Determination of bone age. Stages of bone formation

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Bone age in medical science is understood as the conditional value of age, the level of which corresponds to the development of the skeletal bones of the child being examined. Bone age can be determined by performing an X-ray examination, when specialists compare using specially developed tables normal values bone age indicators of adolescents or children with those that they can see in a particular patient. These tables necessarily take into account not only the height and weight of a person, but also the chest circumference, as well as the period of puberty in which the child is at the time of the examination.

Features of the procedure

To correctly determine bone age in medicine, there are several basic methods that take into account the emergence of epiphyses or terminal sections of the tubular bone, the stages of development of this process, the fusion of epiphyses and metaphyses, the formation of synostoses or bone joints. Since in the hands there is big number ossification nuclei and bone growing tissue or epiphyseal areas, bone age is very often determined specifically for this part of the body.

Usually in children it is normal if the share cartilage tissue significantly higher in the skeleton than in adults. For example, newborns have cartilaginous tissue instead of many bones in the skeleton - epiphyses calcaneus, tibia, femur, talus, cuboid, spongy on the hand, as well as vertebrae - consist of cartilaginous tissue and only rest on ossification points. During the development and growth of the body, cartilage tissue is replaced by bone tissue in a sequence determined by nature.

Indications and contraindications for diagnosis

The main indications for conducting a study to determine the bone age of a child are various disorders in his physical development, slow growth, pituitary gland diseases, thyroid gland and hypothalamus. At the same time, the problem is dealt with by such specialists as, sending the patient for an X-ray examination in any medical institution where there is an X-ray machine.

At the same time, by X-ray examination of the hand it is possible to determine, for example, the presence in the child’s body of such pathologies as pituitary dwarfism or dwarfism as a result of growth hormone deficiency, premature puberty, impaired bone development due to genetic disorders such as:

• Shereshevsky-Turner syndrome;
• congenital adrenal hyperplasia.

Among the main contraindications to conducting a study to determine the bone age of a child, doctors identify the age of up to 14 years, when such a procedure can be carried out exclusively as prescribed by the attending physician. Also not to be repeated this examination more often than once every six months, due to strong ionizing radiation, which is harmful to a fragile organism. It is important to remember that the patient does not need to undergo any specialized preparation for the study.

Research methods and results

To correctly determine a patient’s bone age, radiographs are most often used. wrist joint and brushes. During the procedure, the specialist analyzes and compares the picture he sees on the x-ray with the data that is recognized as the norm in this age group.

When diagnosed and possible pathologies pituitary gland physical development largely lags behind real age indicators child. Such a lag can sometimes reach two years. But when diagnosing skeletal dysplasia or short stature caused by genetics, bone growth retardation is usually absent or expressed by minimal indicators.

Also, when diagnosing the human skeleton, it is important to remember that he has not only age, but also gender characteristics. For example, the female skeleton develops significantly, sometimes 1-2 years, faster than the male one. Such features of ossification, which depend on sexual characteristics, manifest themselves from the first year of a child’s life.

Thus, based on X-ray data, one can judge the stage of puberty at which the patient is at the time of examination. Upon occurrence sesamoid bone metacarpophalangeal joint can be judged increased function gonads in the body, with ossification of the metacarpal bone in girls, menstrual cycles, and boys have regular wet dreams.

In this case, a growth spurt is observed when the body length increases very sharply in a short period of time. With premature puberty, we can talk about the development of bone maturity, and with reduced synthesis of growth hormone or pituitary dwarfism, we can talk about its slowdown.

When examined using the device, a pathological condition of the sella turcica is revealed, which indicates pituitary diseases. Pituitary dwarfism is characterized by a decrease in the size of the sella; with neoplasms in the pituitary gland, its walls become thinner, the entrance widens, and areas of calcification appear. In the presence of an intracranial tumor that originates from the pituitary cells - craniopharyngiomas - the cranial sutures diverge and depressions appear with inside cranium child.

Any X-ray results must be provided to the specialist who referred the patient for analysis so that he can diagnose the disease in a timely manner and prescribe effective therapy.

After birth, the child continues to grow and differentiate bones and form the skeleton. Functions in the body bone tissue diverse: firstly, it is support and protection internal organs, bone marrow; secondly, bones, in fact, are a reservoir of inorganic (calcium, phosphorus, magnesium) and some organic substances; thirdly, bone tissue in extreme conditions is a protection against acidosis after the exhaustion of kidney and lung functions; fourthly, it is a “trap for foreign substances"(heavy, radioactive, etc.).

The architecture of bone tissue can be divided into two types: trabecular and cancellous. Trabecular bone in its structure resembles the lattice structure surrounding the vessels. Osteophytes in it are scattered throughout the structure. In the fetus and embryo, almost all skeletal bones have a trabecular structure. After birth, this structure remains in the vertebrae, flat bones, as well as in tubular bones, being a temporary structure during the formation of lamellar bone.

Dense bone is the final structure found in the adult human skeleton. It consists of a system of Haversian canals and is built of a hard calcified matrix. Osteophytes in it are arranged in an orderly manner and oriented along the vascular canals. The development of dense bone is gradual as physical activity increases.

The main cellular elements of bone tissue are osteocyte, osteoblast and osteoclast. Osteogenesis in humans is unique and different from all representatives of the animal world. The final bone structure is formed after birth, which is associated with the onset of steady walking.

By the time a child is born, the diaphyses and epiphyses of the tubular bones are already represented by bone tissue. All spongy bones (hands, feet, skull) are made of cartilage tissue. At birth, ossification nuclei form in these bones, giving rise to dense bone growth. Based on the ossification points, one can judge the biological age of the child. The growth of tubular bones occurs due to the growth of cartilage tissue. Elongation of bones occurs due to the growth of cartilage tissue in length. The growth of the bone in width occurs due to the periosteum. At the same time, from the side of the medullary canal, the cortical layer of the periosteum is subject to constant resorption, as a result of which, as the bone grows in diameter, the volume of the medullary canal increases.

After birth, the bone is rebuilt many times in its development - from a coarse fibrous structure to structural bone.

With age, the process of osteogenesis occurs - remodeling of bone tissue. Bone density increases gradually. Contents of the main mineral component bone tissue - hydroxyapatite - increases with age in children.

In general, there are three stages in the process of bone formation:

1) formation of the protein basis of bone tissue; it mainly occurs in utero;

2) the formation of crystallization centers (hydroxyapatite) with subsequent mineralization (osteosynthesis); it is characteristic of the postpartum period;

3) osteogenesis, when the process of bone remodeling and self-renewal occurs.

At all stages of osteogenesis, vitamin D and the normal presence of Ca, Mg, and P ions in food are necessary. An indispensable condition correct formation skeletal system is exposure to air, external insolation.

If any of these components is deficient, the child develops rickets, characterized by changes in bone and muscular system, disorders of the central nervous system.

In children, unlike adults, the younger they are, the more abundantly the bones are supplied with blood. The blood supply to the metaphyses and epiphyses is especially developed. By the age of 2, a unified intraosseous circulatory system is formed, the network of epimetaphyseal vessels and growth cartilage are well developed. After 2 years, the number of bone vessels decreases significantly and increases again by puberty.

The periosteum in children is thicker than in adults. Due to this, the bone grows in thickness. Bone marrow cavities form with age. By the age of 12, a child’s bone already resembles that of an adult.

In the development of bones in children, periods can be distinguished when bones are especially sensitive to harmful factors.

1. Breast period, early or preschool period, the first 3 years of life, when bone growth and calcification, saturation and deposition occur minerals(calcium, phosphorus). Various osteopathies occur easily - rickets, rickets-like conditions. Therefore, rational feeding of the child and compliance with his daily routine are of particular importance.

2. School and teenage periods when differentiation and accumulation of bone mass is complete. Borderline osteochondropathy is observed in children. Risk factors for impaired bone formation in children are nutritional disorders and inadequate physical activity.

Scull

The skull of a newborn consists of many bones. Sutures such as sagittal, coronal, and occipital are open. Their closure begins by 3-4 months of age. In full-term babies, the lateral fontanelles are closed at birth. The posterior, or small, fontanel, located at the level of the occipital and parietal bones, is open in 25% of newborns. It closes by 4-8 weeks of the baby's life. The large fontanel is located at the junction of the parietal and frontal bones, or coronal and sagittal sutures. It is always open, and its size in a newborn ranges from 3x3 cm to 1.5x2 cm. Normally, the large fontanel closes by 10-18 months.

The shape of the head in children can be different, but more often it is round and symmetrical. The facial skull develops with age.

Spine

The human spine is unique bone formation, promoting his upright posture, which is formed parallel to the growth of the child. Gradually, with age, the spine acquires its own curves, which take on the movement of the center of gravity of a walking or standing person.

The first curves of the spine appear from the beginning of holding the head and shoulder girdle, and by 2-4 months the anterior curve of the cervical spine is formed. After developing the ability to stand upright and walk, an anterior bend in the lumbar spine and almost simultaneously a thoracic curve of the spine are formed. The uneven growth of individual segments of the body, spine, head and limbs leads to the fact that the center of gravity of the body moves significantly as children grow. So, if a newborn has vertical position the center of gravity is at the level of the processus xyphoideus, then in an older child it moves down, but does not reach the level of the navel. At the age of 5-6 years, the center of gravity is already below the navel, and by 13 years - below the level of the iliac crests.

In children, unlike adults, the fixation of the spine is unstable, imperfect, and under the influence external factors(wrong posture) may occur persistent deformation spinal bones (scoliosis and pathological posture).

Rib cage

How smaller child, the more his chest is relatively wider and shorter, while the ribs are located horizontally. The chest of a child is more rounded than that of an adult. Its transverse size in a newborn is 25% greater than the average longitudinal one; their chest is in a state of inhalation. Subsequently, there is growth chest in length, while the ribs descend, forming an obtuse angle with the spine, its anterior diameter rapidly increases. At 3 years old, effective costal breathing is formed. By the age of 12, the chest enters a state of maximum inspiration, and by the age of 15, the final increase in its transverse diameter is completed.

Pelvic bones in children early age resemble a funnel. The formation of sexual differences in the pelvis begins at puberty.

Methods for studying the skeletal system and joints

Data on the history of diseases of the skeletal system are usually collected from the words of parents, immediate relatives or persons involved in raising the child. Older children can significantly add to the history of the disease themselves. When questioning, pay attention to the timing of the appearance of certain changes. Firstly, the presence of pain is detected (arthralgia, myalgia, osalgia), secondly, changes in the configuration of bones and joints, and thirdly, the state of mobility in the joints. When complaining of pain, note its localization, symmetry, nature and intensity, duration, and frequency. Then they ask about factors that contribute to the intensification or disappearance of pain (warmth, rest, medications). Next moment- identification of mobility impairments (morning stiffness, limitation of movements due to pain, etc.). After this, they ask about the connection between the onset and appearance of pain or changes in the joints and bones with any disease (previous infections, injuries).

The examination is carried out from top to bottom (head, torso, limbs), and good lighting is important. In young children, pay attention to pathological changes head shapes, which are especially often observed with rickets. The bones of the skull can be sloping, asymmetrical, the frontal, parietal and occipital tubercles increase. Often the occipital bone becomes denser and smoother.

At congenital syphilis pathological fragility of the skull bones may develop. In newborn children, skull deformation associated with birth trauma, manifested by a tiled arrangement of bones (they are located on top of each other), their depression or protrusion, often followed by subperiosteal hemorrhages (cephalohematomas). Brain hernias may also be observed.

The head is measured to assess physical development or to identify pathology (micro- and macrocephaly).

Microcephaly develops in utero or with early closure of sutures (against the background of vitamin D hypervitaminosis). Big head with macrocephaly, a pathological condition most often develops when hemocerebrospinal fluid dynamics is impaired - hydrocephalus. At the same time, the fontanelles and even the seams are always open.

When examining, pay attention to the age-related proportionality of the development of the facial and cerebral skull.

Then the chest is examined. Pay attention to its shape, symmetry, uniformity of participation in the act of breathing, various deformations (“chicken breast”, funnel chest, peripneumonic fissure of Filatov-Garrison, cardiac hump, etc.), indicating a congenital or acquired defect.

Assess the child's posture in a standing position: heels together, arms at sides. With postural disorders, there are lateral curvatures of the spine - scoliosis, lag of the shoulder blades from the chest, stoop, pathological lordosis (increased forward bending of the spine) and kyphosis (increased backward bending of the spine). Sideways curvature of the spine is especially common - scoliosis (this is always a pathology). Suspicion of scoliosis must be confirmed x-ray.

It is necessary to examine the pain of the vertebrae when palpating and moving, especially if the child complains of pain in the spine.

Inspection upper limbs are produced to determine their length and the presence of deformation. There are standards for the development of limbs in children of different ages. Long-armedness is more often detected in diseases connective tissue(Marfan's disease). Shortening of the limbs is associated with Down's disease and chondrodystrophy. The fingers are also examined to identify the symptom “ drumsticks", osteopathies, arthritis and other changes.

Upon examination lower limbs in a newborn, pay attention to the symmetry of the buttock folds, the number of folds on the inner surface of the thighs (with congenital dislocation hip joint there are more folds), shortening of the limbs, X- or O-shaped curvature of the legs (with rickets). Often in older children, flat feet are diagnosed, which is pathological condition. To determine it, plantography is performed - a foot print is studied on a sheet of paper.

The following standard sequence assists in rapid screening examination of the skeletal system and its recording:

1. Inspection from the front, arms extended along the body. At the same time, the shape of the legs, the position of the head, the symmetry of the shoulders, waist triangles are determined, deformation of the chest, and the symmetry of the hips are excluded.

2. Side inspection. The shape of the chest, abdomen, protrusion of the shoulder blades, and the shape of the back are determined.

3. Inspection from the back. The symmetry of the angles of the shoulder blades, the shape of the spine, the shape of the legs, and the axis of the heels are revealed.

4. At the end of the examination, the child is asked to walk around the room to identify gait disorders.

Based on the inspection results, testing is carried out: 1) without deviations - negative values ​​for all points; 2) minor deviations requiring observation by a pediatrician - with positive answers to questions 3-7; 3) significant deviations requiring further examination and treatment by an orthopedist or vertebrologist - positive answers to 5 questions (1, 2, 8, 9, 10).

Palpation of bones is a medical procedure. It is aimed at identifying softening of bones, the condition of fontanelles or skull sutures in newborns and infants. They also palpate the ribs and bones of the limbs, examine the joints and, based on changes in their shape, size and range of motion, judge about a particular pathology. If necessary, an x-ray examination is prescribed. It is carried out if Inflammatory-dystrophic changes in bones and joints are suspected; for bone tumors, to determine bone (biological) age, in the diagnosis of diseases accompanied by osteoporosis, softening of bones. It is also used to diagnose diseases of the skeletal system. laboratory methods: determine the level of Ca, P, alkaline phosphatase in blood and urine.

Teeth

In children, the first teeth are the baby teeth. They erupt in a certain sequence.

The formation of the occlusion of baby teeth is of great importance. It is formed by 2.5-3.5 years and is characterized by the following positions:

1) small spaces between teeth;

2) absence of tooth wear;

3) the distal surfaces of the upper and lower dental incisors are located in the same frontal plane;

4) orthognathic bite, when the upper incisors slightly cover the lower incisors.

The next period of dental development begins at the age of 3.5 - 6 years. At this time, interdental gaps (diastemas) appear - between the incisors or trema - between other teeth. The teeth are already worn out, the lower and upper teeth do not match. Orthognastic bite turns into a straight bite. Milk bite has teeth great importance to develop the ability to chew food and develop speech.

Period mixed bite begins with the appearance permanent teeth, while the baby teeth are also preserved. First permanent teeth They erupt at the age of 5 - these are the first molars. Then the baby teeth fall out sequentially and the permanent teeth appear. By the age of 11, the second molars erupt. Third molars (wisdom teeth) appear between the ages of 17 and 20, and sometimes even later. To estimate the number of permanent teeth, use the following formula:

X = 4n - 20, where n is the child’s age, years.

Children of any age often experience dental disease - caries, in which gradual destruction of the tooth structure occurs. Therefore, caries prevention occupies a special place in raising a child.

In this regard, they matter balanced diet, compliance with the principles of feeding a child breast milk. Special meaning add fluoride to food as a means of preventing caries. Children should brush their teeth with prophylactic toothpastes that do not contain fluoride, but it must be contained in food products. In addition to fluoride, the child also needs calcium.

A balanced diet should also include organic, indigestible carbohydrates. The latter have positive influence for growth normal flora oral cavity. For proper development teeth, caries prevention requires a diet containing starch, glycogen, disaccharides, and glucose. It is important to teach your child to chew food properly. After eating, be sure to rinse your mouth and brush your teeth with toothpaste. at least twice a day - in the evening and in the morning.

skeleton supporting motor synarthrosis

Determining age from radiographs of the hand skeleton is of great importance in the diagnosis of many diseases. Typically, developmental age (biological age) is determined by the degree of skeletal ossification. In world practice, it is customary to define “bone” or “radiological” age as a convenient criterion for biological age, since it is a more subtle indicator physiological state and the originality of the constitution of the subject being studied, than passport age and any anthropometric data.

The passport age itself only indicates the number of years lived and does not always coincide with biological age. The condition of the skeletal system reflects general processes developments taking place in the body.

To determine bone age, it is enough to study the ossification, size and relationship of the skeleton of the hand and the distal forearm, as the most accessible part of the skeleton for radiography and providing the most complete information about the development of the entire organism.

Behind last decades There has been and is an acceleration of the physical development of children and adolescents, called acceleration. Acceleration forces us to take a new approach to assessing norms and pathologies in physical development. The effect of acceleration on the growth and development of the skeleton is manifested by accelerated ossification, an increase in bone size, earlier disappearance and a decrease in the frequency of occurrence of pseudoepiphyses. Therefore, assessment according to old standards is methodologically incorrect, since it leads to errors. To determine bone age, you should use tables developed in 1968-1977.

Determination of bone age has a large diagnostic value primarily for growth pathologies in children and adolescents.

Correct determination of bone age is of great practical value in endocrinology for diagnosis and differential diagnosis myxedema, pituitary and cerebral dwarfism, some chromosomal diseases, disorders of sexual differentiation, Itsenko-Cushing's disease and syndrome, virile and diencephalic syndrome, some tumors of the adrenal glands and ovaries, etc.

Determination of bone age allows you to control the treatment of patients hormonal drugs, which are widely used for the treatment of many diseases, including growth stimulation.

The resulting standards for ossification and size of hand bones can be used in forensic medical examination.

Therefore, it is necessary not only for radiologists, but also for doctors of other specialties to master the technique of determining age from radiographs of the bones of the hand and distal forearm, since the establishment of correct diagnosis and carrying out rational treatment of the patient.

The order and timing of ossification of the skeleton of the hand and distal forearm.

Bone development is characterized by both qualitative and quantitative indicators. Qualitative indicators include the timely appearance of ossification points and synostosis of the hand bones. These processes are known as skeletal differentiation (ossification, ossification). Quantitative indicators include an increase in bone size.

Thanks to X-ray examination, it is possible to deeply penetrate into the dynamics of ossification and observe all the features of this complex process for many years. Besides, x-ray method research allows you to establish control over the effects of various therapeutic activities, especially hormonal drugs.

The most convenient object for x-ray examination The pace of ossification is determined by the hands and the distal forearms, since here the appearance of individual points of ossification and synostosis are distributed sequentially and evenly over a long period of time (13-18 years).

Dedicated to the order, timing of ossification and synostosis of the skeleton. a large number of works However, it has now been established that, thanks to acceleration processes, skeletal ossification occurs faster than 20-40 years ago. Despite this fact, manuals on anatomy, radiology, pediatrics, endocrinology, and forensic medicine provide information based on research from the 30s and 40s. The current use of these tables leads to erroneous conclusions.

To determine bone age, one should take into account standards not only for skeletal ossification, but also for the size of the hand bones in the age aspect. Determining bone age using tables of ossification dates and sizes of the carpal bones, metacarpal bones and phalanges of the fingers makes it possible to obtain more reliable conclusions about the age of the subject. This should be especially remembered when determining bone age in forensic practice.

Taking into account the above, we have developed tables of standards for the timing of ossification, the size of the bones of the hand and distal forearms, the development of epiphyseal cartilage and a number of indicators characterizing the processes of bone evolution at the present time.

The results of the study are presented age-related changes hand skeleton in children and adolescents of Kyiv for the period 1969-1974. For this purpose, we studied 2675 radiographs of the hand bones and distal forearms in individuals aged from several days to 20 years. There were 1460 boys and young men, 1215 girls and boys. The obtained radiographs were grouped taking into account age-related physiology. Each age group consisted of 30-100 people.

When processing the material, the fact of the presence or absence of a particular ossification point is taken into account, regardless of its size. As for synostosis, the age at which the cartilaginous layer between the metaphysis and the epiphysis disappears is taken into account.

We have established the earliest and most late dates the appearance of ossification points and the onset of synostosis. In addition, the “average” periods of ossification have been determined. The average period of ossification is considered when at least 50% of representatives of a certain age exhibit this phase of differentiation of the bones of the hand skeleton.

To determine age, it is enough to determine average term ossification, in forensic medical practice the earliest and latest periods of ossification are also taken into account.

Correct determination of bone age and the presence of signs of growth disturbance requires appropriate radiograph technology. It is necessary to take x-rays of both hands, which will make it possible to identify the presence of such pathological symptom ossification, like asymmetry. The hands should be placed on the cassette so that all phalanges of the fingers and bones of the wrist joint are captured on the radiograph. Both hands are placed on a cassette measuring 18x24 or 24x30 cm (depending on the age of the subject), palms down so that the axis of the middle finger is a continuation of the axis of the forearm. The misalignment of these axes significantly changes the angle of the wrist. The first finger should be in a position of rotation at an angle of 30 * relative to index finger. The central beam is directed to the intersection of the line connecting the heads of the third metacarpal bones of both hands with a vertical line drawn through the center of the cassette. The distance from the anode of the X-ray tube to the film should be 100 cm. From these X-ray images, bone age can be determined, as well as the developmental features of the skeletal bones.

The order of appearance of ossification points and synostosis were studied in detail by the Leningrad School of Radiologists (1936). Behind last years there is an increase in growth intensity and a decrease average duration individual phases of ossification. An acceleration of the rate of ossification by 0.5-3 years is observed, compared with data from 1936. This acceleration occurs unevenly and depends on the phase of ossification and the sex of the subject. The acceleration of ossification of the hand skeleton is in full accordance with the noted acceleration of physical and sexual development of children and adolescents.

Rate of ossification in different periods life is different. Alone age periods are characterized by an increase in the intensity of ossification of the skeleton (the appearance of sesamoid bones in the first metacarpophalangeal joint), others - by a decrease in it (the appearance of the styloid process and the pisiform bone). The duration of individual phases of ossification in boys before synostosis in the first metacarpophalangeal joint is longer than in girls. Their total duration is 15.5 years for boys, 13 years for girls. This is 1.5-2 years faster than according to 1936 data. Phases of synostosis, starting from the distal phalanges and ending with the distal epiphysis radius, longer in girls than in boys (3 and 2 years, respectively).

The acceleration of ossification at different age periods occurs unevenly. Before three years old There is a slight acceleration in the rate of ossification (2-6 months) and only the triquetral bone appears in girls one year earlier than in boys. Before the appearance of the distal epiphysis ulna, which is determined one year earlier in girls, no acceleration of ossification is observed. The timing of the appearance of the styloid process and pisiform bone in boys is more constant; in girls, these bones appear one year earlier than in 1936. The stability of the appearance of these ossification points in boys is also noted in a study of Moscow children, Extremely! about the North, Poland. Sesamoid bones in the first metacarpophalangeal joint appear 1.5 years earlier in both boys and girls, compared to data from 1936.

The next phase of development - the appearance of synostoses of the first metacarpal bone - is an indicator of the inclusion of the gonads in the work of the endocrine apparatus. This phase begins 1.5-2 years earlier. Further synostosis of the bones of the hand skeleton is significantly accelerated (by 2-3 years). Differentiation of the hand bones ends in boys at 18 years old, in girls at 16-17 years old (Table 1).

It must be remembered that there is a certain order in the appearance of points of ossification and synostosis of the bones of the hand skeleton (Table 1). Some perversions of the order of ossification are acceptable. Thus, the lunate bone is often found before the appearance of the triquetrum, the trapezoid and scaphoid bones sometimes appear before the lunate, and the distal epiphysis of the ulna - before the trapezoid and scaphoid bones. Synostosis often occurs in the distal phalanges in the absence of synostosis in the first metacarpal bone. These changes should be regarded as pathological only in cases of other symptoms of impaired ossification and bone growth.

Sex differences in the rate of ossification appear already from the first days of a child’s life, long before the inclusion of the gonads. Greater differentiation of skeletal bones in girls is observed throughout the entire period of ossification and is especially pronounced during puberty.

For many years there was a point of view according to which the rate of ossification depends on nationality and climatic conditions. Many authors have pointed this out directly or indirectly. Currently, most scientists who have studied the processes of ossification in residents of various nations of the USSR, Poland, England, the USA, Africa, Australia, and Peru come to the conclusion that when assessing radiographic age it is not necessary to use local standards for the timing of ossification. A comparison of data on the ossification of the skeleton of the hand of different peoples shows that the order, timing of ossification and synostosis of the skeleton of the hand of representatives of different nationalities living in different climatic conditions, approximately the same.

U healthy children and adolescents, bone age corresponds to the passport age. For various disorders, to determine the rate of ossification, in addition to bone age, other radiological indicators of the rate of ossification should be taken into account: ossification deficiency (DO) - the difference between passport and bone age (normally DO equal to zero; fluctuations of ±1 are allowed), ossification coefficient (OC) is the radiological age divided by the passport age (normally, KO is equal to one; fluctuations of ±0.2 are allowed).

We have found that the CR indicator is the most reliable for assessing the severity of delayed ossification and growth. It can be recommended for diagnosis and differential diagnosis various violations growth, as well as to monitor the feasibility and effectiveness of treating patients with hormonal drugs.

How to determine radiographic age in cases where there is asymmetry or distortion of ossification?

With asymmetry of ossification, the presence of an ossification point is taken into account, regardless of the fact that it is present on only one hand. For example: the boy has right hand there is a triquetral bone, but on the left it is absent; there are also ossification points that appear before the triquetral bone (see Table 1). The X-ray age according to the table for this boy corresponds to three years.

In cases of ossification distortion, the sequence of appearance of ossification points is disrupted due to “jumping” over the row. In such cases, age is determined by the presence of later points of ossification and synostosis, without taking into account the absence of previous points of ossification.

Accessory epiphyses and pseudoepiphyses of the metacarpal bones and phalanges of the fingers.

At normal development short tubular bones have one epiphysis or ossification point. In addition to the true epiphyses, there are additional psendoepiphyses. The presence of pseudoepiphyses is additional information to determine bone age.

For example:

On radiographs cervical spine With functional tests(without a direct photograph) there is synostosis of the cervical vertebrae in the anterior sections, compaction of the longitudinal ligaments throughout, synostosis of the C5 - C6 bodies in the area of ​​the intervertebral discs.

The presence of a fibromuscular ring of the posterior arch of the C1 vertebra with the formation of a dense bridge.

Uncovertebral joints without features.

In the area of ​​the projection of the soft tissues of the posterior surface of the neck muscles (at the level of the spinous process of the C6 vertebra) there is a dense formation bone density, oval shape, dimensions 1.4 x 0.7 cm.