Pazzaglia Ugo Ernesto, Beluffi Giampiero, Benetti Anna, Bondioni Maria Pia, Zarattini Guido
Orthopaedic Clinic, University of Brescia, Brescia, Italy.
Fetal Pediatr Pathol. 2011;30(3):199-208. doi: 10.3109/15513815.2010.524693. Epub 2011 Feb 28.
Autoptic samples of human bones (from 8 weeks of gestation to 12 years of age) and a second group of serial, skeletal x-rays (required for pathologies not related to bone dysplasia in children from 4 months to 17 years of age) provided the material for the analysis of the physes normal growth mechanism presented in this review. Before the appearance of the ossification centers epiphyseal growth rests exclusively on chondrocytes proliferation (interstitial growth), without any detectable differentiated cellular organization. When endochondral ossification starts a defined spatial disposition of chondrocytes and a corresponding organization of the intercellular matrix is set up, so that it is possible to identify a growth vector corresponding to the columns of piled chondrocytes with direction from hypertrophic toward the proliferative cell layers. The complexity of the tubular bones growth process is well represented by the spatial arrangement of the growth vectors. In the late epiphyseal growth another mechanism is active in addition to endochondral ossification, namely, articular cartilage interstitial growth and subchondral remodelling. The knowledge of the normal mode of organization of the physis and its temporal sequence can help to better understand of the deviaton from the normal development of metaphyseal and epiphyseal dysplasias.
人体骨骼的尸检样本（来自妊娠8周龄至12岁的个体）以及另一组连续的骨骼X光片（针对4个月至17岁儿童中与骨发育异常无关的病症）为本次综述中骨骺正常生长机制的分析提供了材料。在骨化中心出现之前，骨骺生长完全依赖于软骨细胞增殖（间质生长），不存在任何可检测到的分化细胞组织。当软骨内成骨开始时，软骨细胞会形成特定的空间排列，细胞间基质也会相应组织化，从而能够识别出一个与堆积软骨细胞柱相对应的生长向量，其方向是从肥大细胞层指向增殖细胞层。管状骨生长过程的复杂性通过生长向量的空间排列得到了很好的体现。在骨骺生长后期，除了软骨内成骨外，另一种机制也在起作用，即关节软骨间质生长和软骨下重塑。了解骨骺正常的组织模式及其时间顺序有助于更好地理解干骺端和骨骺发育异常与正常发育的偏差。
