大弧损伤性月骨脱位的分型及影像学表现  

Classification and imaging findings of lunate dislocation caused by greater arc injury

作　　者：王达 桑辉[1] 王勇[1] 张平[2] 张欲翔 张泽坤 WANG Da;SANG Hui;WANG Yong;ZHANG Ping;ZHANG Yuxiang;ZHANG Zekun(Department of Radiology,Hebei Hospital of Chinese Medicine,Shijiazhuang 050011,China;CT Room,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北省中医院放射科,河北石家庄050011 [2]河北医科大学第三医院CT室,河北石家庄050051

出　　处：《实用放射学杂志》2022年第3期464-467,共4页Journal of Practical Radiology

摘　　要：目的探讨腕关节大弧损伤性月骨脱位的分型及影像学表现.方法回顾性分析23例腕关节大弧损伤性月骨脱位病例资料.16例行数字X线摄影(DR)检查,19例行CT扫描,应用多平面重建(MPR)、曲面重建(CPR)及容积再现(VR)技术进行图像重建.结果23例患者近排腕骨近侧及远侧关节面连线均不连续.综合X线平片及CT改变,经三角骨月骨脱位伴茎突骨折7例,经舟骨、三角骨月骨脱位伴茎突骨折6例,经舟骨月骨脱位伴茎突骨折5例,经三角骨月骨脱位3例,经舟骨、三角骨月骨脱位1例,经舟骨月骨脱位1例.X线正位平片显示月骨与头状骨重叠,头月关节间隙、桡月关节间隙变窄,轮廓不清;侧位平片显示月骨向掌侧旋转移位,月骨窝状关节面空虚、朝向掌侧,呈“倾倒茶杯”征,舟骨和/或三角骨骨折块伴随月骨移位,16例X线平片侧位测量桡月角22°~110°,桡舟角25°~72°,桡头角-6°~22°.CT横断面、冠状面重建显示舟骨或/和三角骨骨折断端伴月骨向前旋转移位,冠状面重建显示“月骨丢失”征;矢状面重建显示月骨“倾倒茶杯”征;三维重建多方位、多角度显示月骨移位、旋转,CT对小的撕脱骨折显示清晰.结论大弧损伤性月骨脱位分型以经舟骨和/或三角骨月骨脱位伴茎突骨折常见,月骨旋转移位征象及月骨周围腕骨骨折是诊断的依据.Objective To investigate the classification and imaging features of lunate dislocation of wrist joints caused by greater arc injury.Methods A total of 23 patients with lunate dislocation of wrist joints caused by greater arc injury were analyzed retrospectively.16 patients underwent digital radiography(DR)examination,19 patients underwent CT scan,multiplanar reconstruction(MPR),curve planar reformation(CPR),and volume rendering(VR)were used for image reconstruction.Results The proximal and distal articular surfaces lines of the proximal row of carpal were discontinuous in all the 23 patients.Combining X-ray and CT changes,there were 7 cases of lunate dislocation passing through triangular bone with styloid fracture,6 cases of lunate dislocation passing through scaphoid and triangular bone with styloid fracture,5 cases of lunate dislocation passing through scaphoid bone with styloid fracture,3 cases of lunate dislocation passing through triangular bone,1 case of lunate dislocation passing through scaphoid and triangular bone,and 1 case of lunate dislocation passing through scaphoid bone.The X-ray anteroposterior film showed that the lunate bone overlapped with the cephalic bone,and the space between the lunate joint and the radial joint became narrow and unclear.The lateral film of 16 patients showed rotatory displacement of the lunate bone toward the palmar side,hole-shaped articular surface void toward the palmar,showing the“dumping cup”sign,and the scaphoid and/or triangular bone fractures with lunate bone displacement.The radius-lunate angle was ranged between 22°to 110°,the radius-scaphoid angle was ranged between 25°to 72°,and the radius-cephalic angle was ranged between-6°to 22°.CT transect and coronal reconstruction showed the scaphoid and/or the broken end of the triangular bone fractures forward rotation with displacement of lunate bone,and coronal reconstruction showed“lunate bone loss”.Sagittal reconstruction showed“dumping cup”sign of lunate bone.Three-dimensional reconstructions sho

关 键 词：腕关节 大弧损伤 月骨 脱位 计算机体层成像 

分 类 号：R681.7[医药卫生—骨科学] R681[医药卫生—外科学] R814.42[医药卫生—临床医学]