Goodwin S J, Irwin L J, Irwin G J
1 Consultant Paediatric Radiologist, Department of Radiology, Royal Hospital for Children, Glasgow, UK.
2 Medical Student, University of Aberdeen, UK.
Scott Med J. 2019 Feb;64(1):2-9. doi: 10.1177/0036933018812000. Epub 2018 Nov 14.
The predictable order of appearance of elbow secondary ossification centres in children is important in interpreting elbow radiographs, most commonly in the context of trauma. The usual sequence of appearance of these ossification centres is given by the acronym CRITOL, but exceptions have been described and are recognised as normal variants.
To investigate the extent to which the appearance of the elbow secondary ossification centres follows a predictable sequence, and to establish the incidence of exceptions to the usual CRITOL order.
Two-stage retrospective review of 421 elbow radiographs in children at our centre.
Of 64 children with two visible ossification centres, there was a 23% overall variant incidence (49 CR, 15 CI). Twenty-eight children had four visible ossification centres, with an overall variant incidence of 32% (19 CRIT, 9 CRIO). The variants were significantly more common in girls than in boys ( p < 0.001).
Whilst the majority of radiographs remained consistent with the described CRITOL sequence, variance in this order was seen in a quarter of children with two visible ossification centres, and a third of children with four visible ossification centres. Incidence of variance was much more common in girls, reaching statistical significance. Awareness of these normal variations, particularly in girls, should help to avoid misinterpretation.
儿童肘部继发骨化中心出现的可预测顺序对于解读肘部X线片很重要，最常见于创伤情况下。这些骨化中心出现的通常顺序由首字母缩写CRITOL表示，但也有例外情况被描述并被视为正常变异。
研究肘部继发骨化中心的出现遵循可预测顺序的程度，并确定偏离通常CRITOL顺序的例外情况的发生率。
对本中心421例儿童肘部X线片进行两阶段回顾性研究。
在64例有两个可见骨化中心的儿童中，总体变异发生率为23%（49例CR，15例CI）。28例儿童有四个可见骨化中心，总体变异发生率为32%（19例CRIT，9例CRIO）。变异在女孩中比在男孩中更常见（p < 0.001）。
虽然大多数X线片与所描述的CRITOL顺序一致，但在有两个可见骨化中心的儿童中有四分之一，以及有四个可见骨化中心的儿童中有三分之一出现了顺序变异。变异发生率在女孩中更为常见，具有统计学意义。了解这些正常变异，尤其是女孩中的变异，应有助于避免误诊。
