Kleinman P K, Marks S C, Nimkin K, Rayder S M, Kessler S C
Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA.
Radiology. 1996 Sep;200(3):807-10. doi: 10.1148/radiology.200.3.8756936.
To examine the morphologic alterations of fractures of the lateral and anterior rib arcs and costochondral junction (CCJ) to better understand the factors that influence radiographic visualization and to gain insight into the mechanism of injury in rib fractures of abused infants.
Thirty-one infants (average age, 3 months) who died with inflicted skeletal injuries were studied with high-detail, pre- or postmortem skeletal surveys, or both, and radiography of specimens, with histologic analysis. The distribution and number of fractures were determined for each technique, and dating was performed on the basis of radiographic and histologic criteria. The radiologic features were correlated with the pathologic findings in comparable histologic sections.
Of 165 fractures, 84 (51%) involved the ribs. Only 30 rib fractures (36%) were visible with skeletal survey examination. Lateral and anterior arc fractures tended to impact along the inner cortex of the rib. CCJ fractures tended to involve the inner aspect of the osteochondral interface with an associated osseous fragment.
Acute and healing rib fractures are common in infants who died with inflicted injury; detection is technique-dependent. Use of high-detail skeletal radiography to identify these injuries in live and deceased infants appears justified.
研究外侧和前侧肋骨弓及肋软骨连接部（CCJ）骨折的形态学改变，以更好地理解影响影像学显示的因素，并深入了解受虐婴儿肋骨骨折的损伤机制。
对31例因遭受骨骼损伤死亡的婴儿（平均年龄3个月）进行了高分辨率的生前或死后骨骼检查，或两者兼用，并对标本进行了放射摄影及组织学分析。确定每种技术下骨折的分布和数量，并根据放射学和组织学标准进行年代测定。将放射学特征与可比组织学切片中的病理学发现进行关联。
在165处骨折中，84处（51%）累及肋骨。骨骼检查仅发现30处肋骨骨折（36%）。外侧和前侧弓骨折倾向于沿肋骨内皮质撞击。CCJ骨折倾向于累及骨软骨界面的内侧并伴有骨碎片。
急性和愈合中的肋骨骨折在因受虐死亡的婴儿中很常见；其检测依赖于技术。使用高分辨率骨骼放射摄影来识别活婴和死婴中的这些损伤似乎是合理的。
