Kleinman P K, Marks S C
Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA.
AJR Am J Roentgenol. 1996 Feb;166(2):421-6. doi: 10.2214/ajr.166.2.8553960.
The purpose of this study was to systematically analyze the spectrum of morphologic alterations of the classic metaphyseal lesion (CML) involving the proximal tibia of abused infants and to identify features that aid in the radiologic diagnosis and assessment of healing.
Thirty-one infants who died with evidence of inflicted skeletal injury were studied with high-detail skeletal surveys, resected specimen radiography, and histopathologic analysis. The number of fractures identified, the portions of the proximal tibial metaphyses involved, and the age of the lesions were assessed.
Seventeen proximal tibial CMLs were noted. They were bilateral in six instances and unilateral in five. When the lesion was visible radiographically, it always involved the medial aspect of the metaphysis, with involvement of the lateral metaphyseal margin in more extensive injuries. Fractures tended to be less conspicuous when acute and were more easily recognizable with healing, especially with specimen radiography. Histologically, the fracture line consistently undercut the medial subperiosteal bone collar. Extension of hypertrophic chondrocytes from the growth plate into the region of fracture was a common finding.
The CML of the proximal tibia has distinctive radiologic and histopathologic characteristics that relate to the anatomy of the region. Because the proximal tibia is a common site for this strong indicator of infant abuse, the region should be carefully evaluated with well-collimated, high-detail skeletal radiographs in all cases of suspected infant abuse.
本研究旨在系统分析累及受虐婴儿胫骨近端的经典干骺端病变（CML）的形态学改变谱，并确定有助于放射学诊断及愈合评估的特征。
对31例有骨骼受虐证据的死亡婴儿进行了高细节骨骼检查、切除标本放射摄影及组织病理学分析。评估所发现骨折的数量、胫骨近端干骺端受累部分及病变的年龄。
共发现17例胫骨近端CML。其中6例为双侧，5例为单侧。当病变在放射影像上可见时，总是累及干骺端的内侧，在更广泛的损伤中，外侧干骺端边缘也会受累。骨折在急性期往往不太明显，愈合时更容易识别，尤其是通过标本放射摄影。组织学上，骨折线始终位于内侧骨膜下骨皮质下方。肥大软骨细胞从生长板延伸至骨折区域是常见表现。
胫骨近端CML具有与该区域解剖结构相关的独特放射学和组织病理学特征。由于胫骨近端是婴儿受虐这一有力指标的常见部位，在所有疑似婴儿受虐病例中，均应使用准直良好的高细节骨骼X线片对该区域进行仔细评估。
