Institute of Legal Medicine, Münster University Hospital, Röntgenstraße 23, 48149 Münster, Germany.
Int J Legal Med. 2013 May;127(3):691-8. doi: 10.1007/s00414-013-0845-4. Epub 2013 Mar 13.
Until final completion of maturation processes at the age of approximately 18 years, determination of the skeletal age of the hand plays a central role in forensic age diagnostics in living persons in criminal proceedings. In this process, assessment of hand radiographs relies primarily on the stage of development of the epiphyseal nuclei, the increase in size of the individual bones and of the hand skeleton as a whole, changes in the shape of the various skeletal elements and ossification of the epiphyseal plates. To achieve this, there are a variety of methodological approaches based on two different fundamental principles. The methods proposed by Greulich and Pyle, Thiemann et al. and Gilsanz and Ratib rank among the so-called atlas techniques, whilst the methods proposed by Tanner et al. and Roche et al. are classified as so-called bone-specific techniques. In order to be applicable in the field of criminal procedure, the methods of estimating the skeletal age of the hand developed with clinical aspects in mind must satisfy the demands of a high degree of estimate accuracy and good reproducibility of the estimated results. In the course of the present study, a study population of 92 persons was used to compare the above-mentioned atlas and bone-specific techniques for determining hand skeleton age in view of these qualitative criteria. Estimate accuracy was studied using Pearson's correlation coefficients, and weighted kappa coefficients were determined for studying the intra-and interobserver agreement of an estimate result. In the inter-method comparison, a basically good agreement was shown between the skeletal ages and the chronological age of the test persons on the one hand and the skeletal age diagnoses of one or of two examiners on the other. No general advantage of the methodological approach of the bone-specific technique was discernible in the course of comparison; in the female gender, particularly, the RUS2 and RUS3 score of the method of Tanner et al. proved unfavourable. For age estimation practice in criminal proceedings, the atlas methods of Greulich and Pyle and Thiemann et al. are particularly recommendable.
在大约 18 岁时完成成熟过程之前，手部骨骼年龄的确定在刑事诉讼中对活体进行法医年龄诊断中起着核心作用。在此过程中，对手部 X 光片的评估主要依赖于骺核的发育阶段、各个骨骼的大小以及手部骨骼的整体大小、各种骨骼元素形状的变化以及骺板的骨化。为此，有多种基于两种不同基本原则的方法方法。Greulich 和 Pyle、Thiemann 等人以及 Gilsanz 和 Ratib 提出的方法属于所谓的图谱技术，而 Tanner 等人以及 Roche 等人提出的方法则属于所谓的骨特异性技术。为了在刑事诉讼领域中适用，基于临床方面开发的手部骨骼年龄估算方法必须满足高度估算准确性和估算结果良好可重复性的要求。在本研究中，使用 92 人的研究人群，根据这些定性标准，比较了上述图谱和骨特异性技术对手部骨骼年龄的确定。使用 Pearson 相关系数研究了估计准确性，并确定了加权 Kappa 系数，以研究估计结果的观察者内和观察者间一致性。在方法间比较中，一方面测试人员的骨骼年龄和实际年龄与一名或两名检查者的骨骼年龄诊断之间，另一方面骨骼年龄和实际年龄之间，显示出基本良好的一致性。在比较过程中，没有发现骨特异性技术方法的方法具有普遍优势；尤其是在女性中，Tanner 等人方法的 RUS2 和 RUS3 评分结果不利。对于刑事诉讼中的年龄估计实践，Greulich 和 Pyle 以及 Thiemann 等人的图谱方法特别值得推荐。
