X线平片、CT、MRI对尺骨撞击综合征的对照研究  

Imaging Comparison Study of X-ray Plain Film, CT and MRI in Ulnar Impaction Syndrome

作　　者：陈君蓉[1] 但倩 张滔[1] 代承忠 

机构地区：[1]四川省骨科医院放射科,成都610041

出　　处：《华西医学》2015年第3期488-491,共4页West China Medical Journal

基　　金：四川省卫生厅科研课题(100429);四川省中医药管理局科研项目(2014A035)~~

摘　　要：目的分析尺骨撞击综合征的X线平片、CT及MRI表现,并探讨MRI在尺骨撞击综合征中的应用价值。方法回顾性分析2010年1月-2013年6月符合临床标准的18例尺骨撞击综合征患者的腕关节正位片、CT三维重建像及MRI冠状像,着重观察并记录尺骨头、月骨和三角骨影像特征。结果 17例患者为尺骨阳性变异（94.6%）,变异范围1.5~3.8 mm,平均2.6 mm;1例患者为尺骨中性变异,加摄腕关节动力位片显示为尺骨阳性变异。X线平片示14例月骨、12例三角骨及3例尺骨头不同程度骨质硬化或囊变;CT示16例月骨异常,6例伴缺血性坏死,三角骨坏死4例,月骨和三角骨同时坏死3例;MRI示所有患者表现为月骨尺侧面、三角骨桡侧面、尺骨关节软骨以及三角纤维软骨盘（TFC）不同程度损伤、退变,发生率分别是：月骨尺侧面18例,三角骨桡侧面17例,尺骨头关节面12例,TFC损伤15例,病变早期骨髓不同程度水肿,随后呈大小不一囊变样,晚期关节面塌陷。结论尺骨阳性变异对尺骨撞击综合征的诊断具有重要的参考价值。MRI可准确、全面显示尺骨撞击综合征早期改变,从而为临床诊治提供可靠的决策依据。Objective To discuss the imaging manifestations of ulnar impaction syndrome, and to evaluate the diagnostic value of MR imaging. Methods The clinical data of 18 patients with clinical standard-proved ulnar impaction syndrome between January 2010 and June 2013 were retrospectively reviewed. Results Seventeen cases were diagnosed as ulna positive variation（94.6%）, and the range of ulnar variance was 1.5 to 3.8 mm and the average ulnar variance was 2.6 mm. Neutral variance was found in one case. Fourteen cases had avascular necrosis or bone sclerosis of semilunar bone, and avascular necrosis or bone sclerosis of the triquetrum and ulnar was presented in 12 cases and3 cases respectively on X-ray detection. CT scan showed that 16 cases of semilunar bone abnormalities（6 with ischemic necrosis）, triquetrum osteonecrosis in 4 cases, and botThnecrosis of semilunar bone and triquetrum in 3 cases. On MRI, all cases had dif erent degrees of damage, degeneration of semilunar bone, triquetrum, ulnar and triangular fibocartilage complex（ulnar side of the proximal end of the lunate in 18, radial side of the triquetrum in 17, distal joint surface of ulnar in 12, and triangular fibocartilage complex in 15）. In the early stage, lesions were presented as edema of bone marrow and followed as dif erent sizes of cystic change. Articular surface was collapsed later. Conclusions Ulnar positive variance has important reference value in the diagnosis of ulnar impaction syndrome. MRI can show the early change of ulnar impaction syndrome, and provide reliable decision basis for clinical diagnosis and treatment.

关 键 词：尺骨 撞击 月骨 三角骨 骨坏死 

分 类 号：R681[医药卫生—骨科学] R445.2[医药卫生—外科学] R816.8[医药卫生—临床医学]