骨挫伤

,重庆医科大学附属第一医院骨科 安 洪,骨 挫 伤,骨挫伤的概念,Mink等(1987 )骨挫伤(骨弥漫性或局限性充血、水肿、出血伴或者不伴有骨小梁的微骨折，而相应的软骨和骨皮质正常。,骨挫伤的分型, 骨挫伤按照形态可分为三型 I 型：表现为干骺端和骨干区的弥漫性 信号改变； II型：软骨下骨质的连续性中断； III型：软骨下骨内可见到局限性的 信号改变区。,病因及基本病理改变, 病因 直接暴力、剪切暴力、垂直挤压以及关节囊或韧带的牵拉 主要组织病理学改变 髓腔内出血、水肿和骨小梁微骨折,临床表现,多见于中青年 58例 男40例 ，女18例 年龄 574岁 平均30.5岁,临床表现,有明确的外伤史 受伤至检查时间为4小时360天,临床表现,膝、踝、肩关节为好发部位,临床表现,损伤部位的疼痛和压痛,临床表现,常伴有关节结构损伤 58例中侧副韧带损伤20例（45%为同侧骨挫伤；50%为对侧骨挫伤） 半月板损伤37例（64.9%为同侧骨挫伤；13.5%为对侧骨挫伤；21.6%为双侧骨挫伤） 前交叉韧带损伤10例，80%有股骨外侧髁及胫骨外侧平台的骨挫伤,临床表现,X片和CT等影像学检查 无 阳性发现,核素骨显像和MRI征象,SPECT与MRI均可发现骨挫伤,SPECT,有助于诊断 骨挫伤缺点 解剖分辨率差，定位不准确 不能够很好地显示关节附属结构的 损伤 检查时间有限制 肾功能不全和长期服用激素的病人 易造成假阳性,MRI,常见于骨骺或干骺端，Tlw呈低信号，T2w及准T2w呈高信号，范围广，境界不清，可表现为不规则形、地图样及网状等多种形态 ，但不累及骨皮质 。Chun等STIR( short time inversion recovery)为骨挫伤MRI诊断的最佳序列。,诊 断,外伤史结合MRI的特征性表现骨挫伤常伴有关节其他结构的损伤,鉴别诊断,骨挫伤和隐性骨折 骨挫伤与骨肿瘤等其他疾病鉴别 观 察 病 理,治 疗,？ Tervonen等 无需特殊治疗 Fowler等 应当引起重视 制动。,Coronal T1-weighted spin-echo image of the knee shows the multilaminar appearance of normal articular cartilage. Note the variationsin signal intensity of cartilage as a function of location.,A 30-year-old woman with bone contusions in the presence of an anterior cruciate ligament (ACL) tear. Sagittal oblique fat-suppressed T2-weighted magnetic resonance imaging shows increased signal intensity in the lateral femoral condyle and the posterolateral tibial plateau (arrow). Arthroscopy revealed a high-grade partial ACL tear.,Bone bruise. (A) Coronal T1-weighted spin-echoimage of the knee shows a reticular hypointense lesion(arrow ) in the medial femoral condyle. (B) Coronal turbo-STIRimage of the same knee shows a hyperintense signal.,Osteochondral impaction (geographic type 1). (A)Coronal T1-weighted image of the talar dome shows asubchondral hypointense area with ill-defined margins(arrow). (B) Coronal fat-suppressed turbo spin-echo protondensity-weighted image of an osteochondral impaction of thelateral femoral condyle with associated geographic subchondralbone contusion (arrows).,Osteochondral impaction (geographic type 2). (A) T1-weighted spin-echo image shows a mildly hypointense subchondral lesion with a hypointense rim (short arrow) and minimal impaction (long arrow). (B) Fat-suppressed turbo spin-echo proton-density-weighted image shows a hyperintense geographic lesion with sharp edges (short arrow). Thesubchondral hypointense area is secondary to bone impaction (long arrow).,Chondral fractures (on sagittal fat-suppressed turbo spin-echo T2-weighted sequences). (A) Chondral flap defect (long arrow). A peripheral meniscal tear is also seen (shortarrow). (B) Frayed chondral defect (arrows). (C) Completely detached chondral defect. The transition between normal and detached cartilage is seen (short arrow).,Partially detached osteochondral fracture. (A) Sagittal T1-weighted spin-echo image shows a partially detached fragment (arrow) that is slightly depressed into bone. (B) Sagittal fat-suppressed turbo spin-echo protondensity-weighted image clearly depicts the fracture line(arrow) and the bony edema.,T2-weighted image shows bony edema.,(C) Coronal turbo spin-echo T2-weighted image shows a vertical fracture line (arrows) and bone marrow edema. (D) Axial fat-suppressed turbo spin-echo T2-weighted image clearly depicts the hyperintense fracture line (arrow) in the cortical bone.,Stress fracture (acetabular roof). (A) Plain radiograph shows no abnormality. (B) Coronal T1-weighted spinecho image shows a hypointense fracture line (arrow) in the cancellous bone. (C) Coronal fat-suppressed turbo spin-echo T2-weighted image shows hyperintense bone marrow with a mildly hypointense fracture line (arrow).,.A: On sagittal proton-density image, the anterior cruciate ligament is lax due to proximal distraction of the avulsed fracture fragment from its donor site (arrow). It is difficult to assess bone marrow edema on proton-density images. B: On coronal fat-suppressed intermediate image, the fracture line (arrows) demonstrates no surrounding marrowedema,reflecting traction at the ligamentous attachment site rather than compression.,A 16-year-old girl with torn medial collateral ligament. Coronalproton-density image showsincreased signal and lack of continuity between the proximal and distal portions of the ligament (arrows). B bone marrow edema.,Thirty-three-year-old professional baseball player after medial collateral ligament reconstruction with acute graft rupture. A STIR coronal image reveals increased signal and poor definition of an medial collateral ligament graft (black arrow). A contusion of the radial head is noted (curved arrow) due to lateral impaction and valgus insufficiency. The lateral ulnar collateral ligament (small arrows) is well seen on this image.,T1-weighted MR scans of the (A) right and (B) left foot 3 days after trauma, revealing a geographic area of signal loss of the subcortical tuber calcanei and intermediate portion of the left more than right calcaneus.,T2-weighted MR scans of the (