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。     

CHN骨龄在司法鉴定中的应用价值

目的探讨CHN(中国人手腕骨发育标准CHN法)骨龄在司法鉴定中的应用价值,分析影响其准确性的因素及相关问题。方法对522例年龄鉴定者,均选用不同曝光值拍摄两张左手腕部正位X线片,并加照两次斜位片。使用CHN法测评骨龄。结果522例中男性489例,女性33例。男性达CHN骨龄最高值18.4岁者129例,余平均骨龄16.5岁。女性达CHN骨龄最高值17.3岁者14例,余平均骨龄15.7岁。CHN骨龄在16.0岁以上者共388例,占约74.3%。本组资料显示多种因素影响骨龄鉴定的准确性,其中以骨龄片位置及角度的变化等影响最大。结论如能获得高质量的X线片、并能熟练使用CHN法、注意利用位置和角度的变化正确判定骨骺分级,CHN骨龄基本可满足活体年龄鉴定的需要。     

青少年骨关节X线片的骨龄研究

通过对11～16周岁女性及13～20周岁男性青少年左侧肩、肘、腕、髋、膝、踝关节拍摄X线片,进行了青少年的骨龄研究.根据骨骼生长发育的特点,提出了各大关节X线片判定骨龄的观察指标及分级标准,并使用SPSS软件包进行数据处理,建立了青少年利用6大关节骨骺愈合程度判定女性是否已满14周岁、男性是否已满16周岁或18周岁的判别分析方程.     

X线骨龄评估方法研究进展与展望

骨龄评估的传统方法主要包括计数法、图谱法及计分法等,近年来又有一些学者不断提出其他新的方法。利用骨骼X线片影像学特征推断骨龄是当前法医学工作者进行骨龄评估的主要手段。但是,将此骨龄推断结论作为"证据"直接提供给司法审判机关,因其存在着一定的误差尚值得商榷。因此,为了提高骨龄鉴定结论的精确度,还需进行更多方法学的研究。经参阅国内、外大量相关文献,现就X线片骨龄评估方法的研究与进展进行综述。     

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。     

7146名城市青少年肥胖、超重和体瘦者的年龄推测

目的观察城市青少年肥胖、超重和体瘦者的骨发育特征。方法以《中国人手腕骨发育标准-中华05》RUS-CHN法对5城市7146名(男3986,女3160)12～18岁汉族正常青少年手腕部X线片骨龄进行评价,计算各骨龄组的体重指数(BMI),BMI第85百分位数的受试者分类为肥胖和超重,BMI第15百分位数者分类为体瘦,观察骨龄减年龄差值。结果肥胖、超重青少年偏向发育提前,骨龄减年龄差值分布的下限在-1岁;体瘦青少年偏向于发育延迟,骨龄减年龄差值分布的上限在+1岁。结论应用BMI,肥胖、超重和体瘦青少年的年龄推测范围可能缩小。     

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。     

中国5城市儿童青少年手腕骨发育差异对年龄推测影响

目的探讨中国5城市儿童青少年手腕骨发育差异对年龄推测的影响。方法收集2005年中国上海、广州、温州、大连、石家庄11635名（男5971,女5664）汉族正常儿童青少年手腕部骨X线片,按RUS—CHN法标准评价受试者手腕骨骨龄,比较各城市儿童青少年的骨龄差异。结果广州男在8岁以下以及温州男9～12岁骨发育分别延迟0．14～0．19岁和0．13～0．17岁（P〈0．05）,上海男在7～15岁之间骨发育提前0．14～0．32岁（P〈0．05）。大连女在12岁以下、石家庄女在8岁以下骨发育分别延迟0．15～0．31岁和0．18～0．31岁（P〈0．05）;广州女在5～8岁骨发育延迟0．11～0．22岁（P〈0．05）;而上海女在8～9岁骨发育提前0．12～0．13岁（P〈0．05）。结论中国5城市儿童青少年手腕骨发育在不同年龄段存在不同程度的差异。     

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。     

RUS-CHN图谱骨龄评价法用于推侧青少年年龄

目的探讨RUS-CHN(RC)图谱评价法用于13~18岁青少年年龄推侧的应用价值。方法4 424名(男2 272,女2 152)13~18岁正常城市汉族青少年,以简化RUS-CHN法建立手腕骨发育等级图谱。另以1 048名(男530,女518)13~18岁青少年为检验样本,比较不同方法骨龄与生活年龄的差异。结果RUS-CHN图谱法可仅评价桡骨、尺骨远端和第III指的4块掌指骨骺。检验样本中男14~17岁、女13~16岁年龄组,RC图谱法骨龄与生活年龄之间的差异均无统计学显著性(W ilcoxon符号秩和检验,P>0.05),对男18岁、女17岁组出现显著性差异的可能原因进行了讨论。结论RUS-CHN图谱法骨龄适用于男13~18岁、女13~17岁青少年的年龄推测。     

Dental age estimation in Belgian children: Demirjian's technique revisited.

Aim: The purpose of this study was to evaluate the accuracy of Demirjian's dental age estimation in children in a Belgian Caucasian population and to adapt the scoring system in case of a significant overestimation as frequently reported. We selected 2523 orthopantomograms of 1265 boys and 1258 girls, of which 2116 (1029 boys and 1087 girls) were used for estimating the dental age with the Demirjian's technique. The 407 other orthopantomograms were beyond the original age limit. A second sample of 355 orthopantomograms was used to evaluate the accuracy of the original method and the adapted method. A signed-rank test was performed to search for significant age differences between the obtained dental age and the chronological age. A weighted ANOVA was performed in order to adapt the scoring system for this Belgian population. The overestimation of the chronological age was confirmed. The adapted scoring system resulted in new age scores expressed in years and in a higher accuracy compared to the original method in Belgian Caucasians.     

青少年骨龄标准身高、体重和体重指数生长图表

目的制订青少年骨龄标准身高、体重和体重指数生长图表,为年龄推测时评价青少年基本发育状况提供参考。方法研究样本为2005年中国5城市抽取的3-19岁汉族正常青少年和儿童16570名（男8282,女8288）。应用RUS-CHN法评价受试者手腕部骨龄,由Box-Cox幂指数分布（Box-Cox power exponential distribution,BCPE）模型估价以骨龄分组的身高、体重和体重指数（Body mass index,BMI）百分位数。结果根据最小Akaike信息准测（Akaike Information Criterion,AIC）和广义AIC（Generalized AIC）选择了身高、体重和BMI BCPE模型μ,σ,ν,τ参数的自由度,依据BCPE模型所估价的百分位数曲线下样本例数的百分数与理论期望值相差在0.01%-1.21%之间。结论所选择的BCPE模型符合青少年儿童样本以骨龄分组的身高、体重和BMI数据的实际分布,所提出的生长图表可用于年龄推测中青少年基本生长发育状况的评价。     

Excretion of Delta9-tetrahydrocannabinol in sweat

The aims of this study were: first, to determine the accuracy of the Cameriere method for assessing chronological age in children based on the relationship between age and measurement of open apices in teeth and, second, to compare the accuracy of this method with the widely used Demirjian et al. method and with the method proposed by Willems et al. Orthopantomographs taken from white Italian, Spain and Croatian children (401 girls, 355 boys) aged between 5 and 15 years were analysed following the Cameriere, Demirjian and Willems methods. The difference between chronological and dental age was calculated for each individual and each method (residual). The accuracy of each method was assessed using the mean of the absolute values of the residuals (mean prediction error). Results showed that the Cameriere method slightly underestimated the real age of children. The median of the residuals was 0.081 years (interquartile range, IQR=0.668 years) for girls and 0.036 years for boys (interquartile range, IQR=0.732 years). The Willems method showed an overestimation of the real age of boys, with a median residual error of -0.247 years and an underestimation of the real age of girls (median residual error=0.073 years). Lastly, the Demirjian method overestimated the real age of both boys and girls, with a median residual error of -0.750 years for girls and -0.611 years for boys. The Cameriere method yielded a mean prediction error of 0.407 years for girls and 0.380 years for boys. Although the accuracy of this method was better for boys than for girls, the difference between the two mean prediction errors was not statistically significant (p=0.19). The Demirjian method was found to overestimate age for both boys and girls but the mean prediction error for girls was significantly greater than that for boys (p=0.024), and was significantly less accurate than the Cameriere method (p<0.001). The Willems method was better than that of Demirjian (p=0.0032), but was significantly less accurate than that of Cameriere (p<0.001).     

Applicability of Greulich and Pyle skeletal age standards to Indian children

A total 375 Indian children of age 1 day to 19 years were studied (male 194 and female 181). For determining the bone age (skeletal age), wrist and hand radiographs were taken. The skeletal age was determined by blinded review of radiograph using Greulich and Pyle atlas (2nd edition, 1959). If we consider all age group (1-19 years), the Indian boys were retarded in skeletal age by 0.7 years and females by 0.33 years. Male and female children skeletally lag behind the American standard (GP Atlas) in all age groups except 12-13 years age group in which girls are accelerated by 0.22 years. Chronological age and skeletal age difference of more than 1 year is seen between age group 7 years and 12 years in males. Females after second year showed a retardation, which ranged from 0.2 to 0.8 years, up to the age of 19 years. The present study concludes that, Greulich and Pyle atlas is not applicable to the Indian children of both sexes especially in middle and late childhood.     

Permanent teeth development in a Spanish sample. Application to dental age estimation

The purpose of this study is to clarify the chronology of different stages of dental development, according to Demirjian, in a sample of Spanish children, which will enable us to build a database that will be used as a reference in regard to the dental development of individuals of our socio-geographic environment. In the same studied sample, a calculation of the dental age according to Demirjian was carried out. This study was conducted in a final sample consisting of 1010 orthopantograms, corresponding to Spanish children (485 boys and 525 girls) ages 2-16. Comparing the age of onset of the different stages among the children, evidence was found that girls had an earlier general development than boys. These differences were only statistically significant in teeth and concrete stages. The canine teeth revealed greater gender dimorphism, with significant differences in all stages compared with the upper canines. The method proposed by Demirjian for dental age calculation resulted in a significant overestimation of dental age in relation to the chronological age in boys (average of 0.87 years) and girls (average of 0.55 years). Data from this study may be used as reference for dental maturity, as well as a standard for estimating age in Spanish children.     

The accuracy of three methods of age estimation using radiographic measurements of developing teeth

The accuracy of age estimation using three quantitative methods of developing permanent teeth was investigated. These were M?rnstad et al. [Scand. J. Dent. Res. 102 (1994) 137], Liversidge and Molleson [J. For. Sci. 44 (1999) 917] and Carels et al. [J. Biol. Bucc. 19 (1991) 297]. The sample consisted of 145 white Caucasian children (75 girls, 70 boys) aged between 8 and 13 years. Tooth length and apex width of mandibular canine, premolars and first and second molars were measured from orthopantomographs using a digitiser. These data were substituted into equations from the three methods and estimated age was calculated and compared to chronological age. Age was under-estimated in boys and girls using all the three methods; the mean difference between chronological and estimated ages for method I was -0.83 (standard deviation +/-0.96) years for boys and -0.67 (+/-0.76) years for girls; method II -0.79 (+/-0.93) and -0.63 (+/-0.92); method III -1.03 (+/-1.48) and -1.35 (+/-1.11) for boys and girls, respectively. Further analysis of age cohorts, found the most accurate method to be method I for the age group 8.00-8.99 years where age could be predicted to 0.14+/-0.44 years (boys) and 0.10+/-0.32 years (girls). Accuracy was greater for younger children compared to older children and this decreased with age.     

Bone age assessment: the applicability of the Greulich-Pyle method in eastern Turkish children

The aim of this study was to investigate whether or not the Greulich-Pyle (GP) method is adequate for Turkish children. A group of 767 individuals (425 girls and 342 boys) between 7 and 17 years were studied. Bone age (BA) from plain radiographs of left hands and wrists by GP standards was estimated. The total mean differences between BA and chronological age (CA) for girls and boys were found to be 0.20 and -0.13 years, respectively. There were significant differences between BA and CA in age groups 7-, 8-, 10-, 11-, 12-, 13-, 15-, and 16-year-olds for girls and 7-, 10-, and 12-year-olds for boys. The results of this study suggest that the mean differences between BA and CA are low enough to be of no practical significance, and thus, for the time being unless any other methods will be proved more useful, this method could be used in all age groups.