拇指伸肌与屈肌正常结构解剖及损伤的磁共振成像表现  

MRI manifestations of anatomy and injuries of thumb extensor and flexor mechanism

作　　者：叶薇[1] 钱占华[1] 白荣杰[1] 詹惠荔 李亚雄[1] 王崧铭 Ye Wei;Qian Zhanhua;Bai Rongjie;Zhan Huili;Li Yaxiong;Wang Songming(Department of Radiology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院放射科,北京100035

出　　处：《中华全科医师杂志》2022年第5期464-470,共7页Chinese Journal of General Practitioners

基　　金：国家自然科学基金面上项目(82171921,81371515);北京市自然科学基金面上项目(7202063)。

摘　　要：目的了解拇指伸肌与屈肌结构的正常解剖及损伤的磁共振成像(MRI)表现。方法对2013年9月至2021年9月北京积水潭医院放射科招募的10名无拇指外伤史及疼痛史且功能活动正常的健康志愿者及20例拇指伸肌或屈肌结构损伤患者的MRI检查影像资料,采用盲法进行回顾性阅读,对照分析拇指伸肌及屈肌结构的正常解剖及损伤的MRI特点;并将影像学表现与手术或随访结果进行对照。20例患者中,拇长伸肌腱损伤8例,拇短伸肌腱损伤1例,拇长屈肌腱损伤6例,拇指滑车损伤5例;诊断经手术证实5例、随访证实15例。结果10名健康志愿者的拇指伸肌腱和屈肌腱MRI表现为T1加权(T1WI)及质子密度脂肪抑制(PD-FS)序列上的细条带状均匀低信号;掌指关节、指间关节水平的环状滑车MRI表现为包绕屈肌腱的低或稍低信号环状结构。20例拇指肌腱损伤患者8例拇长伸肌腱损伤中,4例为单纯损伤、2例为部分撕裂,2例为完全断裂(均为手术证实);1例拇短伸肌腱损伤为完全断裂(手术证实)。6例拇长屈肌腱损伤中,2例为单纯损伤、2例为部分撕裂、2例为完全断裂(均为手术证实)。5例滑车损伤均为部分撕裂,其中A1滑车1例、A2滑车4例。MRI表现为损伤结构T1WI序列信号不清,PD-FS序列损伤结构信号不均匀增高,根据损伤程度的不同纤维有部分或完全中断,可见周围软组织水肿。结论MRI是评价拇指伸肌与屈肌结构正常解剖及损伤的有效方法,对拇指肌腱损伤的诊断和治疗具有重要的应用价值。Objective To explore the anatomy and injuries features of the thumb extensor and flexor mechanism with MRI.Methods Ten healthy subjects without thumb injury and 20 patients with thumb extensor or flexor mechanism injuries were recruited in the study between September 2013 and September 2021.All subjects underwent MRI examination,the MRI features of thumb extensor or flexor mechanism in healthy subjects and patients were analyzed.The imaging findings were compared with the surgical results and confirmed by followed up in patients.Results The healthy subjects showed homogeneous low-signal-intensity on T1-weighted and proton-fat saturation sequence(PD FS)images.Twenty patients with thumb extensor or flexor mechanism injures(including 8 cases of extensor pollicislongusinjury,1 case of extensor pollicisbrevis injury,4 cases of flexor pollicislongus injury,2 cases offlexor pollicis brevis injury and 5casesofpulley injury)demonstrated poor definition in T1WI,and heterogeneously increased signal intensity in PD-FS.Depending on the degree of injury,the fibers may be partially or completely discontinuity of the involved tendons.There was edema in the soft tissues surrounding the injured sites.Conclusion MRI is an accurate method for evaluation of the anatomy and pathological conditions of the thumb extensor and flexor mechanism.

关 键 词：拇指 肌腱 滑车 解剖 损伤 磁共振成像 

分 类 号：R658.2[医药卫生—外科学] R445.2[医药卫生—临床医学]