiometer, forming an angle of 90° with the hips.
Tables are used to evaluate the results obtained age standards ratio of the upper segment to the lower (body proportions change with age). Severe disproportions may be observed when various diseases skeleton, after irradiation of the spinal region, with disorders of sexual development.

Body weight

Body weight is the easiest parameter to measure. Body weight should be assessed only in comparison with height indicators. An example is a weight-for-height chart, in which percentiles of body weight are correlated with the child’s height.

Bone age

Bone age testing is important for comprehensive assessment growth. The degree of skeletal maturation can be assessed from various bones, but greatest distribution received X-ray examination hand bones. This is due to the presence of multiple ossification centers in this area, which makes it possible to identify different stages of skeletal maturation throughout the growth period.

Methods for assessing bone age:

1. Buchman's method (common in Russia): X-rays of both hands and wrist joints are taken at once, and using special tables, taking into account the sex of the child, the age range is determined, which corresponds to the number of ossified nuclei on one or the other side.
2. Greulich-Pahl method: assessment by radiograph of one left hand with wrist joint. Bone age is determined using the atlas by comparison with photographs and descriptions of radiographs, which at certain age periods differ not only in the number of ossification nuclei, but also in their sizes and relative position. After selecting the most similar one from the atlas X-ray picture using tables, the age of each individual bone is estimated, and then the average is calculated.
3. Tanner-Whitehouse method: also use an x-ray of the left hand and wrist joint. In accordance with the attached descriptions and drawings, the degree of maturity of 20 ossification centers is assessed one by one, and then the bone age is calculated using the appropriate formula.

It should be noted that bone age testing itself is of relative importance. Bone age may differ from the chronological one not only for different
diseases, but also in healthy children, in whom this difference is sometimes 2-3 years. At the same time, comparing bone age with a child’s growth, especially over time, can provide very valuable information about future growth prognosis.

BONE AGE(syn. "skeletal" age) - a person’s age, determined by the state of the skeletal system.

B ok developing organism There is a direct correspondence between the degree of development of the skeletal system and a person’s age. This is important in the clinic, especially when dynamic observations, and to the court-med. practice. The main indicators of age-related differentiation of skeletal bones are the appearance of ossification nuclei and the onset of synostoses (table), the size of bones and their appearance, the nature of the microstructure and mineral composition bone tissue(see Bone).

V. to. is determined by a set of characteristics: in newborns and children from 1 to 3 years old, along with the degree of differentiation of the skeleton and size tubular bones and the skulls take into account the nature of the overgrowth of the fontanelles; in children over 3 years of age, adolescents and young people with an unfinished process of skeletal formation - the timing of the appearance of ossification nuclei and the onset of synostosis, the size of the tubular bones and head, the degree of overgrowth of the sutures of the vault and base of the skull, the nature of the articulating surfaces of the bones and the microstructure of bone tissue, as well as timing of teething (see) and the degree of their abrasion. The incompleteness of the formation of the skeleton is evidenced by the non-fusion of the sutures of the cranial vault and its facial section, presence in the area of ​​the symphysis, crest ilium, as well as the top and bottom surfaces the vertebral bodies have characteristic striations (Fig. 1). To study the state of ossification, radiographs of the hand and distal forearm are most often used (Fig. 2 and 3). It should be taken into account that due to the acceleration observed in recent decades, the timing of the appearance of ossification nuclei and the onset of synostosis differs significantly from similar data of the 30-40s of the 20th century.

In adults and elderly people, V. k. is established according to dystrophic changes bone tissue, characterized by osteoporosis and associated changes in the microstructure of bone tissue and often its mineral composition; bone growths (including osteophytes, Heberden and Bouchard nodes) in the interphalangeal joints of the hand, joints of long bones and vertebrae and joint deformation developing in connection with this (usually after 40-45 years); strengthening the bone relief at the attachment points of ligaments and tendons; healing of the sutures of the skull; changes in shape, appearance and the weight of certain bones, etc. Involutive signs appear already by 40-45 years and progress with age. Bone growths distal phalanges brushes (Fig. 4) are observed in men starting from 40-45 years old, in women - from 45-50 years old. The olive-shaped tuberosity of the distal phalanges gradually gives way to a mushroom-shaped one (Fig. 5 and 6).

The timing and intensity of healing of the skull sutures depend on a number of reasons, including its shape: with dolichocephaly (long heads), synostosis begins somewhat earlier and proceeds more intensely than with brachycephaly (short heads). Complete obliteration of the sutures of the cranial vault occurs most often by 60-70 years of age. Thinned, narrow plate-shaped, horseshoe-shaped lower jaw characteristic of the elderly and senile age.

To determine V. to, use the complex various methods: anatomical and morphological, radiological, osteometric, microscopic and spectrographic.

Bibliography: Burov S. A. and Reznikov B. D. Features of ossification of the hand and distal forearm and their significance in determining age, Forensic Med. examination, No. 15 p. 21, 1972; Burov S.A. and Reunov V.M. The problem of acceleration in forensic medicine, Proceedings Saratovsk. honey. Institute, t. 60, p. 158, 1969; Vinogradova T. P. Some senile changes in bone and cartilaginous substance, in the book: Problems, geront. and geriatrician, in orthopedics and traumatism, ed. M. V. Volkova, p. 46, Kyiv, 1966; Neklyudov Yu. A. On the stability of the radiographic structure nail phalanges brushes, in the book: Forensic medical. examination and criminology in the service of investigation, ed. A. S. Litvak, p. 635, Stavropol, 1967; Nikityuk B. A. Modern representations on skeletal aging, in the book: Morph, humans and animals, Anthropology, Results of Science, ser. biol., p. 5, M., 1968; Podrushnyak E. P. Age-related changes in human joints, Kyiv, 1972.

V. I. Pashkova.

Growth is one of the main indicators that allows you to assess the development of a child as clearly as possible. Besides standard methods height measurements, there is also sufficient quantity less known methods growth rate estimates. One of them is bone age assessment. In combination with other forecasting methods, it allows you to most accurately determine the condition of the bones and, if significant deviations are found, prescribe treatment.

The essence of the method

Bone age in a child is an indicator of skeletal growth and serves to make predictions regarding the duration of its development process. The very method of obtaining the necessary data is that the patient undergoes an x-ray of certain bones, the results of which are studied by the doctor.

There are certain signs on the patient’s bones, by which a specialist can easily determine the various stages of skeletal maturation and form a final conclusion about the absence or presence of growth problems. In case of serious discrepancies, the child may be prescribed treatment to correct his growth problems, and the sooner this is done, the less consequences there will be.

By what criteria is it determined

Various anatomy manuals give different versions of how exactly bone age should be determined, all of them are equally reliable, but each doctor uses the source that is most preferable to him personally.

On different stages During the life of a child, it is possible to determine the centers of ossification of different bones. Therefore, different x-rays will be required at each age.

The most universal object of study for determining bone age is the hand. It is here that there is a fairly large amount that allows you to use it at almost any age and not worry about the correctness of the result.

Method of determination

As mentioned above, bone age is determined by an x-ray of the skeleton, on which the doctor determines the ossification nuclei. If they are detected in the bone being examined, the child’s age is equated to a certain value. It has been reliably determined in which part of the skeleton and at what age certain ossification nuclei are formed. For example, the capitate and hamate bones have such a core already by 3-4 months, and the epiphysis ulna- by 7-8 years.

As can be seen in the examples, the accuracy of determining bone age can vary within one year. This is quite normal, since people are very different, and the development of their bodies may differ, including within a year of life.

Research results

It is almost impossible to establish absolutely specific bone age figures, since the scatter of results is quite large. Therefore, research parameters are always indicated in a certain interval:

• Bone age corresponds to passport or biological age.
• It matches puberty.
• Bone age corresponds to a different period of life. The doctor must determine the interval and make a diagnosis.

You should not seriously worry about minor deviations in biological and passport age from bone age. Such deviations will not always indicate that there is a health problem. However, if the differences are significant, it makes sense to check the child’s health more carefully and, if necessary, undergo a course of treatment.

What else can it be used for?

However, the indicator can be determined not only in medicine. Archeology and anthropology also study bones, including to determine the age of the oldest bone remains of ancestors. At the moment, almost any archaeological find with bones is accompanied by data on the age of the bones. This is extremely important for reconstructing the circumstances of the death of the person whose remains were found and, as a consequence, obtaining new information about this person's life.

It is bone age that is the main characteristic that allows us to determine the maturity of a person from his remains. No other techniques can be performed if the bones found do not constitute complete skeleton, or when it is impossible to accurately determine the stage of development based on its existing dimensions.

In addition, in addition to archaeology, criminologists also use determination of skeletal age in order to clarify the picture of the crime. The method in this case is the same as in the previously described areas of research. This technique in forensic science, it helps to clarify the identity of the victim, which, in turn, speeds up the clarification of the circumstances of her death.

The method for determining bone age or skeletal maturity is standard when working with bones. However, it is also important in medicine, since significant stunting is a clear disorder requiring treatment.

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