早期类风湿性腕关节炎造影诊断77例分析

作者对７７例可疑为早期类风湿性腕关节炎患者施行了腕关节造影，其Ｘ线征象是：（１）滑膜增厚，桡腕关节之桡侧面呈现多数大小不等的结节或皱褶样；（２）淋巴管显影，侧位相于掌侧面可见弯曲的细线样影像；（３）下尺桡关节充盈造影剂；（４）桡腕与腕间关节相交通；（５）腱鞘显影。本文还就影像征象形成的机理进行了探讨。     

早期类风湿性腕关节炎造影诊断7例分析

作者对７７种可疑为早期类风湿性腕关节炎患者施行了腕关节造影，其Ｘ线征象是：（１）滑膜增厚，桡腕关节之桡侧面呈现多数大小不等的结节或皱褶样；（２）淋巴管显影，侧位相于掌侧面可见弯曲的细线样影像；（３）下尺桡关节充盈造影剂；（４）桡腕与腕间关节相交通；（５）腱鞘显影。本文还就影像征象形成的机理进行了探讨。     

正常腕关节X线测量

正常腕关节Ｘ线测量朱建民金宗达陈新刚张庆宏某些腕关节及其周围病变和损伤可导致腕关节形态学改变，测量正常腕关节Ｘ线片有关参数有助于这些疾病和损伤的诊断和疗效的评定。笔者采用标准Ｘ线摄片技术，报告２００个（１００人）正常腕关节Ｘ线正、侧位片有关参数的测量...     

腕关节侧位X线摄影测量尺月间距评估尺骨长度变异

目的 探讨测量腕关节侧位X线摄影尺月间距，确定是否存在尺骨变异，并为确诊尺腕撞击综合征和判断手术预后提供依据。方法 选取患者年龄18～70岁，共82例标准体位腕关节X线摄影片。分别测量后前位桡尺间距和侧位尺月间距。依据后前位测量结果将患者分为三组：1）尺骨中性变异组（-1mm≤桡尺间距≤1mm）27例；2）尺骨正向变异组（桡尺间距>1mm）37例；3）尺骨负向变异组（桡尺间距<-1mm）18例。分别测量每组病例腕关节侧位片中尺骨头最远端平面和月骨最近端平面间距，并进行统计学分析。结果 尺骨中性变异组尺月间距0.00～1.60 mm，平均（0.68±0.44）mm；尺骨正向变异组尺月间距0.30～4.40 mm，平均（1.93±1.06）mm；尺骨负向变异组尺月间距-3.80～-0.70 mm，平均（-2.19±0.98）mm。三者间比较差异有统计学意义（F=131.63,P <0.001）。结论 腕关节侧位X线摄影片中尺月间距能准确判断尺骨变异，可以为尺腕撞击综合征诊断和尺骨短缩长度提供有效依据。     

三角骨骨折X线分型与损伤机理的探讨(附30例报告)

目的：从三角骨骨折的Ｘ线分型探讨其损伤机理。方法：回顾分析了腕关节损伤资料２００份，其中三角骨骨折３０例。结果：背侧撞击型２１例，掌侧撞击型５例，横折型３例，纵折型１例。结论：Ｘ线分型能从腕关节解剖、生物力学、三柱理论和伤势，揭示三角骨骨折常见的损伤机理     

腕关节造影的新进展

腕关节造影是手外科常用的诊断技术。它通过追踪和记录造影剂在关节内充盈流动情况，显示了Ｘ线平片所不能揭示的关节内软组织损伤。因而，已成为腕关节损伤、慢性腕关节疼痛患者的常规检查方法之一。近１０年来这项技术又有了新的进展。     

腕三角骨背侧骨折X线及多排螺旋CT表现

目的 分析腕三角骨背侧骨折的X线及多排螺旋CT表现,以提高对该病的认识和诊断.方法 回顾性分析6例资料完整的腕三角骨背侧骨折病例,并结合文献复习.6例均行X线检查,其中5例行多排螺旋CT检查.结果 6例腕关节X线正位片均不能明确显示腕三角背侧骨折,而腕关节侧位片均能显示骨折片,多排螺旋CT能显示腕三角骨骨皮质缺损及骨折片移位.结论 X线侧位片可显示三角骨背侧骨折片,多排螺旋CT检查是良好的诊断手段.     

腕高、腕高率和腕高指数的X线测量及其临床意义

腕高、腕高率和腕高指数是腕骨塌陷的定量指标，对于Ｋｉｅｎｂｏｃｋ’ｓ病、腕舟状骨骨折不连接、腕关节类风湿性关节炎、桡骨远端骨折和腕关节不稳等疾病的诊断和治疗均有重要的临床意义。其中腕高指数优于腕高率优于腕高。     

腕关节造影术（附31例分析）

腕关节三角纤维软骨盘损伤，过去很少引起注意，近十年来，我院对40例腕关节受伤，而X线平片显示骨质正常的病人进行了腕关节造影检查，其中造影成功，有完整的临床资料和X线照片者31例，现报告如下。     

腕肘关节左右斜位片在外伤诊断中的作用

腕肘关节斜位片在外伤诊断中起着重要作用。常规腕肘关节作X线检查时 ,一般是照正侧位片。腕关节、肘关节正侧位片如果没有明显骨折 ,大多数实际上是没有骨折的。但是也有例外 ,也就是腕肘关节正侧位片未能显示或者是未能清楚地显示骨折征 ,而其左右斜位片却更能清楚地显示骨折征。笔者曾见过 5例是通过加照腕肘关节左右斜位片时发现骨折征象的。病例 1,男 ,2 0岁。右腕关节被刀砍伤 ,活动受限 ,右腕关节正侧位片未见明显骨折 ,加拍右腕关节左右斜位片 ,发现右桡骨远端背内侧缘可见一个小游离骨碎片 ,约为半个米粒大小 ,为右桡骨远端撕裂性…     

四肢类风湿性关节炎MRI的诊断

目的：探讨四肢类风湿性关节炎的ＭＲＩ诊断价值。方法：回顾分析１６例４２ 个关节类风湿性关节炎ＭＲＩ表现及Ｘ线表现。结果：ＭＲＩ可以清楚显示四肢类风湿性关节炎的滑膜增生、软骨关节面破坏、骨性关节面侵蚀及骨内囊肿形成、韧带及关节囊增厚、腱鞘积液及关节变形等所造成的形态和信号改变。但ＭＲＩ在反映类风湿性关节炎的骨质疏松方面不如Ｘ线照片。结论：ＭＲＩ可较全面反映类风湿性关节炎的病理变化,有利于类风湿性关节炎诊断及鉴别诊断。     

高场强磁共振成像对类风湿关节炎的诊断价值

目的探讨高场强磁共振成像（MRI）在类风湿关节炎（RA）的早期诊断及活动性评估中的优越性。方法对我院2011年6月至2012年5月26例确诊为风湿性关节炎患者的双侧腕关节进行x线、CT、MRI检查,并对检查结果进行分析比较。结果所有26例患者的52个腕关节中具有骨侵蚀病灶,X线、CT、MRI的检出分别为：13、22、50个。在MRI表现中有骨侵蚀改变的50个关节中滑膜的厚度95％的可信区间为1．98～4．10mm,并通过对相关临床指标的统计学分析发现滑膜的厚度与RA患者的活动性有一定的联系。结论MRI在RA早期影像学诊断中具有非常重要的意义。在早期及活动期其敏感性优于x线和CT检查,MRI对RA的活动性评估有一定的价值。     

Computed tomography of the wrist

CT is a diagnostic tool that allows imaging of the wrist, wrist joint and distal radioulnar joint in the axial plane without superimposition. The differentiation of bone, joint space and soft tissue is possible in a single examination. This is helpful in the diagnosis of traumatic, degenerative or malignant lesions of bones together with the soft tissue reactions. Further information can be obtained by means of three-dimensional reconstructions.     

异位骨化的影像学表现（附7例分析）

目的探讨异位骨化的影像学表现。方法回顾性分析本院确诊的7例异位骨化患者影像学资料,总结异位骨化的影像学特征。结果异位骨化累及腕部1例,踝关节2例,膝关节3例,髋关节2例。X线平片上表现为软组织内的条状、片状或层状不规则骨化影,可伴有软组织肿胀;CT可清楚显示骨化区范围;骨化区在MRI T2WI均表现为低信号,周围可见片状高信号。结论异位骨化影像学表现具有一定特异性,掌握其特征性影像学表现并结合临床表现有助于对该病的诊断。     

Symptomatic fibrous lunato-triquetral coalition

In general, carpal coalitions are considered to be asymptomatic. Incomplete separated joints and associated changes similar to osteoarthritis and pseudoarthrosis are known as possible causes of wrist pain. We present the clinical history, plain-film, and MR imaging findings of two patients with symptomatic fibrous lunato-triquetral coalition. Conventional films disclosed a narrowed space between the lunate and triquetral bone with cysts and sclerosis similar to pseudoarthrosis. Magnetic resonance imaging showed bone marrow edema adjacent to the incomplete separated lunato-triquetral joint and Gd-DTPA enhancing fibrovascular tissue in the synovium and subarticular cysts, explaining the pain over the ulnar-sided wrist. Patients with congenital lunato-triquetral coalition may poorly tolerate stress loading or trauma, resulting in a symptomatic state similar to degenerative arthritis or pseudoarthrosis, which is demonstrated by enhanced MR imaging. Received: 17 June 1998; Revision received: 22 October 1998; Accepted: 27 October 1998     

螺旋CT三维重建对外伤性髋关节骨折的诊断和术前评估价值

目的 评估螺旋CT三维重建(3D-CT)在外伤性髋关节骨折的诊断价值及治疗对策.方法 回顾性分析26例外伤性髋关节损伤的X线片和螺旋CT三维重建等临床资料.结果 26例外伤性髋关节骨折中,11例复合型骨折经3D-CT检查证实X线片检查漏诊4例;合并股骨头脱位及骨折5例中3D-CT 发现X线片漏诊股骨头骨折2例.结论 3D-CT在外伤性髋关节损伤的诊断中,与普通的X线片和CT扫描相比,显示了其明显的优越性.     

Ultrasonography of hip joint effusions

In order to evaluate ultrasonography in patients with suspected hip joint effusions, 123 consecutive patients were examined prospectively. Twenty healthy subjects were used as a control group. The normal sonoanatomy, the recommended scanning approach, and the diagnostic features of intra-articular joint effusions are presented. Even minor fluid collections of 1 or 2 ml could be accurately detected. Transient synovitis and fresh hemorrhagic effusions proved to be echofree, whereas clotted hemorrhagic collections or septic arthritis showed non-echofree effusions. Based on intraoperative and computed tomography (CT) data, ultrasonography is clearly superior to X-ray films in detecting joint effusions. A negative sonogram will exclude a fluid collection; the depiction of an echofree effusion with virtually rule out septic arthritis. The use of additional imaging techniques can be reduced greatly, as ultrasonography seems to be an improved method for the early diagnosis of septic arthritis.     

Arthritic disorders of the adult radiocarpal joint: anatomic considerations and an evaluation of fifty consecutive abnormal cases.

The anatomy and pathology of the radiocarpal compartment of the adult wrist are described in a study of human cadavers and 50 consecutive patients with radiocarpal joint abnormalities. The most frequently encountered diseases were adult onset rheumatoid arthritis (42) and calcium pyrophosphate deposition disease (22%). Features allowing radiographic diagnosis included the degree of symmetry and the presence of demineralization, sclerosis, joint space narrowing, subchondral cysts and erosions. Evaluation of abnormalities in other compartments of the wrist and the ulnar styloid is mandatory.     

手舟状骨X线DR投照体位探讨

目的：探讨舟状骨显示较为理想的X线DR投照体位,提高平片对舟状骨骨折的诊断准确性,降低舟状骨骨折并发症的发生率。方法：选取健康志愿者2例（男女各1例）,分别对腕关节采用不同体位进行投照。根据舟状骨显示情况对投照体位进行评分,比较各投照体住对舟状骨的显示情况。另选取志愿者6例．进一步验证上述预实验所优化的投照体位。结果：舟状骨握拳尺偏位、旋前60°和旋后45°斜位片及侧位片可以从不同角度显示舟状骨。结论：舟状骨握拳尺偏位、旋前60°和旋后45°斜位片及侧位相结合是用于评价舟状骨骨折较为理想的X线投照体位。     

Magnetic resonance imaging of the wrist in early rheumatoid arthritis: a pictorial essay

This pictorial essay describes the changes seen in the wrist in early rheumatoid arthritis (RA) on MRI. Magnetic resonance imaging can demonstrate bone erosions, bone marrow signal changes, synovitis and tenosynovitis in early rheumatoid arthritis. Magnetic resonance imaging of the wrist can identify erosions in RA earlier than plain radiographs and can detect more erosions. Common sites include the capitate, lunate and scaphoid. Bone marrow signal changes occur frequently and are most common in the capitate, lunate and triquetrum. Synovial thickening and enhancement are clearly demonstrated with MRI and are most commonly seen in the radiocarpal joint (RCJ). Tenosynovitis can be seen in the wrist in more than half of patients presenting with RA. This most commonly involves the extensor carpi ulnaris tendon and is seen as sheath fluid, thickening and enhancement.