Secondary Ossification Center Appearance and Closure in the Pelvis and Proximal Femur
Secondary Ossification Center Appearance and Closure in the Pelvis and Proximal Femur
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DOI：
10.1097/bpo.0000000000000836
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发表时间：
2018-09-01
影响因子：
1.7
通讯作者：
Pennock, Andrew T.
中科院分区：
文献类型：
--
作者：
Parvaresh, Kevin C.;Upasani, Vidyadhar V.;Pennock, Andrew T.
前言：骨性不成熟患者骨盆的不同骨化类型使骨盆X线片的解释具有挑战性。先前研究之间的不一致和缺乏性别比较强调了对次级骨化中心进行更全面描述的必要性。本研究利用计算机断层扫描(CT)评估骨盆和股骨近端继发骨化中心的出现和闭合的时间顺序和性别差异。方法：对2009年1月至2014年12月在2个三级1级创伤中心接受腹部和骨盆CT扫描的患者进行回顾性分析。患者年龄在2岁到32岁之间，骨盆和股骨近端有足够的影像。有骨科创伤或骨化病理病史的患者被排除在外。CT扫描评估以下继发性骨化中心的出现和闭合情况：髂前下棘(AIIs)、髂前上棘(ASIS)、股骨头(FH)、大转子(GT)、髂骨顶(IC)、坐骨结节(IT)、小转子(LT)、后上棘(PSIS)、耻骨联合(SP)和放射软骨(TRC)。结果：共有496例CT扫描符合纳入标准，其中男性240例，女性256例。次级骨化中心的出现顺序为：(男)GT、LT、AIIs、IT、ASIS、PSIS、IC、SP；(女)GT、LT、IT、AIIs、PSIS、IC、ASIS、SP。闭合顺序相似：(男)TRC、LT、FH、AIIs、GT、ASIS、PSIS、IT、IC和SP；(女)LT、TRC、AIIs、FH、GT、ASIS、PSIS、IT、IC和SP。所有部位的女性骨化中心均比男性早1~2岁。除TRC、IC和SP外，其余部位女性骨化中心均比男性早1~2岁关闭。结论：骨盆和股骨近端次级骨化中心的出现和关闭遵循可预测的发展模式，女性略早于男性。更精确的发育年龄和性别差异的知识更好地描述了这种复杂的骨骼发育。未来的研究可能会使用次级骨化中心来进一步评估骨骼成熟度，评估儿科病理学，并辅助外科治疗。
Introduction: Variable ossification patterns of the pelvis in skeletally immature patients can make the interpretation of pelvic radiographs challenging. Inconsistencies among prior studies and lack of sex comparisons underscore the need for a more comprehensive characterization of the secondary ossification centers. This study evaluates the chronology and sex differences for appearance and closure of pelvic and proximal femoral secondary ossification centers using computed tomography (CT).Methods: Patients who underwent abdominal and pelvic CT scans between January 2009 and December 2014 at 2 tertiary level 1 trauma centers were retrospectively reviewed. Patients between the ages of 2 and 32 years with adequate imaging of the pelvis and proximal femurs were included. Patients with a history of orthopaedic trauma or pathology affecting ossification were excluded. CT scans were assessed for the appearance and closure of the following secondary ossification centers: anterior inferior iliac spine (AIIS), anterior superior iliac spine (ASIS), femoral head (FH), greater trochanter (GT), iliac crest (IC), ischial tuberosity (IT), lesser trochanter (LT), posterior superior iliac spine (PSIS), symphysis pubis (SP), and triradiate cartilage (TRC). Basic descriptive statistics are reported.Results: A total of 496 CT scans met inclusion criteria (240 males and 256 females). The order of appearance of the secondary ossification centers was: (male) GT, LT, AIIS, IT, ASIS, PSIS, IC, and SP; (female) GT, LT, IT, AIIS, PSIS, IC, ASIS, and SP. The order of closure was similar: (male) TRC, LT, FH, AIIS, GT, ASIS, PSIS, IT, IC, and SP; (female) LT, TRC, AIIS, FH, GT, ASIS, PSIS, IT, IC, and SP. Female ossification centers appeared similar to 1 to 2 years before males in all locations. Female ossification centers closed similar to 1 to 2 years before males in all locations except TRC, IC, and SP.Conclusions: The appearance and closure of the pelvis and proximal femur secondary ossification centers follow a predictable pattern of development, occurring slightly earlier in females than males. Knowledge of more precise ages of development and sex differences better characterize this complex skeletal development. Future studies may use secondary ossification centers to further evaluate skeletal maturity, assess pediatric pathology, and aid surgical management.