Kleinman P K, Marks S C
Department of Radiology, University of Massachusetts Medical Center, Worcester, MA 01655, USA.
AJR Am J Roentgenol. 1996 May;166(5):1207-12. doi: 10.2214/ajr.166.5.8615271.
The purpose of this study was to analyze systematically the spectrum of morphologic alterations of classic metaphyseal lesions (CML) involving the distal tibia of abused infants and to identify features that assist in the radiologic diagnosis and assessment of healing.
Thirty-one infants who died with evidence of inflicted injury were studied with high-detailed skeletal surveys, resected-specimen radiography, and histopathologic analysis. The number of fractures identified, the portions of the distal tibial metaphyses involved, and the age of the lesion were assessed.
A total of 16 CML of the distal tibia were noted. Eight infants had unilateral injury that always involved the left side, and four had bilateral lesions. When a CML was visible radiographically, it was always seen along the medial aspect of the metaphysis; lateral metaphyseal involvement was evident with more extensive injuries and always accompanied medial involvement. Fractures tended to be less conspicuous when acute and were more easily recognized with healing, especially with specimen radiography. Radiographically, the typical fracture separated a medial fragment that was tall and triangular; this appearance was histologically related to the undercutting of the long subperiosteal bone collar. In healing lesions, extension of hypertrophic chondrocytes from the growth plate into the region of the fracture was a consistent finding.
CML of the distal tibia have distinctive radiologic and histopathologic characteristics that relate to the anatomy of the region. Visualization of these fractures depends on the quality of the radiographs obtained. An understanding of the radiologic and histopathologic features of CML should aid in the recognition of this strong indicator of infant abuse.
本研究旨在系统分析累及受虐婴儿胫骨远端的经典干骺端病变（CML）的形态学改变谱，并确定有助于影像学诊断和愈合评估的特征。
对31例有受虐证据死亡的婴儿进行了高细节骨骼检查、切除标本X线摄影及组织病理学分析。评估所发现骨折的数量、胫骨远端干骺端受累部位及病变的年龄。
共发现16例胫骨远端CML。8例婴儿为单侧损伤，均累及左侧，4例为双侧病变。当CML在X线片上可见时，总是位于干骺端的内侧；外侧干骺端受累见于更广泛的损伤，且总是伴有内侧受累。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X线摄影。在X线片上，典型骨折分离出一个高而呈三角形的内侧碎片；这种表现与长骨骨膜下骨环的底切在组织学上相关。在愈合病变中，肥大软骨细胞从生长板延伸至骨折区域是一个一致的发现。
胫骨远端CML具有与该区域解剖结构相关的独特影像学和组织病理学特征。这些骨折的显示取决于所获得X线片的质量。了解CML的影像学和组织病理学特征应有助于识别这种婴儿受虐的有力指标。
