踝关节外侧韧带解剖及损伤的磁共振表现  

MRI anatomy and injury of the lateral collateral ligaments of ankle

作　　者：钱占华[1] 刘悦[1] 白荣杰[1] 詹惠荔 张恒[1] 李亚雄[1] 吴伯栋 

机构地区：[1]北京积水潭医院放射科、北京市创伤骨科研究所,100035

出　　处：《中华医学杂志》2017年第29期2271-2274,共4页National Medical Journal of China

基　　金：国家自然科学基金面上项目（81371515）;首都卫生发展科研专项项目（首发2016-2-1122）;北京市自然科学基金面上项目（7142075）

摘　　要：目的探讨踝关节外侧韧带损伤的磁共振（MR）表现及MR对踝关节外侧韧带损伤的诊断价值。方法回顾性分析2013年1月至2016年9月，10名健康志愿者，北京积水潭医院26例经手术治疗的踝关节外侧韧带损伤患者的临床及影像学资料。健康志愿者包括男5名、女5名，年龄21～27岁，平均年龄（24.4±2.2）岁；踝关节外侧韧带损伤患者包括男16例、女10例，年龄16～64岁，平均年龄（38.6±12.8）岁。所有患者及志愿者均行踝关节MR检查，将外侧韧带损伤患者与正常志愿者的MRI表现进行影像对照，并与手术结果进行对照分析，研究损伤的MRI表现特点。结果10名正常踝关节外侧韧带MRI表现为T1WI和质子密度压脂（PD－FS）序列均为条带状均匀低信号。正常距腓前韧带、距腓后韧带至少可在1个层面上完整显示韧带的全长。跟腓韧带至少在3个层面上清晰显示，但不能在1个层面完整显示韧带全程，需三个层面结合，观察韧带全长。26例外侧韧带损伤患者（其中单纯距腓前韧带损伤19例，单纯跟腓韧带损伤1例，距腓前韧带合并跟腓韧带损伤3例，距腓前韧带合并跟腓韧带、距腓后韧带损伤3例）主要表现为损伤韧带T1WI序列信号不清晰、纤维连续性中断，PD压脂序列韧带信号不均匀增高，肌纤维连续性中断，形态异常，腱鞘积液，周围软组织水肿。 结论MR检查是明确踝关节外侧韧带正常结构及损伤的有效方法，在踝关节韧带外侧损伤的诊断和治疗方面具有重要的临床应用价值。ObjectiveTo explore the MRI features of the lateral collateral ligament injuries of the ankle and determine the value MRI in diagnosing the ligament injuries of the ankle.MethodsThe study was reviewed and approved by an institutional review board of hospital. Retrospective analysised 10 healthy volunteers and 26 ankle injury cases underwent surgery since January 2013 to September 2016, the MR imaging findings of patients were compared with volunteers′ and operative documents, to analysis the MRI feature of the ligament injuries of the ankle.ResultsThe normal anterior talofibular ligament and posterior talofibular ligament can be manifest in 3-4 layers of MRI, and can be fully displayed in 1 layer. The normal calcaneofibular ligament can be manifest in 3 layers of MRI, but can not be fully displayed in 1 layer. 26 cases of lateral ligament injury （including 1 case of ATFL injury, 1 case of CFL injury, 3 cases of ATFL conjunction with CFL injury, 3 cases of ATFL conjunction with CFL and PTFL injury） manifested the heterogeneous signal of the T1-weighted image, the ligament disruption, the increased signal intensity on fat-suppression PD-weighted image , the surrounding soft tissue edema and bone marrow edema.ConclusionMR imaging is an accurate method for evaluation of the ligament injuries of the ankle, and it is a useful tool for diagnosis and treatment.

关 键 词：外侧韧带  踝 磁共振成像 踝损伤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R684[医药卫生—诊断学]