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一第一節(jié)骨與關(guān)節(jié)創(chuàng)傷

1、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一第一節(jié)骨與關(guān)節(jié)創(chuàng)傷 一，骨折（一）骨折總論3圖1骨痂形成示意圖4圖2骨折類型示意圖5圖3骨折移位示意圖6圖4骨骺損傷的Salte-Harris分型7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8圖6A1肱骨髁上骨折A large elbow effusion is identified by anterior and posterior fat pad elevation (arrows).This is caused by a supracondylar fracture, wi

2、th mild dorsal displacement of the distal fragment. Unlike this case, the fracture line is frequently invisible on initial radiographs.9圖6A2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 “s

3、tep-off” of the volar cortex.10圖7A1Colles fractureX線表現(xiàn)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)11圖7A2Colles fractureLateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fracture fragment.12圖8A蒙泰賈骨折 (Monteggia

4、 fracture)Monteggia fracture-dislocationLateral radiograph of the forearm demonstrates fracture of the ulnar shaft with anterior dislocation of the radius.13圖9A加萊阿齊骨折（Galeazzis fracture )Galeazzis fracture-dislocationAP radiograph of the forearm demonstrates a fracture of the radial shaft and disloc

5、ation of the inferior radioulnar joint.14圖10A1指掌骨骨折boxers fractureAP(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圖10A2指掌骨骨折boxers fractureAP(a) and oblique (b) radiographs of t

6、he hand demonstrate a fracture through the fifth metacarpal shaft with volar and radial angulation of the distal fracture fragment.16圖11A1股骨頸骨折a. AP radiograph of the hip demonstrates a fracture through the femoral neck.17圖11A2股骨頸骨折b. AP radiograph after fixation of the femoral neck fracture with th

7、ree cannulated screws.18圖12A脛骨粉碎性骨折Comminuted fracture of the mid tibia with medial displacement and medial angulation of the distal fragment.19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）.20圖14A距骨骨折合并脫位Fracture

8、dislocation of the talus(距骨).There is a comminuted fracture of the waist of the talus with posterior dislocation and rotation of the proximal fragment.21圖15A脊柱壓縮骨折Compression fracture.Lateral radiograph of the L1 vertebra demonstrates a wedging deformity that occurred after trauma.22圖16AB脊柱爆裂骨折(burs

9、t 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).AB23 脊柱安全帶型骨折（lap seat-belt-type fracture)Lap seat-belt-type fractures occur from forced hyperflexion and are subd

10、ivided into three groups:Type I, the Chance fracture, occurs when the fracture 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 III, invo

11、lves one side only due to a rotational component.24 圖17A脊柱安全帶型骨折（lap seat-belt-type fracture)A, 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

12、） (arrows) but superior to the spinous process.AB25圖18AB脊柱骨折脫位Hangmans fracture.There 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

13、on the left.26圖19A旋轉(zhuǎn)性寰樞關(guān)節(jié)半脫位（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 demonstrates a characteristic rounded corticated margin

14、of the stump of the odontoid.AB27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 of C1 with respect to C2, and significant prevertebral soft-tissue swelling. B, Open-mouth odontoid view demonstrates lateral displacement of

15、the lateral masses of C1.28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）29圖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.A30圖22B寰椎骨折（Jefferson fracture)B, Axial CT scan demonstrates a comminuted fra

16、cture of the atlas（寰椎）.B31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 anterior pelvis, with fracture of the right iliac wing, due to a rotating distractive on the posterior pelvis.

17、32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34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-S

18、achs, or batcher deformity.35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.A36圖24A3肩關(guān)節(jié)后脫位B, A “swimmers view” demonstrates the articular suface of the hum

19、errus projected posteriorly and lying postreior to the glenoid (arrowheads).B37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38圖25A1肩袖撕裂 （Rotator Cuff Tear)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39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 rotat

20、ion cuff tear.40圖25C肩袖撕裂 （Rotator Cuff 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 be identified.41圖26A肘關(guān)節(jié)脫位Complete elbow disl

21、ocation. There is also a fracture of the radial head, with small bone fragments seen overlying the ulna and radial soft tissues.42圖27A1肱骨外髁骨骺骨折 （Salter-Harris IV 型-暫缺）43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 epip

22、hysis.44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)上髁骨骺分離45圖28A肱骨髁間骨折（暫缺）46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.47圖29A2第1掌骨基底骨折 （Bennet fracture)Bennets fracture of the thumb metacarpal with dislocation of the maj

23、or 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)48圖30A月骨脫位Lunate dislocation.Although easily appreciated on the lateral view (A) the lunate (L) has taken on

24、 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.AB49圖31A月骨周圍脫位（見備注）Transscaphoid/perilunate fracture dislocation. There is disruption of

25、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(舟狀骨）, which is overlaid by the capitate(頭狀的） (C) on the frontal view. The distal scaphoid fragment is in normal r

26、elationship to the capitate. Dorsal displacement of the majority of the carpal bones is identified on the lateral view(B).50圖32A1髖關(guān)節(jié)前脫位病史摘要男性，35歲。車禍后股骨外展畸形，髖關(guān)節(jié)不能活動(dòng)。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。51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52圖33A1髖臼骨折Fracture dislocation of the left fe

27、moral 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.53圖33A2B1髖臼骨折（見備注

28、）AB54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)55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(hào)影貫穿低信號(hào)半月板全層（箭）ab56圖34C2膝關(guān)節(jié)半月板撕裂MRI 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. Hi

29、gh signal effusion is identified extending into the posterior soft tissues from rupture of a Bakers cyst (arrowheads).57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 con

30、dyle, indicating in this case an osteochondral fracture.58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59圖35膝關(guān)節(jié)內(nèi)外側(cè)副韌帶復(fù)合體損傷（暫缺）60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膝關(guān)節(jié)矢狀位T1WI示前交叉韌帶信號(hào)完全中斷61圖36C2膝關(guān)節(jié)前后交叉韌帶損傷（anterior and posterior cruciate ligament injuries)膝關(guān)

31、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(diǎn)受牽拉，其下方的骨髓挫傷， T2WI信號(hào)增高第二節(jié)骨關(guān)節(jié)發(fā)育畸形一，四肢畸形63圖37-1先天性巨肢癥（暫缺）64圖37-2A營(yíng)養(yǎng)異常性巨大發(fā)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 tis

32、sues along the plantar aspect of the foot.65圖38先天性肩胛高位癥（Sprengel 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66圖39A1馬德隆畸形（Madelungs deformity )Madelungs deformity.PA (a) and lateral (b) radiographs of the wrist demonstrate bowing of the distal end of the radius and a decreased carpal angle. Note dorsal displaceme

33、nt of the ulna.67圖39A2馬德隆畸形（Madelungs 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68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(cè)得左前臂較右前臂短3cm。圖39A3X線表現(xiàn)左橈骨呈弓形縮短，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(duì)較長(zhǎng)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69圖40-1先天性髖關(guān)節(jié)脫位測(cè)量示意圖（右側(cè)正常，左側(cè)脫位見備注） 70圖40A先天性髖關(guān)節(jié)脫位Congenital dislocation of

34、the hip. In this advanced case, the diagnosis 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.71圖41A1先天性髖內(nèi)翻病史女性，7歲。單胎，順產(chǎn)，自幼開始走路即發(fā)現(xiàn)類似鴨步，左右搖擺，隨著年齡的增長(zhǎng)，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