Kleinman P K, Marks S C
Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA.
AJR Am J Roentgenol. 1998 Jan;170(1):43-7. doi: 10.2214/ajr.170.1.9423596.
The purpose of this study was to analyze the spectrum of morphologic alterations of the classic metaphyseal lesion involving the distal femur of abused infants and to identify features that aid in 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 histologic analysis. We recorded the number of fractures, the portions of the distal femoral metaphyses involved, and the age of the lesions.
Fifteen classic metaphyseal lesions of the distal femur were seen in 11 infants. The lesions were bilateral in four infants and unilateral in seven. Nine healing and three acute classic metaphyseal lesions were found. In the remaining three lesions, the age of the lesions was indeterminate. Fractures always involved the posteromedial aspect of the femur; anterior and lateral extension occurred in more diffuse lesions. Fractures tended to be less conspicuous when they were acute and were more easily recognized 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 found in all nine healing lesions.
The classic metaphyseal lesion of the distal femur has distinctive radiologic and histopathologic characteristics that relate to the anatomy of the region. Because the distal femur 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.
本研究旨在分析涉及受虐婴儿股骨远端的经典干骺端病变的形态学改变谱，并确定有助于放射学诊断和愈合评估的特征。
对31例有骨骼受虐证据死亡的婴儿进行了高细节骨骼检查、切除标本X线摄影及组织学分析。我们记录了骨折数量、股骨远端干骺端受累部位及病变年龄。
11例婴儿中发现15处股骨远端经典干骺端病变。4例婴儿病变为双侧，7例为单侧。发现9处愈合期及3处急性期经典干骺端病变。其余3处病变的年龄无法确定。骨折总是累及股骨后内侧；在更弥漫性病变中出现向前和外侧延伸。骨折在急性期时往往不太明显，愈合时更容易识别，尤其是通过标本X线摄影。组织学上，骨折线始终从内侧骨膜下骨环下方穿过。在所有9处愈合期病变中均发现肥大软骨细胞从生长板延伸至骨折区域。
股骨远端经典干骺端病变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。由于股骨远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、高细节的骨骼X线片对该区域进行仔细评估。
