Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
AJR Am J Roentgenol. 2011 Oct;197(4):1005-8. doi: 10.2214/AJR.11.6540.
The purpose of this article is to determine the relative likelihood of encountering a classic metaphyseal lesion in infants at low and high risk for abuse.
This 10-year retrospective study compared the prevalence of the classic metaphyseal lesion on high-detail American College of Radiology-standardized skeletal surveys in infants at low and high risk for abuse. Low-risk infants met all of the following criteria: skull fracture without significant intracranial injury on CT, history of a fall, and no other social risk factors for abuse. High-risk infants met all of the following criteria: significant intracranial injury, retinal hemorrhages, and skeletal injuries (excluding classic metaphyseal lesions and skull fractures). Differences between the two groups were calculated using the Fisher exact test.
There were 42 low-risk infants (age range, 0.4-12 months; mean age, 4.4 months) and 18 high-risk infants (age range, 0.8-10.3 months; mean age, 4.6 months). At least one classic metaphyseal lesion was identified in nine infants (50%) in the high-risk category. No classic metaphyseal lesions were identified in the low-risk group. The relative prevalence of classic metaphyseal lesions in the low-risk group (0/42) versus that in the high-risk group (9/18) was statistically significant (p < 0.0001; 95% CI, 0-8% to 29-76%).
Classic metaphyseal lesions are commonly encountered in infants at high risk for abuse and are rare in infants with skull fractures associated with falls, but no other risk factors. The findings support the view that the classic metaphyseal lesion is a high-specificity indicator of infant abuse.
本文旨在确定在低风险和高风险受虐待婴儿中，经典干骺端病变的相对可能性。
这项为期 10 年的回顾性研究比较了低风险和高风险受虐待婴儿的高细节美国放射学院标准化骨骼调查中经典干骺端病变的患病率。低风险婴儿符合以下所有标准：CT 无明显颅内损伤的颅骨骨折、有跌倒史且无其他虐待社会风险因素。高风险婴儿符合以下所有标准：严重颅内损伤、视网膜出血和骨骼损伤（不包括经典干骺端病变和颅骨骨折）。使用 Fisher 确切检验计算两组之间的差异。
共有 42 名低风险婴儿（年龄范围 0.4-12 个月；平均年龄 4.4 个月）和 18 名高风险婴儿（年龄范围 0.8-10.3 个月；平均年龄 4.6 个月）。在高风险组中，有 9 名婴儿（50%）至少有一个经典干骺端病变。在低风险组中未发现经典干骺端病变。低风险组（0/42）与高风险组（9/18）中经典干骺端病变的相对患病率具有统计学意义（p<0.0001；95%CI，0-8%至 29-76%）。
经典干骺端病变在高风险受虐待婴儿中很常见，而在与跌倒相关的颅骨骨折但无其他风险因素的婴儿中则很少见。这些发现支持经典干骺端病变是婴儿虐待的高特异性指标的观点。
