1 Clinical Radiologists, SC, 1120 Williams Blvd, Springfield, IL 62704.
AJR Am J Roentgenol. 2014 Jan;202(1):185-96. doi: 10.2214/AJR.13.10540.
The purpose of this study was to review the hypothesis that classic metaphyseal lesions represent traumatic changes in abused infants and compare these lesions with healing rickets.
Using a PubMed search, a multidisciplinary team reviewed studies that reported the histopathologic correlation of classic metaphyseal lesions. Selective studies of growth plate injury and rickets were cross-referenced.
Nine identified classic metaphyseal lesion studies were performed by the same principal investigator. Control subjects were inadequate. Details of abuse determination and metabolic bone disease exclusion were lacking. The presence of only a single radiology reviewer prevented establishment of interobserver variability. Microscopy was performed by two researchers who were not pathologists. Classic metaphyseal lesions have not been experimentally reproduced and are unrecognized in the accidental trauma literature. The proposed primary spongiosa location is inconsistent with the variable radiographic appearances. Classic metaphyseal lesions were not differentiated from tissue processing artifacts. Bleeding and callus were uncommon in spite of the vascular nature of the metaphysis. The conclusion that excessive hypertrophic chondrocytes secondary to vascular disruption were indicative of fracture healing contradicts the paucity of bleeding, callus, and periosteal reaction. Several similarities exist between classic metaphyseal lesions and healing rickets, including excessive hypertrophic chondrocytes. "Bucket-handle" and "corner fracture" classic metaphyseal lesions resemble healing rickets within the growth plate and the perichondrial ring, respectively. The age of presentation was more typical of bone fragility disorders, including rickets, than reported in prior child abuse series.
The hypothesis that classic metaphyseal lesions are secondary to child abuse is poorly supported. Their histologic and radiographic features are similar to healing infantile rickets. Until classic metaphyseal lesions are experimentally replicated and independently validated, their traumatic origin remains unsubstantiated.
本研究旨在回顾经典干骺端病变代表受虐婴儿创伤性改变的假说，并将这些病变与愈合性佝偻病进行比较。
使用 PubMed 搜索，一个多学科团队回顾了报告经典干骺端病变组织病理学相关性的研究。交叉参考了生长板损伤和佝偻病的选择性研究。
确定了 9 项经典干骺端病变研究，均由同一位主要研究者进行。对照组不足。虐待确定和代谢性骨病排除的细节缺乏。仅有一位放射科审查员的存在阻止了观察者间变异性的建立。显微镜检查由两位非病理学家进行。经典干骺端病变尚未通过实验再现，在意外创伤文献中也未被识别。所提出的初级松质骨位置与可变的放射学表现不一致。经典干骺端病变与组织处理伪影无法区分。尽管干骺端具有血管性质，但出血和骨痂并不常见。血管破坏导致过度肥大的软骨细胞是骨折愈合的指标，这与出血、骨痂和骨膜反应的缺乏相矛盾。经典干骺端病变与愈合性佝偻病之间存在几个相似之处，包括过度肥大的软骨细胞。“桶柄”和“角骨折”经典干骺端病变分别类似于生长板内和软骨膜环内的愈合性佝偻病。发病年龄更典型的是佝偻病等骨脆弱性疾病，而不是之前报道的儿童虐待系列。
经典干骺端病变继发于儿童虐待的假说证据不足。它们的组织学和影像学特征与婴儿愈合性佝偻病相似。在经典干骺端病变通过实验复制并独立验证之前，其创伤性起源仍然没有得到证实。
