Kleinman P K, Blackbourne B D, Marks S C, Karellas A, Belanger P L
Department of Radiology, University of Massachusetts Medical Center, Worcester 01655.
N Engl J Med. 1989 Feb 23;320(8):507-11. doi: 10.1056/NEJM198902233200807.
In 1984 we started a two-year program in Worcester (Mass.) and Boston to provide additional radiologic data for the medical investigation of suspected fatal infant abuse. During that period the investigation of 12 cases of unexplained infant death included the review of complete radiographic skeletal surveys by a pediatric radiologist. Autopsies were supplemented with resection, high-detail radiography, and histologic study of all non-cranial sites of suspected osseous injury. Thirty-four bony injuries were noted, including 12 acute and 16 healing fractures of the long-bone metaphyses and posterior-rib arcs in patterns indicative of infant abuse. The investigations determined that there were eight cases of abuse, two accidental deaths, and two natural deaths (sudden infant death syndrome). At this writing, the radiologic and osseous histologic studies appear to have influenced the determination of the manner of death in six of the eight cases of abuse and the criminal prosecution in four of the five convictions. These findings suggest that a thorough postmortem radiologic evaluation followed by selected histologic studies can have an impact on the investigation and prosecution of cases of fatal infant abuse.
1984年，我们在马萨诸塞州的伍斯特市和波士顿启动了一项为期两年的项目，旨在为涉嫌致命性虐待婴儿的医学调查提供更多放射学数据。在此期间，对12例不明原因婴儿死亡案例的调查包括由一名儿科放射科医生对完整的骨骼X线检查进行复查。尸检还补充了对所有疑似骨损伤的非颅骨部位进行切除、高分辨率放射摄影以及组织学研究。共发现34处骨损伤，包括12处急性和16处愈合中的长骨干骺端及后肋弓骨折，其形态表明存在虐待婴儿的情况。调查确定有8例虐待案例、2例意外死亡和2例自然死亡（婴儿猝死综合征）。撰写本文时，放射学和骨组织学研究似乎对8例虐待案例中的6例死亡方式判定以及5例定罪案例中的4例刑事诉讼产生了影响。这些发现表明，全面的死后放射学评估及选定的组织学研究可对致命性虐待婴儿案例的调查和起诉产生影响。
