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第一节骨与关节创伤

1、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图6A2桡骨头骨折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图7A1Colles fractureX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 fractureLateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fracture fragment.12图8A蒙泰贾骨折 (Monteggia

4、 fracture)Monteggia fracture-dislocationLateral radiograph of the forearm demonstrates fracture of the ulnar shaft with anterior dislocation of the radius.13图9A加莱阿齐骨折（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图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图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图11A1股骨颈骨折a. AP radiograph of the hip demonstrates a fracture through the femoral neck.17图11A2股骨颈骨折b. AP radiograph after fixation of the femoral neck fracture with th

7、ree cannulated screws.18图12A胫骨粉碎性骨折Comminuted fracture of the mid tibia with medial displacement and medial angulation of the distal fragment.19图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图14A距骨骨折合并脱位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图15A脊柱压缩骨折Compression fracture.Lateral radiograph of the L1 vertebra demonstrates a wedging deformity that occurred after trauma.22图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 脊柱安全带型骨折（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（关节突） 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 图17A脊柱安全带型骨折（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图18AB脊柱骨折脱位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图19A旋转性寰枢关节半脱位（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图20A创伤性寰枢关节脱位 (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（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图22B寰椎骨折（Jefferson fracture)B, Axial CT scan demonstrates a comminuted fra

16、cture of the atlas（寰椎）.B31图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图24A2肩关节后脱位A, Posterior dislocation of the humerus. The humerus appears in internal rotation , giving rise to a “lightbull” appearance. There is also asymmetry of the glenohumeral joint space.A36图24A3肩关节后脱位B, A “swimmers view” demonstrates the articular suface of the hum

19、errus projected posteriorly and lying postreior to the glenoid (arrowheads).B37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 （Rotator Cuff Tear)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 （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图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图26A肘关节脱位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图27A1肱骨外髁骨骺骨折 （Salter-Harris IV 型-暂缺）43图27A2胫骨远端骨骺骨折 （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Scaphoid fracture. This was not seen on the regular veiws（常规位） but became evident on this specific scaphoid view.47图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图30A月骨脱位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图31A月骨周围脱位（见备注）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(舟状骨）, which is overlaid by the capitate(头状的） (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图33A2B1髋臼骨折（见备注

28、）AB54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）ab56图34C2膝关节半月板撕裂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图34C3膝关节半月板撕裂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（anterior and posterior cruciate ligament injuries)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（anterior and posterior cruciate ligament injuries)膝关

31、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（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图39A2马德隆畸形（Madelungs deformity )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（髋臼）. A pseudoarticulation of the femoral head with the iliac bone occurs.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