腕关节损伤MRI课件.ppt

1、 The First Affiliated hospital of Chongqing Medical UniversityPart I 腕关节损伤腕关节损伤MRIMRI（Wrist MRI）The First Affiliated hospital of Chongqing Medical University基本解剖基本解剖 The First Affiliated hospital of Chongqing Medical University尺桡骨远端位置关系变化尺桡骨远端位置关系变化 The First Affiliated hospital of Chongqing Medical

2、 University The First Affiliated hospital of Chongqing Medical University三角纤维软骨复合体三角纤维软骨复合体TFCC（triangular fibrocartilage complex）The First Affiliated hospital of Chongqing Medical Universitytriangular fibrocartilage complex(TFCC)The First Affiliated hospital of Chongqing Medical University The Firs

3、t Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University尺桡骨远端位置关系 The First Affiliated hospital of Chongqing Medical University韧带韧带 The First Affiliated hospital of Chongqing Medical University 内侧：豆内侧：豆/钩骨钩骨 外侧：桡侧腕屈肌外侧：桡侧腕屈肌 背侧：背侧腕骨背侧：背侧腕骨 掌

4、侧：屈肌支持带掌侧：屈肌支持带 内部：内部：屈肌腱屈肌腱 正中神经正中神经 The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical UniversityGuyons canal 尺动脉和尺神经被周围支持带包绕而成尺动脉和尺神经被周围支持带包绕而成 小的肿块即可引起严重尺神经卡压小的肿块即可引起严重尺神经卡

5、压 The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University常见病变常见病变韧带肌腱损伤韧带肌腱损伤腕骨骨折及并发症腕骨骨折及并发症腕管综合症腕管综合症 The First Affiliated hospital of Chongqing Medical UniversityTFCC撕裂撕裂 The First Affiliated hospital of Chongqing Medical Univers

6、ityTFCC撕裂撕裂Palmer分型分型 The First Affiliated hospital of Chongqing Medical UniversityTFCC撕裂palmer分型 The First Affiliated hospital of Chongqing Medical UniversityTFCC桡侧撕裂桡侧撕裂 The First Affiliated hospital of Chongqing Medical UniversityTFCC桡侧撕裂桡侧撕裂 The First Affiliated hospital of Chongqing Medical Uni

7、versityTFC桡侧撕裂MR造影 The First Affiliated hospital of Chongqing Medical UniversityTFCC尺侧撕裂 The First Affiliated hospital of Chongqing Medical UniversityTFCC尺侧撕裂 The First Affiliated hospital of Chongqing Medical UniversityTFCC尺侧撕裂 The First Affiliated hospital of Chongqing Medical University尺骨撞击综合症尺骨撞

8、击综合症 （Ulnar Impaction Syndrom，UIS)由于尺骨头、尺骨茎突与由于尺骨头、尺骨茎突与TFCCTFCC发生撞发生撞击和腕尺侧过重负荷引起的一组症候击和腕尺侧过重负荷引起的一组症候群。群。19411941年年MilchMilch最先描述由于桡骨远端骨最先描述由于桡骨远端骨折后长度缩短、尺骨撞击腕部导致月折后长度缩短、尺骨撞击腕部导致月骨和三角骨缺血坏死，引起腕尺侧疼骨和三角骨缺血坏死，引起腕尺侧疼痛并命名之。痛并命名之。The First Affiliated hospital of Chongqing Medical University病因和临床症状病因和临床症状病

9、因：病因：先天行尺骨阳性变异、桡骨远端骺早闭先天行尺骨阳性变异、桡骨远端骺早闭 桡骨远端骨折、骨不连、桡骨头切除等桡骨远端骨折、骨不连、桡骨头切除等 腕旋前和用力抓握造成动力型尺骨阳性变异腕旋前和用力抓握造成动力型尺骨阳性变异早期症状：早期症状：局限性腕尺侧痛局限性腕尺侧痛 活动受限活动受限 握力下降握力下降 The First Affiliated hospital of Chongqing Medical University 病理变化病理变化 尺骨头阳性变异即长于尺骨头阳性变异即长于桡骨桡骨 尺侧腕骨负载增加尺侧腕骨负载增加 TFCTFC退行性变退行性变穿孔、穿孔、撕裂撕裂 尺骨头和月骨

10、软骨变性尺骨头和月骨软骨变性/晚期坏死晚期坏死 月三角韧带撕裂月三角韧带撕裂 The First Affiliated hospital of Chongqing Medical UniversityMRIMRI表现表现 The First Affiliated hospital of Chongqing Medical University尺骨阳性变异；尺骨阳性变异；TFCCTFCC尺侧信号增高及月骨、尺侧信号增高及月骨、三角骨软骨及软骨下骨长三角骨软骨及软骨下骨长T1T1信号信号 The First Affiliated hospital of Chongqing Medical Univ

11、ersityTFCC尺侧撕裂及月骨、三角骨软骨下骨滑尺侧撕裂及月骨、三角骨软骨下骨滑液囊肿液囊肿 The First Affiliated hospital of Chongqing Medical University早期早期UISUIS：三角骨尺骨缘软骨变性、局限性骨：三角骨尺骨缘软骨变性、局限性骨髓水肿髓水肿 The First Affiliated hospital of Chongqing Medical UniversityUISUIS：TFCCTFCC撕裂，三角骨、月骨尺侧缘明显撕裂，三角骨、月骨尺侧缘明显滑液囊肿及骨髓水肿，尺侧软组织肿胀滑液囊肿及骨髓水肿，尺侧软组织肿胀 Th

12、e First Affiliated hospital of Chongqing Medical UniversityUISUIS：TFCCTFCC尺侧撕裂，三角骨、月骨尺侧缘滑尺侧撕裂，三角骨、月骨尺侧缘滑液囊肿，月三角韧带撕裂液囊肿，月三角韧带撕裂 The First Affiliated hospital of Chongqing Medical University尺骨茎突撞击症 The First Affiliated hospital of Chongqing Medical University常见病变常见病变腕骨骨骨折及并发症腕骨骨骨折及并发症腕管综合症腕管综合症 The Fi

13、rst Affiliated hospital of Chongqing Medical University舟月韧带撕裂 The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical UniversitySL tear The First Affiliated hospital of Chongqing Medical University舟月韧带部分撕裂T2 FSE/FST2 FSE/FS：掌侧韧带变薄：掌侧韧带变薄 The F

14、irst Affiliated hospital of Chongqing Medical University舟月韧带部分撕裂对比剂渗入对比剂渗入SLSLSLSL韧带纤维化韧带纤维化/瘢痕形成瘢痕形成 The First Affiliated hospital of Chongqing Medical University腕背侧部分嵌入性失稳（DISI）The First Affiliated hospital of Chongqing Medical University腕背侧部分嵌入性失稳（DISI）The First Affiliated hospital of Chongqing M

15、edical University舟月骨进行性塌陷（SLAC腕)The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University舟月骨进行性塌陷（SLAC)The First Affiliated hospital of Chongqing Medical University月三角韧带撕裂MRI The First Affiliated hospital of Chongqing Medical Universi

16、ty掌屈型（掌屈型（VISIVISI）腕关节不稳定）腕关节不稳定 月三角韧带撕裂月三角韧带撕裂 The First Affiliated hospital of Chongqing Medical UniversityExtensor Tendon Ganglion The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University常见病变常见病变韧带肌腱损伤韧带肌腱损伤腕管综合症腕管综合症 The First Af

17、filiated hospital of Chongqing Medical University舟骨骨折舟骨骨折 The First Affiliated hospital of Chongqing Medical University舟骨骨折舟骨骨折 The First Affiliated hospital of Chongqing Medical University细微骨折细微骨折骨挫伤骨挫伤桡骨茎突骨折桡骨茎突骨折 The First Affiliated hospital of Chongqing Medical University舟骨缺血坏死舟骨缺血坏死MRIMRI The

18、First Affiliated hospital of Chongqing Medical UniversityT1WIT2WI/FSGdC The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University舟骨骨不连舟骨骨不连 The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of

19、 Chongqing Medical University舟骨骨不连合并舟骨骨不连合并腕背侧部分嵌入性失稳腕背侧部分嵌入性失稳（DISI）The First Affiliated hospital of Chongqing Medical University舟骨骨不连合并舟骨骨不连合并舟月骨进行性塌陷（舟月骨进行性塌陷（SLAC腕腕)The First Affiliated hospital of Chongqing Medical University月骨缺血性坏死月骨缺血性坏死（Kienbocks Disease)The First Affiliated hospital of Chon

20、gqing Medical University The First Affiliated hospital of Chongqing Medical University月骨缺血性坏死分级级级级级 The First Affiliated hospital of Chongqing Medical University级级级级 The First Affiliated hospital of Chongqing Medical University头状骨骨折头状骨骨折 The First Affiliated hospital of Chongqing Medical University

21、The First Affiliated hospital of Chongqing Medical University头状骨缺血坏死（头状骨缺血坏死（AVN）The First Affiliated hospital of Chongqing Medical University常见病变常见病变韧带肌腱损伤韧带肌腱损伤 The First Affiliated hospital of Chongqing Medical University腕管综合征腕管综合征MRI The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University The First Affiliated hospital of Chongqing Medical University屈肌腱鞘囊肿所致屈肌腱鞘囊肿所致CTSCTS The First Affiliated hospital of Chongqing Medical University