Kleinman P K, Marks S C, Blackbourne B
AJR Am J Roentgenol. 1986 May;146(5):895-905. doi: 10.2214/ajr.146.5.895.
The metaphyseal lesions in abused infants have highly distinctive radiologic characteristics. The so-called "bucket-handle" and "corner" fractures often form the basis for the diagnosis of abuse. However, despite the great familiarity with the radiologic appearances, no systematic histopathologic study of the metaphyseal lesions in abused infants has been carried out. An in-depth study of pre- and postmortem radiologic features combined with histologic analyses of the metaphyses from a group of four abused infants provides new insights into the nature of these peculiar lesions. The basic histologic alteration is a subepiphyseal planar series of microfractures through the most immature portion of metaphyseal bone. This fracture results in the isolation of a mineralized disc or portion of a disc that is identifiable radiographically. Depending upon the size of the injury, the degree of involvement of the periphery of the bone, and the radiographic projection, a bucket-handle lesion, corner fracture, or metaphyseal lucency will result. In some cases, the radiographs may be normal even though there is significant histologic alteration. Although cartilaginous injuries may play a role in infant abuse, none of the specimens examined in this study evidenced injury through the germinal layers of cartilage. On the basis of the findings described here, it is recommended that postmortem analysis of all radiographically suspicious metaphyses be carried out in cases of suspected infant homicide. If there are other clinical or pathologic indications to support abuse, a strong argument can be made for removal of radiologically normal but high-risk metaphyses. Instituting these procedures will require closer cooperation between the radiologist and the medical examiner, but the potential for reducing the number of infant homicides demands this enlightened approach.
受虐婴儿的干骺端病变具有高度独特的放射学特征。所谓的“桶柄样”和“角状”骨折常成为虐待诊断的依据。然而，尽管对这些放射学表现非常熟悉，但尚未对受虐婴儿的干骺端病变进行系统的组织病理学研究。对一组4名受虐婴儿的生前和死后放射学特征进行深入研究，并结合干骺端的组织学分析，为这些特殊病变的本质提供了新的见解。基本的组织学改变是通过干骺端骨最不成熟部分的骨骺下平面系列微骨折。这种骨折导致一个矿化盘或盘的一部分分离，在放射学上可识别。根据损伤的大小、骨周边的受累程度和放射学投照，会导致桶柄样病变、角状骨折或干骺端透亮区。在某些情况下，尽管有明显的组织学改变，但X线片可能正常。虽然软骨损伤可能在婴儿虐待中起作用，但本研究中检查的所有标本均未显示通过软骨生发层的损伤。基于此处描述的发现，建议在疑似婴儿 homicide 案件中对所有放射学可疑的干骺端进行死后分析。如果有其他临床或病理学指征支持虐待，则有充分理由切除放射学正常但高危的干骺端。实施这些程序将需要放射科医生和法医之间更密切的合作，但减少婴儿 homicide 数量的潜力需要这种明智的方法。 （注：原文中“homicide”根据语境推测可能是“虐待致死”之类意思，但单独这个词不好准确翻译，结合整体语境这样处理更合适些。）
