Kleinman P K, Marks S C, Spevak M R, Belanger P L, Richmond J M
Department of Radiology, University of Massachusetts Medical Center, Worcester 01655.
AJR Am J Roentgenol. 1991 Apr;156(4):775-9. doi: 10.2214/ajr.156.4.2003445.
The present study was carried out to determine if healing metaphyseal injury in abused infants is accompanied by an increase in the thickness of the growth-plate zone of hypertrophic cartilage and if a radiolucent extension from the growth plate into the metaphysis correlates with this histologic indicator of healing fracture. The radiologic studies of 13 infants who died with evidence of inflicted injury were reviewed. Thirteen distal metaphyseal fractures were identified. Histologically, nine of these fractures were noted to be healing and four showed no evidence of healing. The nine healing injuries were accompanied by statistically significant thickening of the zone of hypertrophic cartilage. Seven of these demonstrated localized areas of hypertrophic cartilage extension; in six of these, corresponding radiolucent extensions of the growth plate into the metaphysis were seen. The extensions tended to be single and focal with minimal osseous injury and broad and multiple with extensive injury. No similar extension was visible in the four acute injuries. Because metaphyseal injuries are notoriously difficult to date, the presence of a reliable radiologic indicator of healing metaphyseal fracture can be important in the evaluation of infant abuse. Because the radiologic findings reflect the histologic alterations, extension of the growth-plate cartilage into the metaphysis may have implications for estimating fracture age.
本研究旨在确定受虐婴儿干骺端损伤愈合时，肥大软骨生长板区域的厚度是否会增加，以及从生长板向干骺端的透亮延伸是否与骨折愈合的这一组织学指标相关。回顾了13例有受虐证据死亡婴儿的影像学研究。共发现13例远端干骺端骨折。组织学上，其中9例骨折显示正在愈合，4例无愈合迹象。9例愈合损伤伴有肥大软骨区域有统计学意义的增厚。其中7例显示肥大软骨有局部延伸区域；其中6例可见生长板向干骺端相应的透亮延伸。这些延伸往往是单一且局限的，骨损伤最小，而在广泛损伤时则是广泛且多发的。在4例急性损伤中未见到类似的延伸。由于干骺端损伤的时间很难确定，因此在评估婴儿虐待时，存在可靠的干骺端骨折愈合影像学指标可能很重要。由于影像学表现反映了组织学改变，生长板软骨向干骺端的延伸可能对估计骨折年龄有影响。
