青少年膝、踝关节骨骺闭合趋势与骨龄鉴定

目的 针对当代青少年膝、踝关节骨骺发育的特点,分析青少年骨骺生长发育的变化趋势,并探讨其在活体年龄鉴定中应用的可能性. 方法 摄取华东、华中、华南三地区1 709名年龄介于11-21周岁两性青少年双侧膝、踝关节正侧位X线片,从上述关节中遴选出股骨远端、胫骨近端、腓骨近端、胫骨远端及腓骨远端骨5个骨骺作为骨骼发育指标,观察各个骨骺的发育情况;通过统计分析得出各骨骺在不同年龄组中处于骨骺闭合等级的比例,确定研究膝、踝关节骨骺闭合的纳入人群,并计算出每个骨骺闭合的年龄范围.结果 与上世纪60年代的研究资料相比,5个骨骺闭合年龄提前约2-3岁;与本世纪初的其他研究相比,结果 基本一致. 结论 利用骨骺闭合时间推断活体年龄所依据的数据得到有效更新,并对当代两性青少年年龄界定有重要的指导意义.     

应用膝关节MRI T_2加权脂肪抑制像推断活体年龄

目的探索膝关节MRI T2加权脂肪抑制像(T2-FS)在法医年龄推断中的应用价值,建立安全可靠的四川汉族年龄推断方法。方法收集膝关节MRI 324例(男性170例,女性154例),年龄范围为10~30岁。采用西门子1.5T磁共振仪摄片,MRI参数:T2-FS TSE序列,矢状位。将股骨远端、胫骨近端骨骺发育分为6个等级并赋分,分析各指标性别差异及年龄相关性,建立年龄推断回归模型。结果男女性股骨远端、胫骨近端MRI等级与年龄呈正相关性,股骨远端与年龄的相关性男性0.687,女性0.661;胫骨近端与年龄的相关性男性0.684,女性0.488。股骨远端骨骺完全闭合,骺线消失的最小年龄男性18.42岁,女性19.36岁;胫骨近端男性骺线消失的最小年龄为16.93岁,女性为14.68岁。股骨远端等级1~3、5、6和胫骨近端等级1~3、5年龄分布性别差异不显著。分别建立男女年龄推断模型,男性年龄推断平均绝对误差(MAD)=2.90岁;女性年龄推断MAD=3.30岁。结论膝关节MRI T2-FS影像可作为活体年龄推断的指标之一,股骨远端等级6可作为判断18岁的指标之一。     

中国汉族女性青少年法医学活体骨龄推断数学模型的建立

目的建立推断中国汉族女性青少年活体骨龄的数学模型。方法摄取华中、华南及华东等地区的838名年龄介于11～20周岁正常女性青少年双侧锁骨胸骨端以及左侧肩、肘、腕、髋、膝、踝关节的X线片。依据青少年骨发育分级标准对24项骨骼发育指标进行阅片、分级,结合考虑身高、体质量及地区等影响因素．应用SAS8．1及SPSS11．0软件进行统计学处理,探索各指标与年龄的相关性。结果建立了我国汉族女性青少年利用锁骨胸骨端及6大关节骨骺闭合程度联合推断活体年龄的多元回归数学模型．推导出判定我国汉族女性青少年是否已满14、16和18周岁的Fisher’S两类判别分析方程。结论本研究所建立的判定活体年龄的数学模型丰富了活体年龄的法医学鉴定方法,有利于提高活体骨龄鉴定方法的科学性和结论的准确性。     

应用踝关节MRI T1WI推断活体年龄

目的分析踝关节MRI T1加权图像中胫骨、腓骨远端及跟骨骨骺发育特点,为踝关节MRI成像是否有助于青少年14、16及18岁年龄推断提供明确的答案。方法收集1025例8-25岁的汉族青少年踝关节MRI T1加权图像,探索年龄与分期之间的相关性,分析各期年龄分布的性别差异,并建立推断个体是否年满14、16及18岁的Logistic回归方程。结果年龄与胫骨、腓骨远端及跟骨骨骺分期呈正相关。胫骨、腓骨远端骨骺完全闭合的最小年龄为男性14岁,女性13岁;跟骨骨骺完全闭合的最小年龄为男性14岁,女性11岁。除胫骨、腓骨3期,各期年龄分布性别差异有统计学意义。判断个体是否年满14、16及18岁的方程的推断准确率分别为:男性97.52%,90.08%,82.64%;女性97.59%,97.59%,87.95%。结论踝关节MRI T1加权图像在法医鉴定的活体年龄推断中具有重要的意义。     

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。     

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。     

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。     

《中国青少年骨龄鉴定标准图谱法》征订启事

正由司法部司法鉴定科学技术研究所朱广友研究员、王亚辉副研究员、万雷助理研究员主编的《中国青少年骨龄鉴定标准图谱法》已于2016年1月由上海科学技术文献出版社出版发行。本书的主要作者长期从事青少年骨骼年龄法医学鉴定与科学研究,先后进行了中国汉族、维吾尔族和藏族青少年骨发育状况的大样本调查,并在此基础上完成了法医学活体年龄推断技术和中国青     

14岁青少年骨发育的变化趋势

目的描述当前我国14岁青少年手腕骨发育特征,并初步评估14岁的青少年骨发育的变化趋势。方法以湖南娄底地区14岁青少年为对象(男53人,女56人),拍摄左手腕部X线片,参照顾氏图谱法描述各选定观察部位并分析发育特征,将统计结果与顾氏图谱法14岁骨龄标准进行比较分析。结果与顾氏法相比,男生组桡骨远端、第1掌骨近端和近节第4指骨骨骺发育程度较高,而女生组桡骨远端、第2～5掌骨、第1～5近节指骨和第2～5中节指骨骨骺发育程度较高。结论当前我国14岁青少年骨发育存在提前趋势,在女生组尤为显著。14岁是刑事责任年龄点之一,法医推断该年龄时应注意该特征对推断结果的影响。     

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。     

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.     

基于支持向量机实现骨骺发育分级的自动化评估

目的：运用支持向量机（support vector machine，SVM）实现尺、桡骨远端骨骺发育分级的自动化评估。方法收集我国140例11～19周岁青少年左侧腕关节X线正位片作为训练样本。将尺、桡骨远端骨骺分为五个发育分级，每个分级均包含28例样本。另选35例作为独立校验样本。建立尺、桡骨远端骨骺五个发育分级的SVM分类模型，用留一交叉验证法（leave one out cross validation，LOOCV）进行模型内部交叉验证以及梯度方向直方图（histogram of oriented gradient，HOG）进行模型外部验证，分别计算其准确率（PA）。结果桡骨远端骨骺分级SVM建模、LOOCV和HOG的PA分别为100.0%、78.6%和82.8%。尺骨远端骨骺分级SVM建模、LOOCV和HOG的PA分别为100.0%、80.0%和88.6%。结论运用SVM建立的尺、桡骨远端骨骺发育分级的自动化模型具有一定的可行性，为法医学骨龄评估软件的开发奠定基础。     

Age ranges of epiphyseal fusion in the distal tibia and fibula of contemporary males and females

The range of variation in epiphyseal fusion in North American populations has not been sufficiently established. This significant oversight can lead to exclusion of persons of interest in a forensic investigation. This study evaluates epiphyseal fusion of the distal tibia and fibula in 570 European-, African-, and Mexican-American children and young adults. Radiographs of 270 females aged 9 to 17 and 300 males aged 11 to 20 were analyzed to assess the range of variation of epiphyseal fusion at each age. Results indicate that complete fusion in females occurs as early as 12 years in the distal tibia and fibula. All females demonstrated complete fusion by 16 years with no significant differences between ancestral groups. Complete fusion in males occurs as early as 14 years in both epiphyses. All males demonstrated complete fusion by 19 years. Significant differences in the earliest age of complete fusion showed that African- and Mexican-American males demonstrate complete fusion as early as 14 years in both epiphyses while European-American males do not express complete fusion until 16 years.     

Age assessment by magnetic resonance imaging of the knee: a preliminary study

The authors developed an original magnetic resonance imaging (MRI) staging system for epiphyseal fusion of growth plate maturation of the knee and evaluated its reliability and validity for age assessment of living individuals. A total of 290 MRI scans of the knee were reviewed retrospectively in patients aged from 10 to 30 years old (138 males, 152 females). Five original MRI stages were defined to assess the degree of maturation of the distal femoral and proximal tibial epiphyses. Intra-observer variability was excellent and inter-observer variability was good, demonstrating the reliability and the validity of this original MRI staging system. In both sexes, the changes of growth plates (proximal tibial or distal femoral) were associated with age (p<0.001). Our results agreed with classic data on skeletal maturation of the knee, with globally earlier maturation in females than in males, and also earlier maturation of the proximal tibial epiphysis than of the distal femoral epiphysis. MRI of the knee is an efficient non-invasive method of age assessment, without the disadvantage of X-ray exposure. Further studies with larger groups are needed to support our results.     

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。     

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.     

Validity of the use of porcine bone in forensic cut mark studies

Porcine bone is often used as a substitute for human bone in forensic trauma studies, but little has been published on its comparative mechanical behavior. The factors affecting mechanical properties and therefore selection of bone models are complex and include the age of the animal at death, and physiological loading conditions, the latter being of particular relevance when using a quadrupedal animal as a human substitute. The regional variation in hardness of adult and infant porcine bones was investigated using Vickers’ indentation tests and compared to published data for human limb bones to relate differences to inherent genetic effects and loading influences, and to examine the validity of the porcine‐human model. Significant differences in hardness were observed both along and around the adult porcine humerus and femur, but no significant differences were found along the length of the infant bones. Significant differences were found between the forelimb and hindlimb, but only in the infant specimens. The hardness values for porcine adult cortical bone from the femur (52.23 ± 1.00 kg mm^?2) were comparable to those reported in the literature for adult human cortical bone from the fibula, ilium, and calcaneus. These data will help inform subject selection in terms of both species and bone type for use in future trauma studies.     

Size and Shape Differences in the Distal Femur and Proximal Tibia between Normal Weight and Obese American Whites

This study tests for differences in articular and diaphyseal size and shape of the distal femur and proximal tibia between normal weight and obese individuals, and discusses the effects of obesity on the patterns of sexual dimorphism and secular change in the skeletal morphology of the knee. Measurements of the femur and tibia were recorded for 143 American White adult males and females born in the 20th century. The sample was divided into normal and obese weight categories based on the body mass index. Results show differences between normal weight and obese individuals in the size and shape of the femoral shaft and the medial side of the knee joint, none of which affect the pattern of sexual dimorphism. While changes in skeletal morphology associated with obesity may be observed in recent secular changes, its role is still unclear because of the relatively recent increase in obesity prevalence.