膝关节Ⅰ°～Ⅲ°PLC损伤的外侧副韧带和腘肌肌腱复合体MR影像分析

目的：外侧副韧带（lateral collateral ligament ,LCL ）和腘肌肌腱复合体（popliteus tendon ,POP-T ）是膝关节后外侧结构（posterolateral corner ,PLC）的主要组成结构,本文拟总结Ⅰ°～Ⅲ°PLC损伤各分度中两者的MR改变。方法急性膝关节外伤后体检提示Ⅰ°～Ⅲ°PLC损伤患者27例进行MR扫描,分析LCL和POP-T的MR改变,并与关节镜和手术所见对比。结果 Ⅰ°损伤15例：单纯LCL损伤11例,其中部分撕裂2例;POP-T水肿1例;LCL和 POP-T复合损伤3例。Ⅱ°损伤7例：LCL损伤3例,均为撕裂;复合损伤4例。Ⅲ°损伤5例：均为复合损伤,其中3例并骨折。各例关节镜检查并5例同时行开放手术,所见与MR基本相符。结论各分度PLC损伤中LCL和POP-T改变复杂多样,同分度PLC损伤中亦可不同。MR常规扫描具备评价LCL和POP-T不同程度损伤的能力,从而提高PLC损伤分度诊断准确性,以便指导治疗。     

正常膝关节后外侧部解剖结构的MR成像研究

目的　研究膝后外侧部结构的MRI表现及其定位 ,为这些结构的完整显示提供可行的方法。方法　观察 30例胫骨标本确定定位膝关节的骨性标志 ;采用 5 0例尸膝标本 ,测量膝后外侧部结构中各结构长轴与骨性标志所成的角度 ;根据上述结果制定MR斜位像的扫描方案 ;对 4 0例正常膝进行常规和斜位T1WI,观察不同方位图像上膝后外侧部结构的显示效果及MRI表现。结果　胫骨外侧平台可以作为膝关节测量和定位的稳定的骨性标志。在 4 0个正常膝中 ,34个 (85 % )外侧副韧带在 70°后斜冠状斜面像上可以完整显示 ,34个 (85 % )和 36个 (90 % )肌分别在 4 5°内斜矢状和 6 0°后斜冠状斜面像上得到较完整显示 ,32个 (80 % )和 34个 (85 % )腓韧带分别在 6 0°后斜冠状和 70°外斜矢状斜面像上得到完整显示 ;弓状韧带 (冠状面像显示 8个 ,2 0 % )和小豆腓骨韧带 (70°外斜矢状斜面像显示 10个 ,2 5 % )在常规像和斜面像上虽可显示 ,但显示率低 ,且不完整。结论　MR斜位像可完整显示膝后外侧部主要结构 ,可作为诊断该类结构损伤的有效手段。     

MRI在腘绳肌损伤中的应用价值

【摘要】目的：探讨MRI在腘绳肌损伤中的应用价值。方法：14例腘绳肌损伤患者行MRI检查,分析损伤部位和累及范围、肌腱形态改变、肌束是否中断、出血、羽毛样水肿及肌间积液等征象,并根据肌肉和肌腱的连续性对损伤程度进行分级。结果：本组中发生肌腱损伤者3例（3/14）,肌肉损伤者11例（11/14）。肌腱损伤均位于腘绳肌近端肌腱, 其中1例为完全断裂。肌肉损伤全部位于肌肉-肌腱连接处,其中6例发生于股二头肌,3例发生于半膜肌,2例发生于半腱肌。14例腘绳肌损伤中,肌间积液（11/14）和羽毛样水肿（11/14）为较常见的影像表现,3例可见肌肉内出血。14例中Ⅰ级损伤3例, Ⅱ级损伤10例, Ⅲ级损伤1例。结论：腘绳肌最严重的损伤是近端肌腱的完全断裂,肌肉拉伤均发生于肌腱-肌肉连接处且好发于股二头肌;羽毛状水肿、肌间积液、波浪状肌腱和肌束中断是其特征性的影像表现。MRI能准确评估腘绳肌损伤的严重程度。     

膝关节外伤性骨挫伤的MR诊断及临床意义

目的评价MRI对骨挫伤的诊断价值和临床意义。方法选取145例x线平片未显示股骨和胫骨骨折但MRI显示有外伤性骨髓水肿的膝关节外伤患者，MR检查时间为外伤后1-3d，采用膝关节专用线圈，快速SE（FSE）序列，T，WI、T2WI、质子密度加权成像（PDWI）＋脂肪抑制，行冠状面、矢状面、横断面、斜矢状面扫描，层厚3min，层间距0．5mm。根据骨髓水肿的分布，将膝关节外伤性骨挫伤分成5类：轴向旋转性损伤、夹击损伤、仪表盘式损伤、过伸型损伤和髌骨外侧脱位。其中48例行关节镜检查。结果145例中MRI显示轴向旋转性损伤43例，夹击损伤53例，仪表盘式损伤40例，过伸型损伤9例。骨髓水肿在PDWI或T2WI脂肪抑制序列上为片状地图样高信号，在T1WI上为低信号，边界不清。48例行关节镜检查，发现前交叉韧带撕裂11例，后交叉韧带撕裂13例，半月板撕裂22例，5例MRI诊断半月板撕裂而关节镜未能显示，MRI诊断与关节镜诊断结果符合率为89．6％。结论MRI可以准确显示膝关节骨挫伤的部位和范围及膝关节附属结构的损伤，推断其受伤机制，对临床诊断、治疗具有重要意义，应作为常规检查方法应用。     

小切口腘肌腱再张力化手术和关节镜下腘肌腱重建术治疗A型膝关节后外旋转不稳定的疗效对比研究

目的:比较小切口腘肌腱再张力化手术和关节镜下腘肌腱重建术治疗A型膝关节后外侧旋转不稳定的临床疗效.方法:从2012年3月至2018年8月,满足下列要求的患者入选本研究:(1)在我院行小切口腘肌腱再张力化手术或关节镜下腘肌腱重建术的A型后外旋转不稳定患者;(2)最少2年随访,并有麻醉下查体及二次关节镜探查结果.小切口腘肌...     

手指肌腱韧带损伤的MRI研究进展

手指解剖结构复杂精细,人类生活中的捏、握、抓、夹、提等动作都依赖于手指灵活的运动和敏锐的感觉完成。手指肌腱韧带损伤是临床的常见病,这种损伤会导致不同程度的功能障碍或丧失。手指MRI技术的发展为手指肌腱韧带损伤的诊断和治疗提供了重要的依据,具有重要的临床应用价值,关于手指MRI的相关研究已成为目前研究的热点。对手指肌腱韧带的正常解剖、损伤机制及MR征象等相关研究进展予以综述。     

磁共振成像对冈上肌腱损伤分级的评估效能

目的：探讨磁共振成像对冈上肌腱损伤分级的评估效能。方法回顾性分析84例肩部疼痛患者的临床症状、肩关节磁共振扫描方法以及影像表现。结果磁共振斜冠状位诊断冈上肌腱损伤1级40例,2级28例,3级16例;横断位1级59例,2级10例,3级15例;斜矢状位1级65例,2级9例,3级10例。斜冠状位质子压脂序列显示冈上肌腱损伤磁共振分级与临床诊断符合率最高。结论肩关节磁共振扫描能清晰显示冈上肌腱损伤的范围、程度,并进行分级,对临床治疗方法的选择有重要帮助。     

肩关节肱二头肌肌腱损伤的MRI表现

目的:探讨MRI对肩关节肱二头肌长头肌腱损伤的诊断价值。方法:收集2006年1月～2010年8月共12例肩关节肱二头肌长头肌腱损伤的病例资料,回顾性分析患者的肩关节MR扫描图像,所有病例均经肩关节手术证实。结果:①12例肱二头肌长头肌腱断裂,其中部分撕裂4例,表现为肱二头肌长头腱增粗,T2W上可见局部高信号影,肌腱连续性存在;完全撕裂8例,表现为横断面上,结节间沟内未见肱二头肌长头腱显示,斜冠状面可见撕裂肌腱近端或远端呈波浪状。肱二头肌长头肌腱半脱位1例,表现为横断面上,肱二头肌长头肌腱向内侧移位,位于肱骨小结节前方;脱位2例,表现为横断面示空置的结节间沟,肱二头肌长头腱向内侧移位、位于肩胛下肌腱前方;②肱二头肌长头腱损伤伴随腱鞘积液2例,表现为横断面上肌腱被液性高信号影所环绕;伴随肩关节腔内积液12例;③12例肱骨结节间沟宽度≥8mm;深度<3mm、结节间沟变浅3例;3例内壁角<30°;④合并肩袖损伤7例,其中冈上肌腱撕裂5例,冈下肌腱撕裂1例,肩胛下肌肌腱撕裂1例;合并喙肱韧带损伤11例。出现肩峰撞击综合征10例。结论:MRI能够准确的诊断肩关节肱二头肌长头肌腱损伤,从而有助于临床手术方案的制定。     

膝关节MR运动成像对前交叉韧带损伤的诊断研究

<正>膝关节前交叉韧带(anterior cruciate ligament,ACL)对于维持膝关节的稳定至关重要。MRI能在1～2个连续的层面上全程显示后交叉韧带情况,对后交叉韧带的诊断相对简单且明确;但MRI有时难以在1个层面完整显示ACL的全程图像,且ACL的部分损伤及陈旧性损伤目前的诊断符合率均还较低。本文将探讨膝关节MR运动成像对ACL损伤的诊断价值。     

Diagnosis of popliteus injuries with MR imaging

Objective. Popliteal muscle and tendon injuries are thought to be unusual. This report describes the magnetic resonance (MR) appearances of popliteus muscle and tendon injuries. Design and patients. The study included 24 patients where the diagnoses of popliteal injuries were prospectively made based on MR appearances. The study group was taken from 2412 consecutive knee MRIs. The injuries were characterized as to involving the muscular or tendinous portions of the popliteus apparatus. Results. In 95.8% (23/24) of patients, the tears of the popliteus involved the muscular portion. The injuries were either partial and interstitial or complete. Three patients had tears of both the muscular and tendinous portions or the tendon alone. The anterior and posterior cruciate ligaments were torn in 16.7% (4/24) and 29.2% (7/24) of patients, respectively. There were medial and lateral meniscal tears in 45.8% (11/24) and 25% (6/24) of patients, respectively. There were injuries of the medial and lateral collateral ligaments in 8.3% (2/24) and 4.2% (1/24) of patients, respectively. Bone bruises and/or fractures were seen in 33.3% (8/24) patients. In 8.3% (2/24) of patients, the popliteus injury was an isolated finding. Conclusion. Popliteus muscle and tendon injuries are not uncommon. They usually occur in conjunction with other significant injuries of the knee and can be characterized with MR imaging.Presented at RSNA, Chicago, Illinois, December 1992     

外伤性跟腱撕裂的MRI诊断

目的：评价磁共振(MRI)对外伤性跟腱撕裂的诊断价值。方法：收集经删检查并由手术证实的外伤性跟腱撕裂患者10例，回顾、分析其MRI表现。结果：10例患者均诊断正确(敏感性100％，特异性100％)。其中完全性撕裂8例，不完全性撕裂2例；撕裂发生在跟腱中上段2例、跟腱中段7例、跟腱下段1例；MRI主要表现为肌腱增粗10例，肌腱内信号增高10例，宽径／前后径比值缩小8例，肌腱连续性中断9例，断端分离、肌腱缩短3例。跟腱周围软组织肿胀及积液9例。结论：MRI能够直接显示跟腱的形态及其内部结构．对跟腱撕裂的术前诊断具有很高的敏感件和特异性．     

Deep posterior knee pain caused by a ganglion of the popliteus tendon — a case report

The most common causes of posterior and posterolateral knee pain (besides referred pain) are knee joint effusions, tendinitis of the hamstring tendons, Baker cyst (semimembranous cyst), bursitis, meniscal pathologies such as tears and ganglions and lesions of the anterior cruciate ligament. Less common causes include popliteus and gastrocnemius tendinitis, arthrofibrosis after trauma. posterior cruciate ligament sprains. deep venous thrombosis and/or irritations of the common peroneal nerve. We present one patient with posterolateral knee pain after a minor contusion. Magnetic resonance imaging revealed a degenerated posterfor horn of the lateral meniscus and a somewhat unclear polypoid structure in the intercondylar region. As the posterior component of the pain persisted even after an arthroscopic partial meniscectomy, an operative revision was performed. A small ganglion of the sheath of the popliteus tendon was found and excised. The patient was immediately relieved of his pain after this procedure. To our knowledge this is the first report concerning a ganglion of the sheath of the popliteus tendon causing posterior knee pain. A similar pathology of the popliteus tendon has been described earlier but at a different localisation (in the hiatus), simulating a parameniscal cyst.No benefits in any form have been received from a commercial party related directly or indirectly to the subject of this article. This work has been presented at the Annual Meeting of the Swiss Orthopedic Society in Geneva 1995 It won the second poster prize     

Arcuate sign of posterolateral knee injuries: anatomic,radiographic, and MR imaging data related to patterns of injury

Objective The arcuate sign is considered a pathognomonic sign for injuries of the posterolateral (PL) corner of the knee. The purpose of our study was to identify different patterns of injury to the fibular head that may associate with injuries to specific ligaments and tendons of the PL corner of the knee. The anatomic relations between the insertions of fibular collateral ligament (FCL), biceps femoris tendon (BFT), popliteofibular ligament (PFL), and arcuate ligament in normal cadaveric knees were also investigated.Design and patients Magnetic resonance imaging was performed in two cadaveric knees which subsequently were dissected. Radiopaque markers were placed upon the fibular insertions of the FCL, BFT, PFL, and arcuate ligament in the dissected knees, and knee radiographs were then obtained. Twelve patients with radiographic or MR imaging evidence of isolated injury to the PL corner of the knee were retrospectively reviewed, with regard to avulsion fractures and marrow edema in the fibular head and the integrity of the ligaments of the PL corner of the knee.Results and conclusions The PFL and arcuate ligament were seen to attach directly to the posterior and medial aspect of the styloid process of the fibular head. The FCL and BFT attached as a conjoined structure on the lateral aspect of the fibular head lateral, anterior and inferior to the attachment site of the PFL and arcuate ligament. Injury to the arcuate ligament or PFL was diagnosed in 8 patients who presented with a small avulsion fracture of the styloid process of the fibula (n=2), bone marrow edema in the medial aspect of the fibular head (n=3), or both (n=3). In 4 patients with injury to the conjoined tendon or FCL, a larger avulsion fragment and more diffuse proximal fibular edema were seen. Radiographic and MR imaging findings in injuries of the posterolateral corner of the knee may suggest injury to specific structures inserting in the fibular head.Presented at the 87th Annual Meeting of the Radiologic Society of North America, 2001.     

Lesions of the Achilles tendon: Evaluation with ultrasonography and magnetic resonance imaging

Purpose

This work aims at evaluating the role of ultrasonography and magnetic resonance imaging in the diagnosis of the lesions affecting Achilles tendon of the ankle joint.

Patients and methods

The study is a prospective study of 28 patients. Some of them are complaining of a posterior heel pain, stiffness & a limitation of movements, soft tissue thickness and swollen and ecchymotic ankle. Plain X-ray (anteroposterior and lateral views), ultrasound examination were performed for both ankles of all patients with the patients in a prone position, the Achilles tendon was examined from its musculotendinous junction to its calcaneal insertion in both longitudinal and transverse views. Finally, MRI was performed with the patients in supine position, the foot is dorsiflexed, axial and sagittal T1, T2-weighted images, STIR & proton density were done for all patients.

Results

Out of 28 patients that were examined, the final diagnosis included; eight cases of tendinopathy (five cases peritendinosis, and three cases tendinosis), 16 cases of partial thickness tear (as compared to arthroscope), and four cases of full thickness tear.

Conclusion

Ultrasound is an important complementary diagnostic tool in the diagnosis of lesions of Achilles tendon, it is as good as MRI in the diagnosis of tendinopathy and full thickness tear, however MRI is more superior in the diagnosis of partial thickness tear, and in the differentiation of the different types of tendinopathy.     

The wrinkled patellar tendon: an indication of abnormality in the extensor mechanism of the knee

Rupture of the quadriceps tendon is an uncommon condition which requires early diagnosis and treatment to avert prolonged disability. In four patients who had surgically confirmed quadriceps tendon rupture, lateral radiographs of the knee and/or sagittal magnetic resonance (MR) images demonstrated a corrugated appearance to the patellar tendon. Sagittal MR images of the knee following patellectomy in one patient and radiographs of a transverse fracture of the patella in another also demonstrated this appearance. MRI has superb contrast resolution which provides optimal visualization of the contour of the patellar tendon on sagittal images. A retrospective review of 50 consecutive knee MRI examinations was carried out to evaluate the appearance of the normal patellar tendon. In 49 of 50 patients, the sagittal images demonstrated a straight or nearly straight patellar tendon. A corrugated appearance of the patellar tendon on sagittal images indicates a reduction in the normal tensile force applied to it and indicates the need for careful evaluation of the patella and quadriceps tendon mechanism.     

房室间隔缺损的MRI诊断

目的：进一步评价ＭＲＩ在房室间隔缺损中的临床诊断价值。材料与方法：回顾性分析１８例房室间隔缺损的ＭＲＩ，均经手术和（或）心血管造影证实。结果：在ＭＲＩ上，１８例均表现为正常房室间隔结构消失；１０例完全型表现为心脏十字交叉结构缺如和共同房室瓣环；８例部分型表现为原发孔房间隔缺损，２例有小的室间交通，６例室间隔缺损被瓣膜至室间隔嵴的索条样结构封闭。５例伴有心室发育不良。结论：ＭＲＩ作为无创性影像方法，在显示房室间隔缺损的病理解剖时优于超声心动图和心血管造影     

Comparison of supraspinatus tendon and glenohumeral joint axes in MR imaging of the shoulder

Objective. In magnetic resonance (MR) imaging of the shoulder, oblique coronal images are used for evaluating the supraspinatus tendon (SST) of patients with suspected rotator cuff tear or impingement. This study aimed to compare orientation of the SST long axis with planes perpendicular to the glenohumeral joint (GHJ). Design and patients. The axial scans of 100 consecutive patients referred for MR imaging or MR arthrography of the shoulder were reviewed. Using the electronic cursors of a computer workstation, the angle of the SST long axis was measured and compared with the angle obtained through the GHJ utilizing three different landmarks: perpendicular to the joint (GHJ-90), joint–humeral head center axis (GHJ-H) and joint–scapular body axis (GHJ-S). Results. Differences in angulation between axes of the SST and the three GHJ axes averaged only about 5° [range of means 4.5–5.3°, range of standard deviation (SD) 3.8–4.6°]. In the majority of shoulders, angular differences measured 4 or less for all SST/GHJ comparisons. Similarly, small angular differences in the three GHJ axes were found: 4.5° (SD 3.3°) for GHJ-90/GHJ-S, 5.0° (SD 4.0°) for GHJ-S/GHJ-H and 2.9° (SD 3.0°) for GHJ-90/GHJ-H. Correlation between the GHJ-90 and GHJ-H axes was particularly good, with differences of 4° or less in 84% of shoulders. The orientations of the GHJ axes and that of the SST long axis are comparable. Conclusion. The GHJ may potentially be used as a landmark for obtaining oblique coronal images of the SST. Received: 19 November 1999 Revision requested: 18 January 2000 Revision received: 27 March 2000 Accepted: 5 April 2000