Nguyen Jie C, Markhardt B Keegan, Merrow Arnold C, Dwek Jerry R
From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.C.N., B.K.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (A.C.M.); and Department of Radiology, University of California at San Diego, Rady Children's Hospital and Health Center, San Diego, Calif (J.R.D.).
Radiographics. 2017 Oct;37(6):1791-1812. doi: 10.1148/rg.2017170029.
The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction. Direct growth plate insults occur most commonly with Salter-Harris fractures, and injuries that allow the transphyseal communication of vessels are at a higher risk for subsequent transphyseal bone bridge formation. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal blood supply is compromised. Epiphyseal osteonecrosis can result in slowed longitudinal bone growth, with possible growth plate closure, and is often accompanied by an abnormal secondary ossification center. In contrast, the disruption of metaphyseal blood supply alters endochondral ossification and allows the persistence of chondrocytes within the metaphysis, which appear as focal or diffuse growth plate widening. Imaging remains critical for detecting acute injuries and identifying subsequent growth disturbances. Depending on the imaging findings and patient factors, these growth disturbances may be amenable to conservative or surgical treatment. Therefore, an understanding of the anatomy and physiologic features of the normal growth plate and the associated pathophysiologic conditions can increase diagnostic accuracy, enable radiologists to anticipate future growth disturbances, and ensure optimal imaging, with the ultimate goal of timely and appropriate intervention. RSNA, 2017.
生长板，即骨骺板，在几乎所有骨骼未成熟儿童的影像中都可见。这些生长板的正常功能取决于软骨细胞增殖与软骨细胞死亡之间的复杂平衡，软骨细胞增殖需要来自骨骺血管的滋养，而软骨细胞死亡则需要干骺端血管的完整性。因此，生长板损伤（即直接损伤）或生长板两侧的血管受损（即间接损伤）均可导致生长板功能障碍。直接的生长板损伤最常见于Salter-Harris骨折，而那些允许血管经骨骺板沟通的损伤，后续发生骨骺板骨桥形成的风险更高。间接损伤会导致不同的后遗症，这取决于骨骺血供或干骺端血供是否受损。骨骺缺血性坏死可导致纵向骨生长减缓，并可能伴有生长板闭合，且常伴有异常的次级骨化中心。相比之下，干骺端血供中断会改变软骨内成骨，并使干骺端内的软骨细胞持续存在，表现为局部或弥漫性生长板增宽。影像学检查对于检测急性损伤和识别后续生长紊乱仍然至关重要。根据影像学表现和患者因素，这些生长紊乱可能适合保守治疗或手术治疗。因此，了解正常生长板的解剖结构和生理特征以及相关的病理生理状况，可以提高诊断准确性，使放射科医生能够预测未来的生长紊乱，并确保最佳的影像学检查，最终目标是及时进行适当的干预。RSNA，2017年。
