磁共振STIRFIR序列对膝关节外伤的诊断准确性

目的 评价短反转时间快速反转恢复（STIRFIR）序列对膝关节外伤的诊断准确性。方法 60例膝关节外伤的患者均经磁共振检查，其中，35例有关节镜资料证实，对膝关节外伤的患者于外伤后2h～7d行STIR FIR序列、扰相梯度T2加权（Spoiled gradient T2 Weighted Image，GRE T2WI）序列并对其磁共振影像（MRI）表现进行比较分析。结果 扰相GRE T2WI序列显示前交叉韧带损伤40例，后交叉韧带损伤24例，半月板损伤21例，骨挫伤21例，骨挫伤区或其周围发现隐性骨折线19条；STIR序列检出前交叉韧带损伤41例，后交叉韧带损伤25例，半月板损伤21例，骨挫伤60例，骨挫伤区或其周围发现隐性骨折线182条。结论 与GRE T2WI序列比较，STIR FIR序列对膝关节外伤中的骨挫伤、隐性骨折具有更明显的诊断优势，可作为膝关节外伤MRI检查的常规序列。     

Double injuries of the forearm: a common occurrence.

To evaluate the frequency of different types of forearm fractures and, in particular, determine the frequency of double injury to the forearm, the authors prospectively examined 119 consecutive forearm fractures and found double injuries to the forearm in all but five cases. In 79 of the 119 patients (66%), ligamentous injury was seen in addition to the obvious fracture. Nine patients with apparent isolated fractures on initial radiographs underwent examination by means of radionuclide bone scanning, which revealed a second injury in eight of them. Four patients with apparent single fractures did not undergo bone scanning because of their critical conditions. In four patients, a single fracture was initially diagnosed, but after reduction and casting, dislocation of the radioulnar joint was seen. These findings indicate that injury to the forearm almost invariably occurs at two or more sites and involves either both bones or bone and ligament. Because the distal radioulnar joint was affected in 71 patients (60%), scrutiny of the wrist is imperative whenever injuries to the bones of the forearm are discovered.     

创伤性三角纤维软骨复合体损伤的MRI与临床对照研究

目的利用ＭＲＩ技术显示三角纤维软骨复合体（ＴＦＣＣ）结构的损伤与后遗症的相关性。方法选择３４例桡骨远端骨折急诊病人进行ＭＲＩ检查。采用场回波技术，对腕部进行冠状和轴面扫描。结果桡骨远端骨折同时存在ＴＦＣＣ损伤。三角纤维软骨（ＴＦＣ）、尺侧腕伸肌腱鞘纤维（ＥＣＵＳ）和半月板相同物（ＭＨ）损伤占１００％。结论桡骨远端骨折愈合后引发尺侧腕疼痛，是ＥＣＵＳ损伤所致。ＥＣＵＳ和ＭＨ损伤，是限制前臂远端旋转功能恢复的主要原因。治疗桡骨远端骨折时，要注意腕部ＴＦＣＣ损伤的处理。     

The long-term effects of force-transmission in an injured wrist, measured with dual-energy X-ray absorphometry: a case report

PURPOSE: To investigate the feasibility of using a dual-energy X-ray absorphometry (DEXA) scan to predict long-term force-transmission patterns in wrists. MATERIAL AND METHODS: Both wrists of a man with morbid Kienb?ck stage IIIa disease of his left wrist (avascular necrosis of the lunate) were examined by a DEXA scan to determine the differences in bone density in the distal radius. RESULTS: In the distal radius of the injured wrist, a shift in bone density was seen toward the scaphoid fossa, which resembles the shift in force-transmission pattern described in force-transmission studies of the wrist. CONCLUSIONS: These differences can be interpreted as a result of an altered force-transmission pattern in the injured wrist.     

隐性骨与软骨损伤的MRI诊断

目的探讨隐性骨与软骨损伤的MRI特点,分析骨挫伤、隐性骨折和关节软骨损伤间的关系。方法回顾性分析了101例隐性骨与软骨损伤,其中骨挫伤70例,隐性骨折13例,关节软骨损伤18例。观察病变的MRI特点、分布,检出骨挫伤的序列敏感性。结果T1WI,STIR或PDWI(f/s)检出骨挫伤的敏感性为95.7%及100%。骨挫伤病变在关节主要分布于骨骼的边缘,脊椎主要分布于椎体上缘终板下。隐性骨折骨折线走行方向不定,平均宽度为1.8 mm,邻近区域的骨挫伤是其重要的间接征象。关节软骨损伤MRI表现为关节软骨变薄、断裂或缺损,软骨下骨挫伤出现率为100%。结论隐性骨折和关节软骨损伤均合并有骨挫伤,MRI是诊断隐性骨与软骨损伤的敏感方法。     

骨挫伤的MRI诊断价值

目的探讨骨挫伤的MRI影像表现及MRI在骨挫伤影像诊断中的价值.方法回顾性分析34例骨挫伤和3例隐匿性骨折病例的X线平片、CT及MRI影像资料,分析骨挫伤的MRI影像表现,评估X线平片、CT及MRI在骨挫伤影像诊断中的作用.结果全部病例的X线平片均未见异常.CT能有效显示3例隐匿性骨折的部位和形态,但34例骨挫伤病例CT均未能予以诊断.3例CT诊断为隐匿性骨折的病例MRI诊断为骨挫伤而未能显示骨折的存在.MRI能有效显示不同部位骨挫伤的病变部位、范围及形态,在SE序列上骨挫伤的典型MRI表现为不规则片状T1WI低信号、T2WI高信号的异常信号改变,骨皮质及骨轮廓不发生变化.结论在X线平片、CT及MRI三种影像检查方法中,MRI是唯一能有效诊断骨挫伤的检查方法,但MRI不能明确区别骨挫伤和未分离、移位的隐匿性骨折.     

MRI对急性膝关节骨挫伤的临床应用价值

目的：探讨MRI对急性膝关节骨挫伤的临床应用价值。方法：对117例X线平片显示阴性并行MRI检查的外伤性膝关节病例进行回顾性分析,MRI检查时间为外伤后2h．5天,重点观察股骨下端、胫腓骨上端及髌骨的骨质信号,前后交叉韧带、内外侧副韧带、内外侧半月板的完整性和信号情况。结果：急性外伤后骨挫伤的发生率为87．2％（102／117）,合并韧带损伤62例,半月板损伤49例,关节软骨损伤17例,隐性骨折21例。结论：急性膝关节外伤后骨挫伤的发生率较高,MRI能准确显示骨挫伤的部位、范围以及临近结构的损伤,对临床诊断、治疗具有重要意义。     

桡骨远端粉碎性骨折动态及静态外固定支架治疗疗效分析

目的探讨外固定治疗桡骨远端粉碎性骨折的临床疗效,比较动态外固定和静态外固定的疗效差异。方法选择2007年1月～2010年12月我院收治的桡骨远端粉碎性骨折患者78例为研究对象,按收治日期随机分为动态外固定组（46例）,即外固定支架固定3周后对球面关节进行部分解锁、允许腕关节活动;静态外固定组（32例）,为外固定支架球面关节一直锁定、腕关节固定。两组患者均在入院后2天内行手法复位、外固定支架固定,部分患者加植骨及克氏针固定;外固定架固定6～8周,骨折愈合后拆除。术后6个月采用Dienst评定标准评估腕关节功能。结果外固定支架治疗桡骨远端粉碎性骨折有较高的优良率,动态固定组患者临床疗效优良率为91.30%,显著优于静态固定组患者（P〈0.05）。结论动态外固定治疗桡骨远端骨折固定可靠、功能锻炼早及恢复满意,值得临床推广应用。     

Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

Objective The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). Materials and methods We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. Results The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The “rheumatoid” type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Conclusion Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of the hands and wrists. Disease was more extensive in the wrists than in the hands.     

膝部急性隐匿性骨损伤的MRI评价

目的:评价MRI对膝部急性隐匿性骨损伤的诊断价值.方法:回顾性分析113例符合纳入条件的急性膝部创伤患者的MRI图像,采用Mink膝部隐匿性骨损伤分类方法进行观察.结果:骨挫伤71例,骨软骨损伤25例,隐匿骨折15例,应力骨折2例.这些损伤的MRI表现形态各异,信号特点较为一致,以T1WI和STIR显示较好.结论:MR...     

桡骨远端关节内骨折伴腕关节不稳定放射诊断

目的 分析继发性腕关节不稳定与桡骨远端骨折类型的关系，讨论腕关节不稳定发生机制和防治措施。方法 对67例共75个腕部桡骨远端关节内骨折随访2a～6a，在复位前、后和去除外固定后的腕关节正侧位平片上分别测量腕高指数、尺腕距离比、舟月骨距、舟月骨角、桡月骨角、头月骨角，并测定腕关节功能的主、客观指标。比较合并与不合并腕关节不稳定两组的功能恢复情况。结果 伴有腕关节不稳定的发生率为58．67％（44／75），其中，腕背侧镶嵌不稳定（DISI）29例（38．67％），舟月骨分离9例（12．00％），其他为掌侧镶嵌不稳定、尺侧偏移和头月骨间不稳定等，多发生在严重骨折移位患者。骨折愈合后，合并腕关节不稳定的功能明显差于单纯桡骨远端骨折患者。结论 桡骨远端骨折类型、关节面弧度和掌倾角对腕关节不稳定的发生及类型有显著影响。对骨折移位严重或高能量损伤的桡骨远端骨折，要注意是否合并腕关节不稳定。对合并腕关节不稳定的桡骨远端骨折．复位时应尽可能恢复掌倾角.     

High-resolution bone scintigraphy of the adult wrist.

Bony anatomic landmarks of the wrist (e.g., pisiform, hook of hamate, radioulnar joint, and styloid processes of the radius and ulna) were routinely identified in 28 adult patients examined for wrist pain. With the wrists prone and immobilized, bone scintigrams were obtained for 500,000 counts with an asymmetric (133 to 161 keV) Tc-99m energy window and either a converging (best choice) or straight-bore, high-resolution collimator. High-resolution scintigraphy precisely localized degenerative joint disease (nine patients), scaphoid fractures (five), pisiform fracture (one), lunate avascular necrosis (one), radioulnar arthritis (one), septic or inflammatory arthritis (six), ulnocarpal impingement (two), and reflex sympathetic dystrophy syndrome (two). Images obtained palm down with the wrist in ulnar deviation helped identify increased uptake within the scaphoid. Fracture and significant bone or joint disease were excluded in one patient.     

Radiologic examination and measurement of the wrist and distal radio-ulnar joint. New aspects

Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulnar head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles.     

The appearance of kissing contusion in the acutely injured knee in the athletes

Background: Bone contusions are often identified at magnetic resonance imaging (MRI) in the acutely injured knee. Contusions of both surfaces of the joint are known as kissing contusions.

Objective: To determine the frequency, type, and distribution of kissing contusions occurring in association with injuries of the knee joint.

Methods: 255 MRI examinations in athletes with acutely injured knees (197 men; 58 women; mean age 24.2 years) were reviewed by two independent examiners; 219 MRIs were done within the first month after the injury and 36 within two to four months. None of the knees had been injured before. No fractures were present on x ray.

Results: Bone contusions were diagnosed in 71 cases (27.8%); 55 (22.5%) were identified as single contusions and 16 (6.3%) as kissing contusions. Eight of the kissing contusions were associated with anterior cruciate ligament tears, three with menisceal tears, four were isolated lesions, and one was delayed, following a menisceal tear. The 32 bone contusions (16 kissing contusions) were located as follows: lateral femoral condyle (n = 14; 8 type I, 6 type II); lateral tibial condyle (n = 9; 3 type I, 1 type II, 5 type III); medial tibial condyle (n = 7; 2 type I, 5 type III); medial femoral condyle (n = 2; both type I). The associated injuries were confirmed by arthroscopy in 12/16 patients.

Conclusions: Kissing contusion is a significant injury often associated with ligamentous or menisceal injuries. Type I lesions are most common on the lateral femoral condyle and type III on the lateral tibial condyle.

     

膝关节骨与韧带急性损伤的MRI研究

目的:探讨MRI检查中急性膝关节骨损伤与韧带损伤之间的合并关系以及临床应用价值。方法:38例急性膝部骨损伤病人,行MRI重点观察STIR序列的损伤情况。骨损伤分为显性骨折(X线检查可见)与隐性骨损伤(X线检查未见异常),韧带损伤包括撕裂与完全断裂。结果:38例共45处骨损伤,包括显性骨折28处(73%)、隐性骨损伤(骨挫伤)17处(44%)。84%病例的骨损伤累及胫骨。86%的病例合并多韧带损伤,最常累及内侧副韧带、前交叉韧带与后交又韧带,74%的损伤韧带非邻近骨损伤部位。结论:急性膝部骨损伤最常累及腔骨,常合并多韧带损伤,但韧带损伤多不靠近骨损伤部位。MRI脂肪抑制序列能直观地显示韧带的撕裂与完全断裂,且能发现相当多的隐性骨损伤病例。     

Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult fractures

AIM: To determine the clinical value of scaphoid and pronator fat stripes in identifying occult underlying scaphoid and distal radius fractures, respectively. MATERIALS AND METHODS: In our department, all patients with clinically suspected scaphoid fractures and normal scaphoid series of radiographs undergo magnetic resonance imaging (MRI) of the wrist. We selected 50 cases with unequivocal MRI evidence of scaphoid fracture, 50 cases with distal radius fracture and 50 cases with no MRI evidence of bony injury. All 150 initial plain radiographs were examined retrospectively in random order without knowledge of the MRI findings and the scaphoid and pronator fat stripes scrutinized. RESULTS: The scaphoid fat stripe was abnormal in only 25 cases (50%) with confirmed scaphoid fracture on MRI. The pronator fat stripe was abnormal in 13 cases (26%) with confirmed distal radius fracture. In the 50 cases with no MRI evidence of bony injury, the scaphoid fat stripe and pronator fat stripe were abnormal in 25 (50%) and 15 (30%) cases, respectively. The sensitivity and specificity for an abnormal scaphoid fat stripe was 50%. The sensitivity and specificity for an abnormal pronator fat stripe was 26 and 70%, respectively. CONCLUSION: Scaphoid and pronator fat stripes are poor predictors of the presence or absence of underlying occult fractures.     

低场磁共振成像对膝关节外伤的诊断敏感性

目的探讨低场强（0．35T）磁共振成像对膝关节外伤的诊断敏感性，并与X线平片及常规CT检查结果比较。方法64例有膝关节外伤史及相应临床表现的患者，于外伤后1d至3个月内均经自旋回波（SE）和快速自旋回波（FSE）磁共振成像，21例又经X线平片检查，10例又经常规CT检查。对所有患者的MRI表现进行了分析，并与X线及CT所见进行了对比。结果在接受X线平片检查的21例中，各种异常见于15例，其诊断敏感性为72％。在常规cT检查的10例中，骨折、隐匿性骨折及半月板损伤分别见于2，3和1例，其诊断敏感性为60％。在MRI检查的64例中，骨挫伤见于40例（66处），合关骨折及隐匿性骨折23处，合并韧带损伤31例，合并半月板损伤23例，仅2例未见异常。MRI诊断膝关节外伤的敏感性为97％。结论MRI对膝关节外伤的诊断敏感性显著高于X线平片或常规CT。合理选用磁共振扫描序列与参数，能够准确地诊断膝关节外伤。     

Palmar tilt of the distal radius: influence of off-lateral projection initial observations

PURPOSE: To evaluate the effect of slight off-lateral positioning of the wrist on measurements of the palmar tilt of the distal radius on lateral views and to determine how this effect can be corrected quantitatively. MATERIALS AND METHODS: Seven cadaveric forearms in neutral and various oblique positions (5 degrees, 10 degrees, 15 degrees, 20 degrees ) of supination and pronation were examined with lateral radiography. The palmar tilt of the distal radius measured on the radiographs was correlated with each position of the wrist and the distance between the position of the palmar cortex of the pisiform bone (P) and a reference point (point 0), which was defined as the midpoint within the interval between palmar cortices of the distal scaphoid pole and of the capitate head (P0 distance). The same measurements were performed on 11 wrists during arthrography. RESULTS: The apparent palmar tilt of the distal radius increased with supination of the forearm. Regression analysis with the P0 distance as independent and palmar tilt as dependent variables resulted in a slope of 0.95 in the seven cadaveric wrists and of 0.92 in the 11 wrist arthrograms. The squares of the correlation coefficients (R(2)) were 0.89 in cadaveric wrists and 0.69 in 11 wrist arthrograms. CONCLUSION: Differences in the palmar tilt produced by off-lateral projections of the wrist can be estimated from the measured difference of the P0 distance. A 1-mm difference in the P0 distance corresponds to a difference in the palmar tilt of approximately 1 degrees.     

Wrist injuries; diagnosis with multidetector CT

The aim of the study was to assess acute-phase multidetector CT (MDCT) findings in wrist injuries. We retrieved all emergency room MDCT requests processed in the period from August 2000 to May 2003. All patients with a wrist injury who underwent MDCT initially were included. Imaging studies were evaluated in relation to injury mechanism, fracture location, and fracture type. A total of 6422 MDCT examinations were performed during this 34-month period, and 38 patients (24 male, 14 female, age range 21–73 years, mean age 40 years) met the inclusion criteria. MDCT revealed 56 fractures and 7 dislocations in 29 patients. In 9 patients (24%) MDCT findings were normal. Eleven patients (29%) underwent surgical procedures. The main injury mechanism was a fall (58%). In 33 cases the primary radiograph was available. Compared to primary radiographs, MDCT revealed 9 occult fractures, mainly in small carpal bones. In 14 cases a suspected fracture (of the scaphoid in 7 cases) was ruled out by MDCT. Due to high-quality two-dimensional reformatting, MDCT examinations were not dependent on the wrists position in the CT gantry. In the comparison with radiography, MDCT detected occult fractures and ruled out suspected fractures, both mainly in the small carpal bones. High-quality two-dimensional reformats gave significant information about the fracture anatomy. MDCT provides fast and valuable information in assessing complex wrist fractures or when the primary radiograph is equivocal.     

Fracture-dislocation of the elbow with inferior radioulnar dislocation: a variant of the the Essex-Lopresti injury

We describe two patients with an Essex-Lopresti fracture dislocation in association with a dislocation of the elbow. This combination of injuries has not been previously reported. The Essex-Lopresti fracture is a rare injury, and the associated distal radioulnar dislocation is often missed. Meticulous radiographic evaluation of the wrist, including dynamic stress radiographs of the forearm, can lead to an earlier diagnosis and improved care of these patients.