Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt.
South West Thames Trauma and Orthopaedics Training Program, London.
J Pediatr Orthop. 2020 Oct;40(9):e860-e872. doi: 10.1097/BPO.0000000000001584.
To investigate the geometric development of the wrist in relation to the changes in its ossification pattern. This study will help the treating surgeon to identify early deviations from normal in children with musculoskeletal disorders and provide a template for anatomic reduction after trauma scenarios.
A retrospective multicenter analysis was carried out of radiographs of 896 children (896 posteroanterior and 896 lateral views) with normal wrists from January 1996 till April 2016. We stratified patients into different yearly age groups; these included 16 age groups from 1 to 16 years, and 2 sex groups: males and females. We evaluated, depending on the wrist ossification pattern, the ulnar variance, radial and carpal heights, carpal height ratio, radial inclination, volar tilt, together with radiocarpal, scapholunate, and capitate-lunate angles and scapholunate distance.
Our analysis showed that the ulna minus variance predominates in children. Radial height, radial inclination, and radiocarpal angle increase steadily during growth and reach their respective expected values at the beginning of the pubertal growth spurt. The scapholunate and capitolunate angles showed a downward trend with growth till reaching the adult values at puberty. Carpal height increased constantly, whereas the carpal height ratio was similar to that in adults. Volar tilt was not developed until the age of 12 years, when it started to increase gradually to reach the adult values by puberty. Both sexes have similar measurements.
Most radiologic parameters showed reproducible anatomic changes till the 12-year-old time-point. After that, there are minimal changes till adulthood.
The study findings offer a template of pediatric normal values guiding hand and pediatric surgeons in treatment of children with wrist pathology.
研究腕关节的几何发育与骨化模式变化的关系。本研究将帮助治疗外科医生识别患有肌肉骨骼疾病的儿童中早期偏离正常的情况，并为创伤后解剖复位提供模板。
对 1996 年 1 月至 2016 年 4 月期间 896 名（896 张前后位和 896 张侧位）正常腕关节的儿童进行回顾性多中心分析。我们将患者分为不同的年龄组；包括 1 至 16 岁的 16 个年龄组和 2 个性别组：男性和女性。我们根据腕骨骨化模式评估尺侧差异、桡骨和腕骨高度、腕骨高度比、桡骨倾斜度、掌倾角，以及桡腕、舟月和头月角和舟月距离。
我们的分析表明，儿童中尺骨负差异占主导地位。桡骨高度、桡骨倾斜度和桡腕角在生长过程中稳步增加，在青春期生长突增开始时达到各自的预期值。舟月和头月角呈下降趋势，直到青春期达到成人值。腕骨高度持续增加，而腕骨高度比与成人相似。掌倾角直到 12 岁才开始发育，然后逐渐增加，直到青春期达到成人值。男女的测量值相似。
大多数影像学参数在 12 岁之前表现出可重复的解剖变化。之后，直到成年期变化很小。
该研究结果为儿科正常值模板提供了指导，帮助手部和儿科外科医生治疗腕部病理儿童。
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