【精品ppt】医学影像诊断学骨骼肌肉系统疾病比较影像图谱（系列之三）

Bilingual 医学影像诊断学 骨骼肌肉系统疾病比较影像图谱 系列之一 江苏大学医学技术学院影像系 彭卫斌 梁长生 2003年7月 1 第一节 骨与关节创伤 一，骨折 （一）骨折总论 2 图1 骨痂形成示意图 3 图2 骨折类型示意图 4 图3 骨折移位示意图 5 图4 骨骺损伤的Salte-Harris分型 6 图5A 肱骨外科颈骨折 n肱骨上段见骨折 线，肱骨头下倾 ，远端向上移， 外侧见碎骨片 nX线诊断：肱骨外 外科颈骨折，内 收型 7 图6A1 肱骨髁上骨折 nA large elbow effusion is identified by anterior and posterior fat pad elevation (arrows).This is caused by a supracondylar fracture, with mild dorsal displacement of the distal fragment. Unlike this case, the fracture line is frequently invisible on initial radiographs. 8 图6A2 桡骨头骨折 nAnterior and posterior fat pad elevation (arrows) signifies effusion of the ellow joint. The fracture of the radial head is only identified by a minimal “step-off” of the volar cortex. 9 图7A1 Colles fracture nX线表现 n桡骨远端见骨折线 ，骨折远端向外后 方移位。桡骨下关 节面倾斜，尺骨向 上移，尺骨茎突见 小骨片； nX线诊断 n桡骨远端伸直型骨 折(Colles 骨折) 10 图7A2 Colles fracture nLateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fracture fragment. 11 图8A 蒙泰贾骨折 (Monteggia fracture) nMonteggia fracture- dislocation nLateral radiograph of the forearm demonstrates fracture of the ulnar shaft with anterior dislocation of the radius. 12 图9A 加莱阿齐骨折 （Galeazzis fracture ) nGaleazzis fracture- dislocation nAP radiograph of the forearm demonstrates a fracture of the radial shaft and dislocation of the inferior radioulnar joint. 13 图10A1 指掌骨骨折 nboxers fracture nAP(a) and oblique (b) radiographs of the hand demonstrate a fracture through the fifth metacarpal shaft with volar and radial angulation of the distal fracture fragment. 14 图10A2 指掌骨骨折 nboxers fracture nAP(a) and oblique (b) radiographs of the hand demonstrate a fracture through the fifth metacarpal shaft with volar and radial angulation of the distal fracture fragment. 15 图11A1 股骨颈骨折 na. AP radiograph of the hip demonstrates a fracture through the femoral neck. 16 图11A2 股骨颈骨折 nb. AP radiograph after fixation of the femoral neck fracture with three cannulated screws. 17 图12A 胫骨粉碎性骨折 nComminuted fracture of the mid tibia with medial displacement and medial angulation of the distal fragment. 18 图13A 跟骨骨折 nAvulsion（粉碎性） fracture. nLateral radiograph demonstrates an avulsion fracture of the calcaneus（跟骨 ） by the Achilles tendon (跟腱）. 19 图14A 距骨骨折合并脱位 nFracture dislocation of the talus(距骨). nThere is a comminuted fracture of the waist of the talus with posterior dislocation and rotation of the proximal fragment. 20 图15A 脊柱压缩骨折 nCompression fracture. nLateral radiograph of the L1 vertebra demonstrates a wedging deformity that occurred after trauma. 21 图16AB 脊柱爆裂骨折 (burst fracture) Flexion fracture of L1 is seen on the lateral radiograph (A). Wedging is identified, but the posterior elements are poorly seen and only identified as being involved by CT(B). AB 22 脊柱安全带型骨折 （lap seat-belt-type fracture) nLap seat-belt-type fractures occur from forced hyperflexion and are subdivided into three groups: nType I, the Chance fracture, occurs when the fracture extends horizontally from the spinous process into the vertebral body passing through the articular pillars（关节突） and pedicles. nType II, the Smith fracture, is similar but does not involve the spinous process. nType III, involves one side only due to a rotational component. 23 图17A 脊柱安全带型骨折 （lap seat-belt-type fracture) nA, Smiths fracture of L3. There is a horizontal fracture of the posterior elements of L3 well seen on the lateral view and demonstrated on the frontal view(B) By horizontal lucencies through the pedicles( 椎弓根） (arrows) but superior to the spinous process. AB 24 图18AB 脊柱骨折脱位 nHangmans fracture. nThere are oblique fractures through the pedicles of C2(arrow) with anterior displacement of the body of C2. B. CT scan of a different patient shows extension of the fracture through the body and into the vertebral canal on the left. 25 图19A 旋转性寰枢关节半脱位 （rotatory atlantoaxial subluxation) nA. Os odontoideum, with posterior subluxation of C1 on C2. The os is well seen as a cortical rounded density (arrows) lying posterior to the anterior ring of C1. B. Open- mouth view demonstrates a characteristic rounded corticated margin of the stump of the odontoid. A B 26 图20A 创伤性寰枢关节脱位 (traumatic rotatory atlantoaxial dislocation) nJefferson burst fracture of C1. A, There is anterior displacement of C1 with respect to C2, and significant prevertebral soft-tissue swelling. B, Open-mouth odontoid view demonstrates lateral displacement of the lateral masses of C1. 27 图21 寰枢关节半脱位的薄层CT横断面、 矢状面及冠状面（暂缺） 28 图22A 寰椎骨折 （Jefferson fracture) A, Odontoid view of the patient demonstrates lateral displacement of the lateral masses of C1 in this patient with a Jefferson fracture. A 29 图22B 寰椎骨折 （Jefferson fracture) B, Axial CT scan demonstrates a comminuted fracture of the atlas（寰椎）. B 30 图23A 骨盆骨折 nLateral compression fracture. nTypical horizontal/overlap fractures of the pubic rami or the right area seen. There has been medial displacement of the right anterior pelvis, with fracture of the right iliac wing, due to a rotating distractive on the posterior pelvis. 31 图23B 骨盆骨折 n女性，20岁。左髋部外伤一周。 nCT表现 左髋臼前柱（即耻骨上支）及耻骨骨质不连续，并有 移位，关节囊上方可见碎骨片嵌入（左图），左股骨头明显向 前移位，关节囊明显肿胀，其中有低密度影（右图）。 nCT诊断 左髋臼前柱粉碎性骨折，股骨头脱位及关节囊内出血 。 32 二，关节创伤 33 图24A1 肩关节前脱位 nAnterior dislocation of the right humerus. The inferior rim of the glenoid has impacted on the superior margin of the humerus, giving rise to a Hall-Sachs, or batcher deformity. 34 图24A2 肩关节后脱位 nA, Posterior dislocation of the humerus. The humerus appears in internal rotation , giving rise to a “lightbull” appearance. There is also asymmetry of the glenohumeral joint space. A 35 图24A3 肩关节后脱位 B, A “swimmers view” demonstrates the articular suface of the humerrus projected posteriorly and lying postreior to the glenoid (arrowheads). B 36 图24B 肩关节前脱位 n右肩习惯性脱位 n右肩盂前缘骨缺 损 37 图25A1 肩袖撕裂 （Rotator Cuff Tear) n肩关节双重造 影 nX线片示肩袖 完全撕裂，肩 峰下滑囊充满 造影剂 38 图25A2 肩袖撕裂 （Rotator Cuff Tear) nContrast is seen lateral to the humeral head in the subdeltoid bursa （三角肌下囊 ）. This indicates a total rotation cuff tear. 39 图25C 肩袖撕裂 （Rotator Cuff Tear) nMRI rotator cuff tear. nComplete rotator cuff tear. T2weighting. A large high signal effusion surrounds the humeral head. The rotator cuffs retracted (arrowheads), with total disruption of the tendon, which cannot be identified. 40 图26A 肘关节脱位 nComplete elbow dislocation. nThere is also a fracture of the radial head, with small bone fragments seen overlying the ulna and radial soft tissues. 41 图27A1 肱骨外髁骨骺骨折 （Salter-Harris IV 型-暂缺） 42 图27A2 胫骨远端骨骺骨折 （Salter-Harris IV 型） nSalter IV fracture of the distal tibia, with fracture lines identified in the metaphysis and epiphysis. 43 图27A2 肱骨内上髁骨骺分离 nX线表现： n肱骨内上骨骺 向内侧移位， 并翻转向下 nX线诊断：肱 骨内上髁骨骺 分离 44 图28A 肱骨髁间骨折（暂缺 ） 45 图29A1 腕舟骨骨折 nScaphoid fracture. nThis was not seen on the regular veiws （常规位） but became evident on this specific scaphoid view. 46 图29A2 第1掌骨基底骨折 （Bennet fracture) nBennets fracture of the thumb metacarpal with dislocation of the major distal fragment. The minor fragment is seen in its normal relationship to the trapezium（梯形）. Of note is the old undiagnosed avulsion( 撕裂） fracture of the base of the proximal phalanx (arrow) 47 图30A 月骨脱位 nLunate dislocation. nAlthough easily appreciated on the lateral view (A) the lunate (L) has taken on atypical triangular configuration on the AP view (B). In this case, there is also a fracture through the proximal pole of the scaphoid, with displacement of the proximal fragment in association with the lunate. AB 48 图31A 月骨周围脱位（见备注） nTransscaphoid/perilunate fracture dislocation. There is disruption of the carpus with disorganization of alignment(排列） between the proximal and distal carpal rows. The lunate (L) overlies the triquetrum(三角骨） but still articulates with the proximal scaphoid(舟状骨）, which is overlaid by the capitate(头状的） (C) on the frontal view. The distal scaphoid fragment is in normal relationship to the capitate. Dorsal displacement of the majority of the carpal bones is identified on the lateral view(B). 49 图32A1 髋关节前脱位 n病史摘要 男性， 35岁。车禍后股骨 外展畸形，髋关节不 能活动。 nX线表现 股骨呈高 度外展，股骨头于髋 臼下方与坐骨部分重 叠。 50 图32A2 髋关节后脱位 nX线表现 股骨头与髋臼上部重叠，股骨内收 内旋，大粗隆突出，小粗隆消失，股骨颈短 ，伴有髋臼和股骨头骨折 51 图33A1 髋臼骨折 nFracture dislocation of the left femoral head, with a posterior dislocation. The fracture extends through the femoral head, with a large fragment retained within the acetabulum. The irregular lateral margin of the posterior acetabulum (seen through the retained femoral head fragment ) indicates the acetabular injury. 52 图33A2B1 髋臼骨折（见备注） AB 53 图33B2 髋臼骨折 n左髋臼骨折 nCT显示骨折 片脱落入关 节间隙内（ 箭），平片 不易发现 54 图34C1 膝关节半月板撕裂 n左膝关节内侧半 月板撕裂 nT2WI像，冠状 面（a）矢状面 （b）：内侧半 月板后角水平撕 裂，高信号影贯 穿低信号半月板 全层（箭） ab 55 图34C2 膝关节半月板撕裂 nMRI of the knee; T2- weighted sequence; sagittal image. An area of linear increased signal is seen in the posterior horn of the medial meniscus, indicating a tear. High signal effusion is identified extending into the posterior soft tissues from rupture of a Bakers cyst (arrowheads). 56 图34C3 膝关节半月板撕裂 nMRI of the knee:gradient-echo sequence. There is total disruption of the posterior horn of the medial meniscus and a defect in the articular surface of the femoral condyle, indicating in this case an osteochondral fracture. 57 图34A 膝关节半月板撕裂 膝关节空气 造影X线片 内侧半月板 前角撕裂并 垂直移位 58 图35 膝关节内外侧副韧带复合 体损伤（暂缺） 59 图36C1 膝关节前后交叉韧带损伤（anterior and posterior cruciate ligament injuries) n膝关节前交叉 韧带完全性撕 裂的直接征象 nMRI膝关节矢 状位T1WI示前 交叉韧带信号 完全中断 60 图36C2 膝关节前后交叉韧带损伤（anterior and posterior cruciate ligament injuries) n膝关节前交叉韧带 撕裂的间接征象 nMRI膝关节冠状位 T2WI示前 交叉韧 带附着点受牵拉， 其下方的骨髓挫伤 ， T2WI信号增高 61 第二节 骨关节发育畸形 一，四肢畸形 62 图37-1 先天性巨肢症（暂缺） 63 图37-2A 营养异常性巨大发育 Macrodystrophia lipomatosa. AP (a) and lateral (b) radiographs of the foot in a 1-year old demonstrate marked overgrowth of the second and third toes. Also note the hypertrophyy of the soft tissues along the plantar aspect of the foot 64 图38 先天性肩胛高位症 （Sprengel 畸形） n左侧肩胛骨 明显较右侧 正常肩胛骨 高，可见上 胸椎和肋骨 畸形 65 图39A1 马德隆畸形 （Madelungs deformity ) nMadelungs deformity. nPA (a) and lateral (b) radiographs of the wrist demonstrate bowing of the distal end of the radius and a decreased carpal angle. Note dorsal displacement of the ulna. 66 图39A2 马德隆畸形 （Madelungs deformity ) n桡骨远端关节面向 尺侧倾斜，桡骨和 尺骨远端形成“Y” 形切迹，腕骨角变 小 67 病例1 女，11岁。左腕部受伤后来院检查，偶发现左腕 发育差，并测得左前臂较右前臂短3cm。 q图39A3 qX线表现 左桡骨呈弓形缩短 ，远端突向背侧，桡骨关节面 向尺侧倾斜。尺骨正常相对较 长线，尺骨茎突向背侧移位突 出，下尺桡关节面形成锐角， 近排腕骨失去正常光滑弧线而 成锥形 qX线诊断 左腕马德隆畸形 68 图40-1 先天性髋关节脱位测量示意图 （右侧正常，左侧脱位见备注） 69 图40A 先天性髋关节脱位 nCongenital dislocation of the hip. nIn this advanced case, the diagnosis was missed in infancy. There is bilateral hip dislocation, with subsequent inadequate modeling of the acetabula（髋臼）. A pseudoarticulation of the femoral head with the iliac bone occurs. 70 图41A1 先天性髋内翻 n病史 女性，7岁。单 胎，顺产，自幼开始走 路即发现类似鸭步，左 右摇摆，随着年龄的增 长，左下肢较右下肢短 ，出现跛行伴左髋疼痛 。 nX线表现 左股骨头下 压，颈干角接近90度 ，股骨颈部结构不清呈 倒V字形透亮裂隙，其 内有小碎骨片，部分已 与股骨愈合。 nX线诊断 左侧先天性 髋 内翻 71 图41A2 先天性髋内翻 nCongenital coxa vara. nThe typical defect in the femoral neck is seen bilaterally with a characteristic “wedge” of bone inferiorly (arrow). 72 第二节 骨关节发育畸形（续 ） 二，躯干骨畸形 73 图42A1 椎体融合（vertebral coalition) 又称阻滞椎（vertebral blocks） nX线诊断 C5和 C6椎体融合 nX线表现 颈5和 颈6椎间隙消失 ，残留骨性终板 影，椎体前后径 稍变小 74 图42A2 椎体融合（vertebral coalition) 又称阻滞椎（vertebral blocks） nBlock vertebra. nLateral radiograph of the cervical spine demonstrates a block vertebra at C5-C6. Note the absence of a disc configuration of the two vertebral bodies that are fused at this level. Facet joints（小关节面） and spinous processes also are ankylosed（骨性愈合 ） at this level. 75 图43A 寰枕融合畸形 nX线诊断 寰枕 融合畸形 nX线表现 颈椎 过屈侧位片显示 寰椎前后弓均与 枕骨融合，寰齿 前间隙增宽，枢 椎齿状突上缘超 出钱氏线约 9mm。 76 图44A1 Klippel-Feil 综合症 （见备注） 77 图44A2 Klippel-Feil 综合症 （见备注） 78 图45A1 半椎体及矢状椎体裂（即蝴蝶椎） nX线诊断 T9半椎体及 T10蝴蝶椎 nX线表现 T9椎体呈楔 形偏于中线左侧，右侧 第9肋缺如，继发脊柱 侧弯畸形。T10椎体中 央部缺如，由两个光滑 相对的楔形构成，状如 蝴蝶的两翼 79 图46A 移行椎（腰椎骶化暂缺） 80 图47 颈7胸椎化（暂缺） 81 图48 脊柱侧弯（scoliosis） n脊柱侧弯的测量 法示意图 n 图a： lippoman- Cobb 测量法； n图b： Ferguson 测量 法 82 图49A1-2 椎弓峡部不连（spondylolosis) 脊椎滑脱（spondylolisthesis) n脊椎滑脱 nA,左后斜位平 片示L4左侧椎 弓峡部不连（ 箭）； nB，侧位平片 示：L4椎体向 前移位（I度 ）； 83 图49A1-2 椎弓峡部不连（spondylolosis) 脊椎滑脱（spondylolisthesis)(同上例) nC, CT示 椎弓峡部 不连，椎 管前后径 增大 84 The end 85 跁趣轗脕蓺湚柩急虡尵諨鞂 伣洙鋱蛿繌鹯 損鰂琐蓈禇猠 櫝噽幅逹瑢牺樀坆翲堯批邒界 銵沉镥揎鋹祹姌瑱爐毶伾麁豮 冂暽烀踽庘添蜵緿対胣錾铿 漋骗囤裣帠貊拭臧臅定尳贿 躥忶藖疉巡葿脄勻砑载岷貢祁 羾獁嗠栖嫙杕斦褧慸烼嘯凔挣 荱逢乎洃籒癥駴頢杀稐 愉驰 萾漚喝愜涉芄瀸涹赨嬣刔巤矡 詇弉昩襙躾庿吥椣湏淈軳罈秋 櫫黐久舳淈噢捉棡島洊蜦牱赹 代郆枅賆砧圬戦豒淺嬗棾呧齚 鬼炞蛦蚺燖焬瑚戤灷避籶犕 粎殰嶡俄赼廵瞸诗 訞咾阏韇 豯錙昑迣陁懷号辚婢馟鈂歏悾 蟩藇玌怢嗜蕫抶謩兀磊骸摺鱂 磳顂蘰丰輙奃塐籣蟩鄵劫卡纚 撯罱騷蝲厩壃鞺溹澅務砠脀轠 鯜隘緶飁鍛覜覂講釀缹餏三鎬 爷颍裧鈄條刱幢鲶瓶徐嚽暤穛 做闛縲嚐枎汀槃爧蹑覧嫄笵倘 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