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.ppt

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 第一节骨与关节创伤 一 骨折 一 骨折总论 3 图1骨痂形成示意图 4 图2骨折类型示意图 5 图3骨折移位示意图 6 图4骨骺损伤的Salte Harris分型 7 图5A肱骨外科颈骨折 肱骨上段见骨折线 肱骨头下倾 远端向上移 外侧见碎骨片X线诊断 肱骨外外科颈骨折 内收型 8 图6A1肱骨髁上骨折 Alargeelboweffusionisidentifiedbyanteriorandposteriorfatpadelevation arrows Thisiscausedbyasupracondylarfracture withmilddorsaldisplacementofthedistalfragment Unlikethiscase thefracturelineisfrequentlyinvisibleoninitialradiographs 9 图6A2桡骨头骨折 Anteriorandposteriorfatpadelevation arrows signifieseffusionoftheellowjoint Thefractureoftheradialheadisonlyidentifiedbyaminimal step off ofthevolarcortex 10 图7A1Colles fracture X线表现桡骨远端见骨折线 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 X线诊断桡骨远端伸直型骨折 Colles骨折 11 图7A2Colles fracture Lateralradiographdemonstratesafractureofthedistalradiuswithdorsalangulationanddisplacementofthedistalfracturefragment 12 图8A蒙泰贾骨折 Monteggiafracture Monteggiafracture dislocationLateralradiographoftheforearmdemonstratesfractureoftheulnarshaftwithanteriordislocationoftheradius 13 图9A加莱阿齐骨折 Galeazzi sfracture Galeazzi sfracture dislocationAPradiographoftheforearmdemonstratesafractureoftheradialshaftanddislocationoftheinferiorradioulnarjoint 14 图10A1指掌骨骨折 boxer sfractureAP a andoblique b radiographsofthehanddemonstrateafracturethroughthefifthmetacarpalshaftwithvolarandradialangulationofthedistalfracturefragment 15 图10A2指掌骨骨折 boxer sfractureAP a andoblique b radiographsofthehanddemonstrateafracturethroughthefifthmetacarpalshaftwithvolarandradialangulationofthedistalfracturefragment 16 图11A1股骨颈骨折 a APradiographofthehipdemonstratesafracturethroughthefemoralneck 17 图11A2股骨颈骨折 b APradiographafterfixationofthefemoralneckfracturewiththreecannulatedscrews 18 图12A胫骨粉碎性骨折 Comminutedfractureofthemidtibiawithmedialdisplacementandmedialangulationofthedistalfragment 19 图13A跟骨骨折 Avulsion 粉碎性 fracture Lateralradiographdemonstratesanavulsionfractureofthecalcaneus 跟骨 bytheAchillestendon 跟腱 20 图14A距骨骨折合并脱位 Fracturedislocationofthetalus 距骨 Thereisacomminutedfractureofthewaistofthetaluswithposteriordislocationandrotationoftheproximalfragment 21 图15A脊柱压缩骨折 Compressionfracture LateralradiographoftheL1vertebrademonstratesawedgingdeformitythatoccurredaftertrauma 22 图16AB脊柱爆裂骨折 burstfracture FlexionfractureofL1isseenonthelateralradiograph A Wedgingisidentified buttheposteriorelementsarepoorlyseenandonlyidentifiedasbeinginvolvedbyCT B A B 23 脊柱安全带型骨折 lapseat belt typefracture Lapseat belt typefracturesoccurfromforcedhyperflexionandaresubdividedintothreegroups TypeI theChancefracture occurswhenthefractureextendshorizontallyfromthespinousprocessintothevertebralbodypassingthroughthearticularpillars 关节突 andpedicles TypeII theSmithfracture issimilarbutdoesnotinvolvethespinousprocess TypeIII involvesonesideonlyduetoarotationalcomponent 24 图17A脊柱安全带型骨折 lapseat belt typefracture A Smith sfractureofL3 ThereisahorizontalfractureoftheposteriorelementsofL3wellseenonthelateralviewanddemonstratedonthefrontalview B Byhorizontallucenciesthroughthepedicles 椎弓根 arrows butsuperiortothespinousprocess A B 25 图18AB脊柱骨折 脱位 Hangman sfracture ThereareobliquefracturesthroughthepediclesofC2 arrow withanteriordisplacementofthebodyofC2 B CTscanofadifferentpatientshowsextensionofthefracturethroughthebodyandintothevertebralcanalontheleft 26 图19A旋转性寰枢关节半脱位 rotatoryatlantoaxialsubluxation A Osodontoideum withposteriorsubluxationofC1onC2 Theosiswellseenasacorticalroundeddensity arrows lyingposteriortotheanteriorringofC1 B Open mouthviewdemonstratesacharacteristicroundedcorticatedmarginofthestumpoftheodontoid A B 27 图20A创伤性寰枢关节脱位 traumaticrotatoryatlantoaxialdislocation JeffersonburstfractureofC1 A ThereisanteriordisplacementofC1withrespecttoC2 andsignificantprevertebralsoft tissueswelling B Open mouthodontoidviewdemonstrateslateraldisplacementofthelateralmassesofC1 28 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 29 图22A寰椎骨折 Jeffersonfracture A OdontoidviewofthepatientdemonstrateslateraldisplacementofthelateralmassesofC1inthispatientwithaJeffersonfracture A 30 图22B寰椎骨折 Jeffersonfracture B AxialCTscandemonstratesacomminutedfractureoftheatlas 寰椎 B 31 图23A骨盆骨折 Lateralcompressionfracture Typicalhorizontal overlapfracturesofthepubicramiortherightareaseen Therehasbeenmedialdisplacementoftherightanteriorpelvis withfractureoftherightiliacwing duetoarotatingdistractiveontheposteriorpelvis 32 图23B骨盆骨折 女性 20岁 左髋部外伤一周 CT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 CT诊断左髋臼前柱粉碎性骨折 股骨头脱位及关节囊内出血 二 关节创伤 34 图24A1肩关节前脱位 Anteriordislocationoftherighthumerus Theinferiorrimoftheglenoidhasimpactedonthesuperiormarginofthehumerus givingrisetoaHall Sachs orbatcherdeformity 35 图24A2肩关节后脱位 A Posteriordislocationofthehumerus Thehumerusappearsininternalrotation givingrisetoa lightbull appearance Thereisalsoasymmetryoftheglenohumeraljointspace A 36 图24A3肩关节后脱位 B A swimmer sview demonstratesthearticularsufaceofthehumerrusprojectedposteriorlyandlyingpostreiortotheglenoid arrowheads B 37 图24B肩关节前脱位 右肩习惯性脱位右肩盂前缘骨缺损 38 图25A1肩袖撕裂 RotatorCuffTear 肩关节双重造影X线片示肩袖完全撕裂 肩峰下滑囊充满造影剂 39 图25A2肩袖撕裂 RotatorCuffTear Contrastisseenlateraltothehumeralheadinthesubdeltoidbursa 三角肌下囊 Thisindicatesatotalrotationcufftear 40 图25C肩袖撕裂 RotatorCuffTear MRIrotatorcufftear Completerotatorcufftear T2weighting Alargehighsignaleffusionsurroundsthehumeralhead Therotatorcuffsretracted arrowheads withtotaldisruptionofthetendon whichcannotbeidentified 41 图26A肘关节脱位 Completeelbowdislocation Thereisalsoafractureoftheradialhead withsmallbonefragmentsseenoverlyingtheulnaandradialsofttissues 42 图27A1肱骨外髁骨骺骨折 Salter HarrisIV型 暂缺 43 图27A2胫骨远端骨骺骨折 Salter HarrisIV型 SalterIVfractureofthedistaltibia withfracturelinesidentifiedinthemetaphysisandepiphysis 44 图27A2肱骨内上髁骨骺分离 X线表现 肱骨内上骨骺向内侧移位 并翻转向下X线诊断 肱骨内上髁骨骺分离 45 图28A肱骨髁间骨折 暂缺 46 图29A1腕舟骨骨折 Scaphoidfracture Thiswasnotseenontheregularveiws 常规位 butbecameevidentonthisspecificscaphoidview 47 图29A2第1掌骨基底骨折 Bennetfracture Bennet sfractureofthethumbmetacarpalwithdislocationofthemajordistalfragment Theminorfragmentisseeninitsnormalrelationshiptothetrapezium 梯形 Ofnoteistheoldundiagnosedavulsion 撕裂 fractureofthebaseoftheproximalphalanx arrow 48 图30A月骨脱位 Lunatedislocation Althougheasilyappreciatedonthelateralview A thelunate L hastakenonatypicaltriangularconfigurationontheAPview B Inthiscase thereisalsoafracturethroughtheproximalpoleofthescaphoid withdisplacementoftheproximalfragmentinassociationwiththelunate A B 49 图31A月骨周围脱位 见备注 Transscaphoid perilunatefracturedislocation Thereisdisruptionofthecarpuswithdisorganizationofalignment 排列 betweentheproximalanddistalcarpalrows Thelunate L overliesthetriquetrum 三角骨 butstillarticulateswiththeproximalscaphoid 舟状骨 whichisoverlaidbythecapitate 头状的 C onthefrontalview Thedistalscaphoidfragmentisinnormalrelationshiptothecapitate Dorsaldisplacementofthemajorityofthecarpalbonesisidentifiedonthelateralview B 50 图32A1髋关节前脱位 病史摘要男性 35岁 车禍后股骨外展畸形 髋关节不能活动 X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 51 图32A2髋关节后脱位 X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 52 图33A1髋臼骨折 Fracturedislocationoftheleftfemoralhead withaposteriordislocation Thefractureextendsthroughthefemoralhead withalargefragmentretainedwithintheacetabulum Theirregularlateralmarginoftheposterioracetabulum seenthroughtheretainedfemoralheadfragment indicatestheacetabularinjury 53 图33A2B1髋臼骨折 见备注 A B 54 图33B2髋臼骨折 左髋臼骨折CT显示骨折片脱落入关节间隙内 箭 平片不易发现 55 图34C1膝关节半月板撕裂 左膝关节内侧半月板撕裂T2WI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 a b 56 图34C2膝关节半月板撕裂 MRIoftheknee T2 weightedsequence sagittalimage Anareaoflinearincreasedsignalisseenintheposteriorhornofthemedialmeniscus indicatingatear HighsignaleffusionisidentifiedextendingintotheposteriorsofttissuesfromruptureofaBaker scyst arrowheads 57 图34C3膝关节半月板撕裂 MRIoftheknee gradient echosequence Thereistotaldisruptionoftheposteriorhornofthemedialmeniscusandadefectinthearticularsurfaceofthefemoralcondyle indicatinginthiscaseanosteochondralfracture 58 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 59 图35膝关节内外侧副韧带复合体损伤 暂缺 60 图36C1膝关节前后交叉韧带损伤 anteriorandposteriorcruciateligamentinjuries 膝关节前交叉韧带完全性撕裂的直接征象MRI膝关节矢状位T1WI示前交叉韧带信号完全中断 61 图36C2膝关节前后交叉韧带损伤 anteriorandposteriorcruciateligamentinjuries 膝关节前交叉韧带撕裂的间接征象MRI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 第二节骨关节发育畸形 一 四肢畸形 63 图37 1先天性巨肢症 暂缺 64 图37 2A营养异常性巨大发育 Macrodystrophialipomatosa AP a andlateral b radiographsofthefootina1 yearolddemonstratemarkedovergrowthofthesecondandthirdtoes Alsonotethehypertrophyyofthesofttissuesalongtheplantaraspectofthefoot 65 图38先天性肩胛高位症 Sprengel畸形 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 66 图39A1马德隆畸形 Madelung sdeformity Madelung sdeformity PA a andlateral b radiographsofthewristdemonstratebowingofthedistalendoftheradiusandadecreasedcarpalangle Notedorsaldisplacementoftheulna 67 图39A2马德隆畸形 Madelung sdeformity 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 68 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 图39A3X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X线诊断左腕马德隆畸形 69 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 70 图40A先天性髋关节脱位 Congenitaldislocationofthehip Inthisadvancedcase thediagnosiswasmissedininfancy Thereisbilateralhipdislocation withsubsequentinadequatemodelingoftheacetabula 髋臼 Apseudoarticulationofthefemoralheadwiththeiliacboneoccurs 71 图41A1先天性髋内翻 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 X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 X线诊断左侧先天性髋内翻 72 图41A2先天性髋内翻 Congenitalcoxavara Thetypicaldefectinthefemoralneckisseenbilaterallywithacharacteristic wedge ofboneinferiorly arrow 第二节骨关节发育畸形 续 二 躯干骨畸形 74 图42A1椎体融合 vertebralcoalition 又称阻滞椎 vertebralblocks X线诊断C5和C6椎体融合X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 75 图42A2椎体融合 vertebralcoalition 又称阻滞椎 vertebralblocks Blockvertebra LateralradiographofthecervicalspinedemonstratesablockvertebraatC5 C6 Notetheabsenceofadiscconfigurationofthetwovertebralbodiesthatarefusedatthislevel Facetjoints 小关节面 andspinousprocessesalsoareankylosed 骨性愈合 atthislevel 76 图43A寰枕融合畸形 X线诊断寰枕融合畸形X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 77 图44A1Klippel Feil综合症 见备注 78 图44A2Klippel Feil综合症 见备注 79 图45A1半椎体及矢状椎体裂 即蝴蝶椎 X线诊断T9半椎体及T10蝴蝶椎X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 80 图46A移行椎 腰椎骶化 暂缺 81 图47颈7胸椎化 暂缺 82 图48脊柱侧弯 scoliosis 脊柱侧弯的测量法示意图图a lippoman Cobb测量法 图b Ferguson测量法 83 图49A1 2椎弓峡部不连 spondylolosis 脊椎滑脱 spondylolisthesis 脊椎滑脱A 左后斜位平片示L4左侧椎弓峡部不连 箭 B 侧位平片示 L4椎体向前移位 I度 84 图49A1 2椎弓峡部不连 spondylolosis 脊椎滑脱 spondylolisthesis 同上例 C CT示椎弓峡部不连 椎管前后径增大 85 Theend 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