Feldman K W, Brewer D K
Pediatrics. 1984 Mar;73(3):339-42.
Rib fractures have occasionally been described in children receiving cardiopulmonary resuscitation (CPR). Because child abuse is sometimes suspected in these cases, it is both medically and legally important to establish whether the rib fractures are secondary to abuse or CPR. One hundred thirteen children, including 41 victims of child abuse, 50 patients who had CPR, and 22 patients who had rib fractures, were studied. Twenty-nine patients had rib fractures; 14/29 (48%) were abusive. Other causes of fracture were: motor vehicle accidents (four), rickets/osteoporosis (five), surgery (five), and osteogenesis imperfecta (one). In spite of prolonged resuscitation performed with variable degrees of skill, no fractures could be attributed to CPR. On the other hand, rib fractures occurred frequently in abused children (6/41 or 15%). Abusive fractures were often multiple, of different ages, and affected multiple adjacent ribs. Patients with abusive rib fracture also had other physical and radiologic signs of abuse or neglect.
在接受心肺复苏术（CPR）的儿童中偶尔会出现肋骨骨折的情况。由于此类病例有时会被怀疑存在虐待儿童的行为，因此确定肋骨骨折是由虐待还是心肺复苏术所致，在医学和法律层面都至关重要。我们对113名儿童进行了研究，其中包括41名受虐儿童、50名接受过心肺复苏术的患者以及22名肋骨骨折患者。共有29名患者发生肋骨骨折；其中14/29（48%）是由虐待所致。骨折的其他原因包括：机动车事故（4例）、佝偻病/骨质疏松症（5例）、手术（5例）和成骨不全（1例）。尽管实施了不同熟练程度的长时间复苏，但没有骨折可归因于心肺复苏术。另一方面，肋骨骨折在受虐儿童中很常见（6/41或15%）。虐待导致的骨折通常是多发性的，年龄不同，且累及多根相邻肋骨。患有虐待性肋骨骨折的患者还存在其他身体和影像学虐待或忽视迹象。
