不典型月骨周围脱位的影像表现及鉴别

目的：总结不典型月骨周围脱位影像特点及与相关骨折脱位的鉴别要点。方法本组16例不典型月骨周围脱位均摄有腕关节正侧位片,5例同时行64排CT扫描及重建,仔细观察分析每一病例的影像表现及特点。结果本组16例均为不典型月骨周围后脱位,伴不同程度月骨向前半脱位。单纯不典型月骨周围后脱位10例,其中同时伴舟骨后脱位3例,半脱位2例,无脱位5例,舟骨无脱位病例中,1例正位头舟间隙明显增宽;经舟骨不典型月骨周围脱位6例,除月骨向前半脱位外,舟骨骨折近段亦随月骨向前半脱位。结论单纯不典型月骨周围后脱位均伴有不同程度月骨向前半脱位,可伴或不伴舟骨后脱位;经舟骨不典型月骨周围后脱位,月骨及骨折近段同时向前半脱位。     

腕头月关节脱位的X线平片和CT表现

目的 分析头月关节脱位的X线平片和CT表现,提高对本病的认识和诊断水平.方法 回顾性分析24例头月关节脱位患者的X线平片及CT薄层扫描、多平面重组(MPR)和容积再现技术(VRT)表现,总结不同影像学检查方法的应用价值.结果 24例患者中,月骨脱位2例,月骨周围后脱位22例,其中不伴有腕舟骨骨折的单纯月骨周围后脱位18例,经舟骨月骨周围后脱位4例;合并尺桡骨远端骨折4例7处,合并腕骨撕脱性骨折6例7处.X线平片准确诊断月骨脱位2例、单纯月骨周围后脱位16例、经舟骨月骨周围后脱位2例,漏诊单纯月骨周围后脱位2例、经舟骨月骨周围后脱位1例,误诊经舟骨月骨周围后脱位1例,漏诊腕骨撕脱性骨折4例5处.CT薄层扫描结合重建技术全部准确显示脱位及骨折(100%).结论 CT薄层扫描及重建技术对显示头月关节脱位更优于X线平片.     

经舟骨月骨周围脱位27例影像资料回顾

<正>经舟骨月骨周围脱位是腕部最严重的一种损伤,占腕部损伤的3%～5%,若得不到早期治疗,将对腕关节功能造成较大影响[1],因此,有必要加深对此病的认识,减少漏诊、误诊。1资料与方法回顾性分析我院诊治的经舟骨月骨周围脱位患者27例,其中男21例,女6例,年龄20～54岁。8例摄腕关节普     

腕骨脱位的X线平片及40层螺旋CT诊断比较

目的 探讨腕骨脱位X线平片及多层螺旋CT的影像学表现,并对两者的检出情况进行比较,以提高对腕骨脱位的诊断水平,减少漏诊误诊.资料与方法对2006年8月-2009年11月共21例腕骨脱位病人的X线平片、多层螺旋CT薄层扫描及容积再现(VR)三维重组和多平面重组(MPR)影像进行回顾性分析.其中男19例,女2例,年龄19~45岁,平均(31±7)岁.腕骨脱位位于左侧14例,右侧7例.结果 月骨脱位8例;月骨周围型脱位13例,其中,单纯月骨周围型脱位3例,经舟状骨月骨周围脱位4例,经舟状骨、三角骨月骨周围脱位1例,经三角骨月骨周围脱位3例,经桡骨茎突月骨周围性脱位2例.在伴有其他腕骨骨折的病例中,桡骨茎突及舟骨骨折于X线平片均得到确诊,而3例合并三角骨骨折的病例在X线平片上或不能显示骨折,或显示骨折片但不能确定具体部位.运用螺旋CT薄层扫描及重组后均做出了正确诊断.结论 X线平片对于腕骨脱位大多可以做出正确诊断,但当合并腕骨骨折,特别是细微骨折时,漏诊率较高,多层螺旋CT的MPR、VR技术可全面、准确地显示腕骨脱位及合并骨折情况,具有较高的临床应用价值.     

经舟骨月骨周围脱位治疗的研究进展

经舟骨月骨周围脱位（trans—scaphoid perilunar dislocation,TSPD）是指合并有舟骨骨折的月骨周围脱位,舟骨近端骨折块和月骨与桡骨远端关节面关系正常,而远端骨折块和其他腕骨一起发生脱位,可分为背侧脱位和掌侧脱位。经舟骨月骨周围骨折脱位是腕部少见的严重损伤,占腕部损伤的3％～5％,多以背侧脱位为主,早期漏诊及误诊率极高,后期常发生舟骨骨不连、舟骨坏死、腕不稳定、创伤性关节炎等并发症,严重影响腕关节及手的功能,治疗上较为困难。对于TSPD的治疗不仅要恢复腕关节正常的解剖结构,而且要确保舟骨骨折的愈合,避免发生舟骨坏死。虽然人们对其研究已有100多年历史,但仍然缺乏定论,存在争议。笔者就TSPD的相关治疗进展作一综述。     

经舟骨月骨周围脱位17例诊治体会

经舟骨月骨周围脱位是腕关节骨折脱位中的特殊类型损伤,对腕及手的功能影响极大,早期容易导致误诊,给治疗带来较大的困难.因此,早期正确的诊断是本病治疗及预后首要条件.现就我院收治的17例分析报告如下.     

经舟骨月骨周围脱位的诊断与治疗

经舟骨月骨周围脱位的诊断与治疗１００８５３北京解放军总医院肖嵩华，张伯勋中国图书资料分类号Ｒ６８４．７经舟骨月骨周围脱位是较为少见的腕部严重损伤，约占所有腕骨骨折脱位的３％。由于腕骨的排列复杂，在Ｘ线片上的影像不易辩认，故常因漏诊而延误治疗。本文着重...     

腕骨脱位影像诊断中若干问题探讨

目的 探讨腕骨脱位的分型及命名、骨折与脱位的关系及其影像学检查方法.方法 56例腕骨脱位患者均摄有腕关节正侧位片,其中16例行64排CT扫描及重组;综合分析影像表现并进行诊断分型.结果 月骨脱位9例,月骨周围脱位19例,经舟骨月骨周围脱位16例,月骨和半舟骨脱位2例,舟骨-月骨周围脱位1例,其他腕骨脱位9例.其中34例伴有至少一处撕脱骨折.16例行平片及CT检查,平片显示撕脱骨折8例12处,未明确骨折部位2处,漏诊豆状骨脱位l例;CT示撕脱骨折11例21处,对骨折部位及脱位诊断均正确.结论 腕骨脱位类型多而复杂,应根据脱位及骨折具体情况进行分型及命名.除脱位外应注意骨折的诊断及骨折与脱位的关系.对于较复杂的骨折脱位CT扫描及重组应作为常规检查.     

腕关节月骨舟骨骨内腱鞘囊肿的影像学表现

目的 观察腕关节月骨、舟骨骨内腱鞘囊肿的影像特点。方法 分析经手术证实的6例共7处(月骨6处、舟骨1处)腕关节骨内腱鞘囊肿的X线(6例)、CT(4例)和MRI(1例)表现。结果 平片典型表现为月骨、舟骨小的囊变，直径为0．5cm左右。边缘光滑、清楚、硬化。6处病灶位于骨内，骨性关节面完整，囊变与关节腔不相通，1处与关节腔相通。4例CT扫描显示病灶比X线平片清楚。1例在MRT1WI表现为月骨骨内的中低信号灶，边缘硬化，T2WI为略高信号。结论 腕关节月骨、舟骨骨内腱鞘囊肿典型表现为骨内囊状破坏，边界清楚硬化。CT显示病灶比平片清楚。在MRT1WI呈中低信号，T2WI呈中高信号。     

陈旧性月骨周围脱位15例

月骨周围腕骨脱位并非罕见,但临床上极易误诊及漏诊,常给治疗带来困难,造成不良后果[1]。我院于2003~2006年共收治陈旧性月骨周围脱位15例。1临床资料1.1一般资料15例均为男性,年龄18~50岁,平均35.5岁。致伤原因:高处坠落伤5例,骑摩托车摔伤3例,踢足球时摔伤2例,机器压伤1例,战     

Trans-radial styloid, trans-scaphoid, trans-triquetral perilunate dislocation.

A rare case of trans-radial styloid, trans-scaphoid, trans-triquetral perilunate dislocation is described. The injury was treated by reduction and internal fixation using a Herbert screw and Kirschner wire. A good functional result was achieved. A review of the literature illustrates that early surgery is recommended. Alternative surgical approaches are discussed.     

MSCT后处理技术对月骨周围脱位的诊断价值

目的：探讨MSCT多平面重组（MPR）和容积再现（VR）技术在月骨周围脱位诊断中的价值。方法：回顾性分析14例月骨周围脱位患者的MPR及VR影像资料。结果：MPR及VR重组图像清晰显示14例月骨周围脱位及伴随19处骨折;MPR显示月骨周围脱位位置明确,骨折线显示清晰,VR显示脱位图像直观、立体感强,脱位的空间位置及骨碎片移位情况比MPR更清晰。结论：MPR、VR可为诊断月骨周围脱位提供重要信息。     

Isolated rotatory subluxation of the carpal navicular.

Rotatory subluxation of the carpal navicular can cause wrist pain and may lead to severe and disabling degenerative changes. Correct diagnosis depends on recognition of the typical roentgenographic signs. Sixteen patients with neither rheumatoid arthritis nor a lunate or a perilunate dislocation had rotatory subluxation in nineteen wrists. Many had only vague or remote histories of trauma. There were a navicular-lunate gap in all nineteen wrists, and foreshortening of the navicular in sixteen wrists, usually with a ring sign. The abnormalities were best demonstrated on well-centered posteroanterior roentgenograms of the wrist with the hand in slight radial deviation. In two patients, wrist arthrography demonstrated abnormal communication between radiocarpal and intercarpal joints.     

尺骨撞击综合征的普通X线表现

目的 探讨尺骨撞击综合征的普通X线表现.资料与方法 分析符合临床和X线诊断标准的28例尺骨撞击综合征患者的腕关节正位片,着重分析尺骨头、月骨和三角骨改变.结果 28例患者中,多数患者存在尺骨阳性变异(92.9%).共40块骨出现骨质异常,依次为月骨24块(60%),三角骨10块(25%),尺骨头6块(15%);表现为骨质硬化11块(27.5%)、囊变6块(15%)、硬化和囊变同时存在23块(57.5%).结论 普通X线片对尺骨撞击综合征的诊断有重要的参考价值.     

Radiologic aspects of lunatomalacia

A radiological classification of lunatomalacia, based upon the chronological radiologic manifestations in 93 patients is presented. Compression fractures were not seen as the initial event. Fifty-seven per cent of the patients had a short ulna (ulna minus variant). The presence of ulna minus variant was especially observed in the younger patients. In 16 patients suffering from a lunate fracture and in 20 patients with lunate or perilunate luxations, lunatomalacia did not develop. Immobilization as treatment of the disorder resulted in a progressive course in all patients, but one, an 8-year-old girl. The lesion of the lunate was arrested and tended to heal following radial osteotomy in all patients.     

16层螺旋CT在足、腕骨病变诊断中的临床应用

目的:探讨16层螺旋CT及其三维重建(3D)与多平面重组(MPR)在足、腕骨病变诊断中的临床应用价值.方法:32例足、腕骨病例均采用16层螺旋CT进行扫描,在工作站上进行3D及MPR影像后处理,并对结果进行比较和综合分析.结果:32例病例中正常足骨5例,腕骨3例,拇指外翻畸形2例,跟骨粉碎性骨折后致慢性骨髓炎,骨质疏松2例,距骨骨折5例,舟月骨骨折并月骨缺血性坏死1例,跟骨结核6例,腕骨骨髓炎、骨质疏松3例,跟骨粉碎性骨折5例.16层螺旋CT的3D图像可清晰显示正常小关节及其病变的立体形态,MPR图像则可以多平面多角度地观察骨关节的大小、形态、密度等的改变,对病变显示满意.结论:多层螺旋CT重建能提供骨关节病变非常有价值的空间关系信息,其表现接近病理解剖,临床应用价值大,有利于临床医师选择治疗方案、制订手术计划.     

抗精神病药物致麻痹性肠梗阻的X线与超声诊断价值探讨

目的：探讨抗精神病药物所致麻痹性肠梗阻的X线和超声表现及其诊断价值。方法：回顾性分析临床确诊的47例抗精神病药物所致麻痹性肠梗阻的X线和超声检查资料，对比其影像学表现和诊断符合率。47例均行立位X线腹部平片和透视检查，其中36例同时行B超检查。结果：依据其典型影像学表现判定，X线诊断符合率为87．2％（41／47），6例漏诊；超声诊断符合率为83．3％（30／36），6例漏诊；卡方检验两者无显著性差异（P〉0.05）。结论：X线检查是诊断抗精神病药物所致麻痹性肠梗阻的首选方法，超声对肠腔积液的发现具有优越性。两者结合能够提高诊断符合率。     

Stress injury of the lunate in tennis players: a case series and related biomechanical considerations

Objective

To investigate clinical and imaging differential diagnosis and tennis stroke biomechanics potentially involved in lunate stress injury pathogenesis.

Methods

The present report describes five competitive tennis players with overuse‐related dorsal wrist pain assessed by magnetic resonance imaging.

Results

Magnetic resonance imaging revealed the presence of lunate stress injury. All players were treated conservatively, with symptom resolution and complete functional recovery achieved at 14 weeks.

Conclusions

Lunate stress injuries should be considered in the differential diagnosis of overuse‐related dorsal wrist pain in tennis players.Wrist injuries are common among tennis players. They have been reported as the cause of 12.6% of on‐site withdrawals from the professional men''s circuit,¹ and the wrist is also the upper limb joint most often affected during Grand Slam tournaments.² In tennis players in general, most wrist injuries occur due to chronic overuse.³Players often complain of dorsal wrist pain, which can in turn disrupt training and competition. The present report describes five cases of overuse‐related dorsal wrist pain in tennis players, in whom MRI imaging studies revealed the presence of a lunate stress injury. To the best of our knowledge, this entity has not been previously analysed. Differential diagnoses and tennis stroke biomechanics potentially involved in lunate stress injuries pathogenesis are also discussed.