Wootton-Gorges Sandra L, Stein-Wexler Rebecca, Walton John W, Rosas Angela J, Coulter Kevin P, Rogers Kristen K
Department of Radiology, University of California, Davis Medical Center and UC Davis Children's Hospital, 4860 Y Street, Sacramento, CA 95817, USA.
Child Abuse Negl. 2008 Jun;32(6):659-63. doi: 10.1016/j.chiabu.2007.06.011. Epub 2008 Jun 17.
Chest radiographs (CXR) are the standard method for evaluating rib fractures in abused infants. Computed tomography (CT) is a sensitive method to detect rib fractures. The purpose of this study was to compare CT and CXR in the evaluation of rib fractures in abused infants.
This retrospective study included all 12 abused infants identified from 1999 to 2004 who had rib fractures and both CXR and CT (8 abdomen CTs, 4 chest CTs). CT exams had been performed for clinical indications, and were obtained within one day of the CXR. Studies were reviewed by two pediatric radiologists to determine the number, locations, and approximate ages of the rib fractures. A total of 225 ribs were completely (192) or partially (33) seen by CT, and the matched ribs on CXR were used for the analysis.
The mean patient age was 2.5 months (1.2-5.6), with seven females and five males. While 131 fractures were visualized by CT, only 79 were seen by CXR (p<.001). One patient had fractures only seen by CT. There were significantly (p<.05) more early subacute (24 vs. 4), subacute (47 vs. 26), and old fractures (4 vs. 0) seen by CT than by CXR. Anterior (42 vs. 11), anterolateral (21 vs. 12), posterolateral (9 vs. 3) and posterior (39 vs. 24) fractures were better seen by CT than by CXR (p<.01). Bilateral fractures were detected more often by CT (11) than by CXR (6).
While this study group is small, these findings suggest that CT is better than CXR in visualizing rib fractures in abused infants.
胸部X线片（CXR）是评估受虐婴儿肋骨骨折的标准方法。计算机断层扫描（CT）是检测肋骨骨折的敏感方法。本研究的目的是比较CT和CXR在评估受虐婴儿肋骨骨折中的作用。
这项回顾性研究纳入了1999年至2004年间确诊的所有12例受虐且伴有肋骨骨折的婴儿，这些婴儿均接受了CXR和CT检查（8例腹部CT，4例胸部CT）。CT检查是根据临床指征进行的，且在CXR检查后一天内完成。两名儿科放射科医生对研究进行了评估，以确定肋骨骨折的数量、位置和大致年龄。CT共完整显示了192根肋骨，部分显示了33根肋骨，共225根，将CXR上对应的肋骨用于分析。
患者平均年龄为2.5个月（1.2 - 5.6个月），其中7名女性，5名男性。CT显示了131处骨折，而CXR仅显示了79处骨折（p <.001）。1例患者的骨折仅在CT上可见。CT显示的早期亚急性骨折（24处对4处）、亚急性骨折（47处对26处）和陈旧性骨折（4处对0处）明显多于CXR（p <.05）。CT对前侧（42处对11处）、前外侧（21处对12处）、后外侧（9处对3处）和后侧（39处对24处）骨折的显示优于CXR（p <.01）。CT检测到双侧骨折的情况（11例）比CXR（6例）更常见。
虽然本研究组规模较小，但这些发现表明，在显示受虐婴儿的肋骨骨折方面，CT优于CXR。
