14岁青少年手腕骨发育的研究Ⅱ.女生骨龄标准的制定

目的研究我国当前青少年手腕骨发育状况,探讨制定专用于法医学推断女性刑事责任年龄14岁的骨龄标准。方法以湖南冷水江地区青少年为对象,按照纳入标准,选取14岁±3个月的健康女性中学生110名,拍摄其左手腕部后前位X线片。选择手腕骨15个部位,按照统一标准进行观察、测量,采用最大百分比法确定发育等级标准,建立骨龄评估方法,以单盲法进行验证。结果桡骨,中排第三、第四指骨干骺端发育等级为部分闭合（〉2/3为主）,其余掌指骨干骺端发育等级则以完全闭合残留骺线痕迹为主;对于中排第三、四指骨,不足14岁和已满14岁发育等级尚存差异,不足14岁组骨骺发育以部分闭合（〉2/3为主）为主,已满14岁组则以残存骺线痕迹为主。各个观察部位骨骺横径宽于干骺横径。30例的验证结果准确率为83.3%。结论根据发育等级特征及测量学方法建立骨龄标准准确性较好。     

14岁青少年手腕骨发育的研究I．男生骨龄标准的制定

目的研究我国当前青少年骨发育状况,制订专用于法医学推断男性刑事责任年龄14岁的骨龄标准。方法以湖南冷水江地区青少年为对象,按照纳入标准,选取14岁±3个月的健康男性中学生103名,拍摄其左手腕部后前位X线片。选择手腕骨15个部位,按照统一标准进行观察、测量,采用最大百分比法确定发育等级标准,建立骨龄评估方法,以单盲法进行验证。结果除第一掌骨、近节第四指骨骨骺发育等级为部分闭合外,其他均为未闭合;对于第四、五掌骨和近三指骨,不足14岁组以未闭合为主,已满14岁组以部分闭合为主。各个观察部位骨骺横径宽于干骺横径。30例的验证结果准确率为80.0%。结论根据发育等级特征及测量学方法建立骨龄评估标准可行,可望得到推广。本文以刑事责任年龄14周岁为对象,制订法医学专业骨龄推断标准,并引入测量学方法,辅助推断年龄。     

基于X线的活体骨骼年龄评定方法及其他技术

国内外通常利用X线片观察骨骼继发性骨化中心的出现和骨骺闭合程度的影像学特征来推断年龄。其中较常用的方法有计数法、计测法、图谱法、评分法及计算机辅助评定骨龄法等。目前国外普遍采用TW评分法。国内也有该评分法的应用报道。主要应用于体育和儿科临床实践中。法医临床学实践中常用六大关节判别方程法推断骨龄和活体年龄推断。其他还有利用牙齿内天冬氨酸的消旋化、骨密度检测以及端粒末端DNA片段长度的变化等年龄推断方法。     

中国男性青少年骨龄鉴定方法

目的研制我国当代男性青少年骨关节X线的法医学骨龄鉴定标准。方法摄取11～20周岁男性青少年X线片,根据继发骨化中心出现、干-骺闭合的影像学特征将骨发育程度分级,用SPSS、SAS软件统计分析。结果大部分指标与年龄呈中度以上相关;建立了推断年龄的最优多元回归方程及判定是否已满14、16和18周岁的判别方程。结论选用多部位、多指标综合推断骨龄可提高准确率;该法适用于国人青少年活体年龄的判定。     

锁骨胸骨端骨骺闭合规律的多元影像学技术研究进展

18周岁作为从轻或减轻刑事责任甚至免于死刑的年龄节点,在我国司法审判中具有重要意义。人体四肢长骨骨骺、第二性征等在18周岁时已基本发育完成,而锁骨胸骨端骨骺是人体各大关节干骺端骨骺闭合较晚的骨骼。近年应用多元影像技术探讨锁骨胸骨端骨骺闭合规律的研究显示,锁骨胸骨端骨骺发育在18周岁年龄推断中有一定价值。X线、超声存在一定弊端,并影响结果的准确性。CT特别是薄层CT目前应用较广,但薄层CT扫描辐射较大,非诊疗目的的影像辐射不符合当今医学伦理。MRI是无辐射的断层影像,易于评估,是锁骨胸骨端发育推断骨龄的研究方向之一。本文总结了锁骨胸骨端骨骺闭合规律在骨龄评估中的研究进展,分析并总结应用锁骨胸骨端骨骺闭合规律进行骨龄评估的可行性。     

未成年人案件中两种骨龄测定法的应用价值的初步研究

目的研究未成年人骨龄与实际年龄和刑事责任年龄间的关系,探讨顾氏图谱法、李果珍骨龄百分计数法在未成年人涉嫌犯罪案件中的应用价值。方法选择33位身体健康、发育正常的未成年人(12～19岁),拍摄左手腕部X线片,分别使用顾氏图谱法、李果珍骨龄百分计数法测定每张X线片的骨龄,再将骨龄与受试者实际年龄比较,用行平均分检验分析两法推测未成年人实际年龄的精确性,用Pearson检验分析两法推断未成年人刑事责任年龄的准确性。结果李果珍骨龄百分计数法推测实际年龄的精确性高于顾氏图谱法(P<0.005);而二者推断刑事责任年龄的准确率分别为90.91%和78.79%,统计学分析结果无显著性差异(P>0.1)。结论两种方法均适用于未成年人涉嫌犯罪案件,基本满足法律实施的要求。     

基于CT扫描并图像重组青少年锁骨胸骨端骨龄数学模型

目的利用我国青少年锁骨胸骨端骨骺发育变化规律,探讨CT容积再现(volume rendering,VR)数据与生物学年龄的相关性,并建立推断骨龄的数学模型。方法通过对我国华东、华南地区684名15~25周岁青少年双侧锁骨胸骨端进行CT薄层扫描并VR三维图像重组,测量并计算双侧锁骨胸骨端骨骺最长径、干骺端最长径及其长度比、骨骺面积、干骺端面积及其面积比等数据,并建立骨龄推断的数学模型。再将50例训练样本代入数学模型,检验模型的准确性。结果左、右两侧骨骺与干骺端长度比、面积比在同一年龄组男女性间差异具有统计学意义(P0.05)。建立的数学模型表明锁骨胸骨端骨骼的发育规律与生物学年龄具有高度的相关性,所有模型的准确率都高于70.5%(±1.0岁)和82.5%(±1.5岁)。结论建立的骨龄数学模型的可操作性强、准确性较高。这不仅可与图谱法相互印证和支持,提高骨龄推断的准确性;同时,该方法对未来研究其他单一部位骨龄推断具有重要的意义。     

青少年手腕骨骨龄与生活年龄的差异观察

目的比较以不同骨龄标准所评价的青少年手腕骨骨龄与生活年龄的差异,观察生长发育长期变化对青少年年龄推测的影响。方法从中国5座大中城市抽取11464名（男5873,女5591）3～18岁汉族正常青少年儿童,并另随机抽取950名（男516,女434）12～18岁骨发育正常的汉族青少年作为验证样本。按CHN法和RC法骨龄标准评价手腕部X线片骨龄,并对不同方法评价的骨龄及生活年龄进行统计学分析。结果各年龄组CHN法骨龄中位数大于RC骨龄,其差异具有显著性意义（P〈0．05）。验证样本中,在男12—16．5岁、女12～14．5岁之间,CHN骨龄减生活年龄之差值分别为0．35—1．00岁和0．57～1．16岁（P〈0．01）;RC骨龄减生活年龄的差值分别为-0．26—0．23岁和-0．27～0．06岁（P〉0．05）。在男17～18岁、女15～17岁之间,CHN骨龄减生活年龄的差值分别为-0．52～-1．05岁和-0．16～-1．13岁（P〈0．05）,RC骨龄减生活年龄的差值分别为-0．35～-0．48岁和-0．22～-0．79岁（P〈0．05）。结论CHN法骨龄高于生活年龄,在大部分年龄组RC骨龄与生活年龄基本一致。     

青少年颌面部X线影像测量数据在年龄推断中的应用

目的建立依据青少年颌面部X线影像测量数据推断其年龄的方法。方法收集273名于山西医科大学口腔医院就诊儿童、青少年患者的头颅侧位X线像。测量SNA角、SNB角、ANB角、NP-FH面角、Y轴角、NA-PA（颌凸角）、MP-FH（下颌平面角）、SN-MP角、1-SN角、1-MP角、1-NA角、1-NB角和1-T角、1-NA距和1-NB距等15个影像数据,使用SPSS 11.5统计分析软件建立数据库,多元逐步回归分析,建立年龄推断公式。结果年龄推断的回归方程为：Y=16.402-0.024（1-1角）＋0.039（ANB角）和Y=17.575＋0.897（ln[1-NB角]）-1.237（ln[NP-FH面角]）。结果说明,青少年的年龄与ANB角呈正相关,与1-1角呈负相关,ANB角的作用大于1-1角的作用;与1-NB角的自然对数值呈正相关,与NP-FH面角的自然对数值呈负相关,NP-FH面角的作用大于1-NB角的作用。结论本研究根据颌面部X线影像测量数据建立的青少年年龄推断方法,可在相关研究和实践中选择使用。     

如何正确看待法医骨龄和刑事责任年龄

骨龄又叫骨骼测定年龄,刑法所规定的“刑事责任年龄”为某一个体的“生活年龄”,二者所代表的含义不同,且存在着较大的差异。司法机关直接利用骨龄作为对犯罪嫌疑人定罪量刑的证据判案时常引发不小争议。故此,实现“骨龄”推断到“生活年龄”推断是法医任重而道远的任务。本文分析了二者的差异及原因,并呼吁尽快出台综合评定其个体“生活年龄”的全新标准或规范。     

Estimation of age from epiphyseal union at the wrist and ankle joints in the capital city of India

Various studies conducted in and outside India for estimation of age from long bone joints revealed that unlike other vital parameters no uniform pattern exists for epiphyseal union of long bones in different countries of the world and also in different parts of the same country. A radiological study was conducted in 180 boys and girls of the capital city of India, Delhi, between the age group of 14-20 years to find out the age at which epiphyseal union at wrist and ankle joint takes place. The result of the study showed that the wrist joint epiphyseal union is completed in all cases in the age group of 19-20 years in males and 18-19 years in females. In the ankle joint, 17-18 years was the age group in males and 16-17 years the age group in females which showed complete epiphyseal union in all cases.     

Determination of sex from femora

The determination of sex from bones or bone fragments considerably contributes to identifying unknown bodies or skeletal remains. Due to temporal change and regional differences anthropometric standards have to be constantly renewed. The present study provides measurements of femoral dimensions in a contemporary German population and analyses sexual dimorphism by discriminant analysis. Maximum length (male: 46.4+/-2.4 cm, female: 43.4+/-2.4 cm), maximum midshaft diameter (male: 3.1+/-0.2 cm, female: 2.8+/-0.2 cm), condylar width (male: 8.4+/-1.0 cm, female: 7.7+/-0.5 cm), vertical head diameter (male: 4.9+/-0.3 cm, female: 4.4+/-0.3 cm), head circumference (male: 15.7+/-0.8 cm, female: 13.8+/-1.0 cm) and transverse head diameter (male: 4.9+/-0.3 cm, female: 4.3+/-0.3 cm) were measured in 170 femora, 100 from male (age: 16-92 years, mean: 60.8 years; body height: 153-190 cm, mean: 171 cm) and 70 from female (age: 20-96 years, mean: 72 years; body height: 146-175 cm, mean: 161 cm) individuals. In the discriminant analysis (leave-one-out-method) 67.7% of cases could be grouped correctly with the maximum length alone, 72.4% with the maximum midshaft diameter, 81.4% with the condylar width, 86.8% with the vertical head diameter, 87.7% with the head circumference and 89.6% with the transverse head diameter. The stepwise procedure with all head measurements showed that the results for the transverse head diameter could not be improved. With all measurements subjected to stepwise procedure 91.7% of cases could be classified correctly combining midshaft diameter and head circumference (D=3.012xmidshaft diameter in cm+0.780xhead circumference in cm 20.569).     

四川省阿坝地区藏族青少年膝关节骨发育趋势

目的探讨四川省藏族青少年膝关节骨发育趋势,更新利用膝关节骨龄推断我国藏族青少年活体年龄的数据资料。方法在我国四川省阿坝地区调查483例14~19周岁藏族男、女性青少年膝关节X线片,选取股骨远端、胫骨近端及腓骨近端骨骺作为骨骼发育指标,观察骨骺发育情况,并运用SPSS 16.0统计学软件计算出青少年膝关节骨骺闭合年龄的描述性数据。结果膝关节中,闭合最早的骨骺是股骨远端骨骺,闭合最晚的是腓骨近端骨骺,其中女性青少年膝关节骨骺发育较男性提前约1岁左右。结论应用于法医学活体骨龄鉴定的藏族青少年相关数据资料应定期更新。本研究结果可为法医学、人类学及临床医学等相关学科在进行骨龄评价时提供参考。     

Development of hand-wrist bones of 14 year-old adolescents. II. Standard of bony age for girls

OBJECTIVE: To study the current development of hand-wrist bones of adolescents in China, and establish special forensic bony age standard for estimating 14 years of criminal responsible age in female adolescents. METHODS: One hundred and ten healthy girls aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang district of Hunan province were enrolled in this study. X-ray films of their left hand-wrists were taken dorsaventrally, and 15 sites on the wrist x-ray films were examined and measured under standard condition. The development grade was confirmed by maximal percentage to establish a method to estimate the bony age, which was then checked by single blind method. RESULTS: Development grade of the radius, the middle third phalanx and the fourth phalanx was partially closed (> 2/3), and the rest was wholly-closed with existence of the epiphyseal line. The development grade of the middle third phalanx and fourth phalanx was different between the younger group (< 14 years, partially closed, > 2/3) and the older group (> 14 years, mostly closed with existence of only epiphyseal line). The cross diameter of the osteoepiphysises were wider than that of all the diaphysises. The confirmed accuracy (in 30 girls) was 83.3%. CONCLUSION: Our study seemes to be feasible in establishing the estimation standard for bony age determination. The standard established by developmental metaphysis and authropometry may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.     

中国豫北地区17～78岁人群锁骨骨骺愈合情况及年龄推断

目的通过观察分析锁骨内侧骨骺的愈合情况,评价其在年龄推断中的作用。方法收集343对已知年龄和性别的尸体锁骨,以1岁为组,观察分析锁骨内侧端骨骺愈合亭台变化,根据软骨细胞失去增值能力,骺软骨骨板被骨组织所代替情况进行分级分析,对所得数据进行统计学分析,按17～30岁和31岁以上年龄分组进行比较。结果男性和女性的锁骨最早于18岁开始愈合,22岁愈合完全。完全愈合时间在男性最迟为32岁,而女性为31岁。不同性别的骨骺愈合情况在两个年龄组中存在显著差异(P<0.01)。结论锁骨骨骺愈合情况随年龄的增长呈规律性变化,特别是17～32岁年龄段,根据锁骨骨骺愈合情况推断年龄,在法医学实践中有应用价值。     

Discriminant function sexing of fragmentary and complete tibiae from medieval Croatian sites

Previous studies have demonstrated that populations differ from each other in size and proportion and that these differences can affect metric assessment of sex. This paper establishes standards for determining sex from fragmentary and complete tibiae in the medieval Croatian population. The sample is composed of 180 tibiae (96 males and 84 females) from six medieval archaeological sites in Croatia. Three of the sites were located in continental Croatia, three on the eastern Adriatic coast and its immediate hinterland. Six tibial dimensions were measured: (1) length of the tibia; (2) maximum epiphyseal breadth of the proximal tibia; (3) maximum epiphyseal breadth of the distal tibia; (4) maximum diameter of the tibia at the nutritient foramen; (5) transverse diameter of the tibia at the nutritient foramen; and (6) circumference of the tibia at the nutritient foramen. Unifactorial and multifactorial analyses were performed on the collected data. Six discriminant functions were generated, one using six variables, two using two variables, and three employing one variable. Results show that complete tibiae can be sexed with 92.2% accuracy. Slightly lower accuracies (91.7 and 87.8%) were achieved using a combination of two variables, while functions employing one variable were accurate from 85.6 to 81.7%. The results of this study show that the medieval Croatian tibia is a good skeletal component for determining sex. Standardized coefficients of the discriminant functions generated in this study support the results of previous studies that found that breadth dimensions provide better separation of the sexes than length.     

Forearm bones and sexual variation in Turkish population

Forensic anthropologists are aware that there are considerable differences between human populations and therefore develop study models for each skeletal population. The purpose of this study was to analyze forearm bones obtained from forensic settings in Turkey. The sample consists of 42 males and 38 females with an average age of 40 and 36 years, respectively. Numerous measurements were taken from the radius and ulna including lengths (in millimeters), midshaft diameters, and epiphyseal breadths (0.01 mm). Individuals with any anomaly and pathology were not included in the investigation. A stepwise analysis, when applied to individual bones, selected only length and midshaft transverse dimension in the radius and length only in the ulna. When the length was excluded from the statistic, head diameter and distal breadth of the radius and distal minimum head and midshaft anteroposterior diameters of the ulna provided the best predicting functions. Classification results were 92% for the radius and 91% for the ulna. For the incomplete bones, the accuracy rates were about 92% and 83%, respectively. In conclusion, a sex determination was made, in different rates of accuracy, in the human skeleton. Correct assessment can vary among populations. Dimorphism in our region forearm bones is greater than American whites. This supported the hypothesis that human variation is diverse, and population difference should be taken into account when osteometric standards are applied to others. Further studies are needed to understand why the forearm is more dimorphic in Turks.     

青少年骨发育X线分级方法

目的 利用青少年骨关节x线影像变化规律制定青少年骨发育X线分级标准.方法 参照国内外权威学者关于不同部位关节骨骼发育分级的研究成果,以骺软骨发育组织学分层(区)为理论支撑、以骨发育X线影像特征为基础的分级原理.横向和纵向观察我国河南、海南、浙江三个省份300名11～20周岁男、女性青少年双侧锁骨胸骨端及左侧肩、肘、腕、髋、膝、踝关节骨发育X线影像特征,选取与年龄变化关系密切的24项骨骼发育指标.结果 根据不同部位关节骨骺生长变化规律,将24项骨骼发育指标分为2级至8级不等.研究显示,各单一关节组成诸骨发育指标的分级基本相同或接近.单一关节内不同的骨骺发育变化具有同步性.结论 本分级标准涉及骨骼发育指标广、适用年龄范围宽、可操作性强,为我国法医学活体骨骼年龄推断建立了良好的基础平台.     

手腕部桡、尺骨骺线消失作为推测18岁年龄的指征

目的探讨手腕部桡、尺骨骺线消失是否可以作为推测青少年18岁年龄的指征。方法研究样本为15～20岁的中国5城市4492名（男1942,女2550）汉族健康青少年。在受试者出生日前后15d内拍摄左手腕正位X线片。根据骺线是否可辨评价桡、尺骨远侧骺的发育,计算年龄组骺线不可辨的例数及其构成比。结果在18岁以下,男、女青少年桡骨骺线不可辨等级出现的构成比分别为0.9%和4.9%,尺骨骺线不可辨等级出现的构成比分别为13.1%和69.2%。结论手腕部桡骨骺线消失可作为推测青少年18岁年龄的指征。