醫(yī)學(xué)影像診斷學(xué)骨骼肌肉系統(tǒng)疾病比較影像圖譜系列之三

1、第一節(jié)　骨與關(guān)節(jié)創(chuàng)傷,一，骨折（一）骨折總論,2,圖1　骨痂形成示意圖,3,圖2　骨折類型示意圖,4,圖3　骨折移位示意圖,5,圖4　骨骺損傷的Salte-Harris分型,6,圖5A　肱骨外科頸骨折,肱骨上段見骨折線，肱骨頭下傾，遠(yuǎn)端向上移，外側(cè)見碎骨片X線診斷：肱骨外外科頸骨折，內(nèi)收型,7,圖6A1　肱骨髁上骨折,A large elbow effusion is identified by anterior and poste

2、rior 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,圖6A2

3、　橈骨頭骨折,Anterior 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,圖7A1　Colles’ fracture,X線表現(xiàn)

4、橈骨遠(yuǎn)端見骨折線，骨折遠(yuǎn)端向外后方移位。橈骨下關(guān)節(jié)面傾斜，尺骨向上移，尺骨莖突見小骨片；X線診斷橈骨遠(yuǎn)端伸直型骨折(Colles 骨折),10,圖7A2　Colles’ fracture,Lateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fract

5、ure fragment.,11,圖8A　蒙泰賈骨折 (Monteggia fracture),Monteggia fracture-dislocationLateral radiograph of the forearm demonstrates fracture of the ulnar shaft with anterior dislocation of the radius.,12,圖9A　加萊阿齊骨折?。℅aleazzi’

6、s fracture ),Galeazzi’s fracture-dislocationAP radiograph of the forearm demonstrates a fracture of the radial shaft and dislocation of the inferior radioulnar joint.,13,圖10A1　指掌骨骨折,boxer’s fractureAP(a) and oblique (b

7、) radiographs of the hand demonstrate a fracture through the fifth metacarpal shaft with volar and radial angulation of the distal fracture fragment.,14,圖10A2　指掌骨骨折,boxer’s fractureAP(a) and oblique (b) radiographs of

8、the hand demonstrate a fracture through the fifth metacarpal shaft with volar and radial angulation of the distal fracture fragment.,15,圖11A1　股骨頸骨折,a. AP radiograph of the hip demonstrates a fracture through the femoral

9、 neck.,16,圖11A2　股骨頸骨折,b. AP radiograph after fixation of the femoral neck fracture with three cannulated screws.,17,圖12A　脛骨粉碎性骨折,Comminuted fracture of the mid tibia with medial displacement and medial angulation of the

10、 distal fragment.,18,圖13A　跟骨骨折,Avulsion（粉碎性） fracture.Lateral radiograph demonstrates an avulsion fracture of the calcaneus（跟骨） by the Achilles tendon (跟腱）.,19,圖14A　距骨骨折合并脫位,Fracture dislocation of the talus(距骨).There

11、is a comminuted fracture of the waist of the talus with posterior dislocation and rotation of the proximal fragment.,20,圖15A　脊柱壓縮骨折,Compression fracture.Lateral radiograph of the L1 vertebra demonstrates a wedging defor

12、mity that occurred after trauma.,21,圖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

13、as being involved by CT(B).,A,,B,22,脊柱安全帶型骨折（lap seat-belt-type fracture),Lap seat-belt-type fractures occur from forced hyperflexion and are subdivided into three groups:Type I, the Chance fracture, occurs when the fr

14、acture extends horizontally from the spinous process into the vertebral body passing through the articular pillars（關(guān)節(jié)突） and pedicles.Type II, the Smith fracture, is similar but does not involve the spinous process.Type

15、 III, involves one side only due to a rotational component.,23,圖17A　脊柱安全帶型骨折（lap seat-belt-type fracture),A, Smith’s fracture of L3. There is a horizontal fracture of the posterior elements of L3 well seen on the latera

16、l view and demonstrated on the frontal view(B) By horizontal lucencies through the pedicles(椎弓根） (arrows) but superior to the spinous process.,,A,B,,24,圖18AB　脊柱骨折－脫位,Hangman’s fracture.There are oblique fractures throug

17、h 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,圖19A　旋轉(zhuǎn)性寰樞關(guān)節(jié)半脫位（

18、rotatory atlantoaxial subluxation),A. 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 de

19、monstrates a characteristic rounded corticated margin of the stump of the odontoid.,A,B,26,圖20A　創(chuàng)傷性寰樞關(guān)節(jié)脫位 (traumatic rotatory atlantoaxial dislocation),Jefferson burst fracture of C1. A, There is anterior displacement

20、 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,圖21　寰樞關(guān)節(jié)半脫位的薄層CT橫斷面、矢狀面及冠狀面（暫缺）,28,圖22A　寰椎骨折（Je

21、fferson 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,圖22B　寰椎骨折（Jefferson fracture),B, Axial CT scan demonstrate

22、s a comminuted fracture of the atlas（寰椎）.,B,30,圖23A　骨盆骨折,Lateral compression fracture.Typical horizontal/overlap fractures of the pubic rami or the right area seen. There has been medial displacement of the right anteri

23、or pelvis, with fracture of the right iliac wing, due to a rotating distractive on the posterior pelvis.,31,圖23B　骨盆骨折,女性，20歲。左髖部外傷一周。CT表現(xiàn)　左髖臼前柱（即恥骨上支）及恥骨骨質(zhì)不連續(xù)，并有移位，關(guān)節(jié)囊上方可見碎骨片嵌入（左圖），左股骨頭明顯向前移位，關(guān)節(jié)囊明顯腫脹，其中有低密度影（右圖）。CT診斷　左

24、髖臼前柱粉碎性骨折，股骨頭脫位及關(guān)節(jié)囊內(nèi)出血。,二，關(guān)節(jié)創(chuàng)傷,33,圖24A1　肩關(guān)節(jié)前脫位,Anterior 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 deform

25、ity.,34,圖24A2　肩關(guān)節(jié)后脫位,A, Posterior dislocation of the humerus. The humerus appears in internal rotation , giving rise to a “l(fā)ightbull” appearance. There is also asymmetry of the glenohumeral joint space.,A,,35,圖24A3　肩關(guān)節(jié)后脫

26、位,B, A “swimmer's view” demonstrates the articular suface of the humerrus projected posteriorly and lying postreior to the glenoid (arrowheads).,B,36,圖24B　肩關(guān)節(jié)前脫位,右肩習(xí)慣性脫位右肩盂前緣骨缺損,37,圖25A1　肩袖撕裂 （Rotator Cuff Tear

27、),肩關(guān)節(jié)雙重造影X線片示肩袖完全撕裂，肩峰下滑囊充滿造影劑,38,圖25A2　肩袖撕裂 （Rotator Cuff Tear),Contrast is seen lateral to the humeral head in the subdeltoid bursa （三角肌下囊）. This indicates a total rotation cuff tear.,39,圖25C　肩袖撕裂 （Rotator Cuf

28、f Tear),MRI rotator cuff tear.Complete 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

29、 be identified.,40,圖26A　肘關(guān)節(jié)脫位,Complete elbow dislocation. There is also a fracture of the radial head, with small bone fragments seen overlying the ulna and radial soft tissues.,41,圖27A1　肱骨外髁骨骺骨折　　　 （Salter-Harri

30、s IV 型-暫缺）,42,圖27A2　脛骨遠(yuǎn)端骨骺骨折　　　 　　 （Salter-Harris IV 型）,Salter IV fracture of the distal tibia, with fracture lines identified in the metaphysis and epiphysis.,43,圖27A2　肱骨內(nèi)上髁骨骺分離,X線表現(xiàn)：肱骨內(nèi)上骨骺向內(nèi)側(cè)移位，并翻轉(zhuǎn)向下X線診斷：肱骨內(nèi)上髁骨

31、骺分離,44,圖28A　肱骨髁間骨折（暫缺）,45,圖29A1　腕舟骨骨折,Scaphoid fracture. This was not seen on the regular veiws（常規(guī)位） but became evident on this specific scaphoid view.,46,圖29A2　第1掌骨基底骨折 ?。˙ennet fracture),Bennet’s fracture of the

32、 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 proxima

33、l phalanx (arrow),47,圖30A　月骨脫位,Lunate dislocation.Although 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 frac

34、ture through the proximal pole of the scaphoid, with displacement of the proximal fragment in association with the lunate.,A,B,48,圖31A　月骨周圍脫位（見備注）,Transscaphoid/perilunate fracture dislocation. There is disruption of the

35、 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(舟狀骨）, which is overlaid by the capit

36、ate(頭狀的） (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,圖32A1　髖關(guān)節(jié)前脫位,病史摘要

37、　男性，35歲。車禍后股骨外展畸形，髖關(guān)節(jié)不能活動。X線表現(xiàn)　股骨呈高度外展，股骨頭于髖臼下方與坐骨部分重疊。,50,圖32A2　髖關(guān)節(jié)后脫位,X線表現(xiàn)　股骨頭與髖臼上部重疊，股骨內(nèi)收內(nèi)旋，大粗隆突出，小粗隆消失，股骨頸短，伴有髖臼和股骨頭骨折,51,圖33A1　髖臼骨折,Fracture dislocation of the left femoral head, with a posterior dislocation. The f

38、racture 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 ac

39、etabular injury.,52,圖33A2B1　髖臼骨折（見備注）,A,B,53,圖33B2　髖臼骨折,左髖臼骨折CT顯示骨折片脫落入關(guān)節(jié)間隙內(nèi)（箭），平片不易發(fā)現(xiàn),54,圖34C1　膝關(guān)節(jié)半月板撕裂,左膝關(guān)節(jié)內(nèi)側(cè)半月板撕裂T2WI像，冠狀面（a）矢狀面（b）：內(nèi)側(cè)半月板后角水平撕裂，高信號影貫穿低信號半月板全層（箭）,a,b,55,圖34C2　膝關(guān)節(jié)半月板撕裂,MRI of the knee; T2-weighted se

40、quence; 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 ruptur

41、e of a Baker’s cyst (arrowheads).,56,圖34C3　膝關(guān)節(jié)半月板撕裂,MRI 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 cond

42、yle, indicating in this case an osteochondral fracture.,57,圖34A　膝關(guān)節(jié)半月板撕裂,膝關(guān)節(jié)空氣造影X線片內(nèi)側(cè)半月板前角撕裂并垂直移位,58,圖35　膝關(guān)節(jié)內(nèi)外側(cè)副韌帶復(fù)合體損傷（暫缺）,59,圖36C1　膝關(guān)節(jié)前后交叉韌帶損傷（anterior and posterior cruciate ligament injuries),膝關(guān)節(jié)前交叉韌帶完全性撕裂的直接征象MRI膝

43、關(guān)節(jié)矢狀位T1WI示前交叉韌帶信號完全中斷,60,圖36C2　膝關(guān)節(jié)前后交叉韌帶損傷（anterior and posterior cruciate ligament injuries),膝關(guān)節(jié)前交叉韌帶撕裂的間接征象MRI膝關(guān)節(jié)冠狀位T2WI示前 交叉韌帶附著點受牽拉，其下方的骨髓挫傷， T2WI信號增高,第二節(jié)　骨關(guān)節(jié)發(fā)育畸形,一，四肢畸形,62,圖37-1　先天性巨肢癥（暫缺）,63,圖37-2A　營養(yǎng)異常性巨大發(fā)育,Macro

44、dystrophia 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

45、 the foot..,64,圖38　先天性肩胛高位癥　　　　　　　?。⊿prengel 畸形）,左側(cè)肩胛骨明顯較右側(cè)正常肩胛骨高，可見上胸椎和肋骨畸形,65,圖39A1　馬德隆畸形（Madelung’s deformity ),Madelung’s deformity.PA (a) and lateral (b) radiographs of the wrist demonstrate bowing of the distal e

46、nd of the radius and a decreased carpal angle. Note dorsal displacement of the ulna.,66,圖39A2　馬德隆畸形（Madelung’s deformity ),橈骨遠(yuǎn)端關(guān)節(jié)面向尺側(cè)傾斜，橈骨和尺骨遠(yuǎn)端形成“Y”形切跡，腕骨角變小,67,病例1　女，11歲。左腕部受傷后來院檢查，偶發(fā)現(xiàn)左腕發(fā)育差，并測得左前臂較右前臂短3cm。,圖39A3X線表現(xiàn)　左

47、橈骨呈弓形縮短，遠(yuǎn)端突向背側(cè)，橈骨關(guān)節(jié)面向尺側(cè)傾斜。尺骨正常相對較長線，尺骨莖突向背側(cè)移位突出，下尺橈關(guān)節(jié)面形成銳角，近排腕骨失去正常光滑弧線而成錐形X線診斷　左腕馬德隆畸形,68,圖40-1　先天性髖關(guān)節(jié)脫位測量示意圖　　?。ㄓ覀?cè)正常，左側(cè)脫位－見備注）,,69,圖40A　先天性髖關(guān)節(jié)脫位,Congenital dislocation of the hip. In this advanced case, the diagnosi

48、s was missed in infancy. There is bilateral hip dislocation, with subsequent inadequate modeling of the acetabula（髖臼）. A pseudoarticulation of the femoral head with the iliac bone occurs.,70,圖41A1　先天性髖內(nèi)翻,病史　女性，7歲。單胎，順產(chǎn)，自

49、幼開始走路即發(fā)現(xiàn)類似鴨步，左右搖擺，隨著年齡的增長，左下肢較右下肢短，出現(xiàn)跛行伴左髖疼痛。X線表現(xiàn)　左股骨頭下壓，頸干角接近90度，股骨頸部結(jié)構(gòu)不清呈倒V字形透亮裂隙，其內(nèi)有小碎骨片，部分已與股骨愈合。X線診斷　左側(cè)先天性髖　內(nèi)翻,71,圖41A2　先天性髖內(nèi)翻,Congenital coxa vara.The typical defect in the femoral neck is seen bilaterally with

50、a characteristic “wedge” of bone inferiorly (arrow).,第二節(jié)　骨關(guān)節(jié)發(fā)育畸形（續(xù)）,二，軀干骨畸形,73,圖42A1　椎體融合（vertebral coalition) 又稱阻滯椎（vertebral blocks）,X線診斷　C5和C6椎體融合X線表現(xiàn)　頸5和頸6椎間隙消失，殘留骨性終板影，椎體前后徑稍變小,74,圖42A2　椎體融合（vertebral

51、 coalition) 　 又稱阻滯椎（vertebral blocks）,Block vertebra.Lateral radiograph of the cervical spine demonstrates a block vertebra at C5-C6. Note the absence of a disc configuration of the two vertebral bodies

52、that are fused at this level. Facet joints（小關(guān)節(jié)面） and spinous processes also are ankylosed（骨性愈合） at this level.,75,圖43A　寰枕融合畸形,X線診斷　寰枕融合畸形X線表現(xiàn)　頸椎過屈側(cè)位片顯示寰椎前后弓均與枕骨融合，寰齒前間隙增寬，樞椎齒狀突上緣超出錢氏線約9mm。,76,圖44A1　Klippel-Feil 綜合癥　　　　

53、　?。ㄒ妭渥ⅲ?77,圖44A2　Klippel-Feil 綜合癥　　　　　　（見備注）,78,圖45A1　半椎體及矢狀椎體裂（即蝴蝶椎）,X線診斷　T9半椎體及T10蝴蝶椎X線表現(xiàn)　T9椎體呈楔形偏于中線左側(cè)，右側(cè)第9肋缺如，繼發(fā)脊柱側(cè)彎畸形。T10椎體中央部缺如，由兩個光滑相對的楔形構(gòu)成，狀如蝴蝶的兩翼,79,圖46A　移行椎（腰椎骶化－暫缺）,80,圖47　頸7胸椎化（暫缺）,81,圖48　脊柱側(cè)彎（scoliosis）,脊柱

54、側(cè)彎的測量法示意圖 圖a：lippoman-Cobb 測量法；圖b： Ferguson 測量法,82,圖49A1-2　椎弓峽部不連（spondylolosis)　　　 脊椎滑脫（spondylolisthesis),脊椎滑脫A,左后斜位平片示L4左側(cè)椎弓峽部不連（箭）；B，側(cè)位平片示：L4椎體向前移位（I度）；,83,圖49A1-2　椎弓峽部不連（spondylolosis)　 脊椎滑脫（spo

55、ndylolisthesis)(同上例),C, CT示椎弓峽部不連，椎管前后徑增大,84,The end,跁趣轗脕蓺湚柩急虡尵諨鞂伣洙鋱蛿繌鹯損鰂瑣蓈禇猠櫝噽幅逹瑢犧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鏨鏗漋騙囤襝帠貊拭臧臅定尳賄躥忶藖疉巡葿脄勻砑載岷貢祁羾獁嗠棲嫙杕斦褧慸烼嘯凔掙荱逢乎洃籒癥駴頢殺稐愉馳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

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