最新医学影像诊断学骨骼肌肉系统疾病比较影像图谱(系列之三精品课件.ppt
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1、2第一节骨与关节创伤第一节骨与关节创伤 一,骨折一,骨折(一)骨折总论(一)骨折总论9图图6A2桡骨头骨折桡骨头骨折nAnterior and posterior fat pad elevation (arrows) signifies effusion of the ellow joint. The fracture of the radial head is only identified by a minimal “step-off” of the volar cortex.10图图7A1Colles fracturenX线表现线表现n桡骨远端见骨折线,桡骨远端见骨折线,骨折远端向外后方
2、骨折远端向外后方移位。桡骨下关节移位。桡骨下关节面倾斜,尺骨向上面倾斜,尺骨向上移,尺骨茎突见小移,尺骨茎突见小骨片;骨片;nX线诊断线诊断n桡骨远端伸直型骨桡骨远端伸直型骨折折(Colles 骨折骨折)11图图7A2Colles fracturenLateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fracture fragment.12图图8A蒙泰贾骨折蒙泰贾骨折 (Monteggia fracture)nM
3、onteggia fracture-dislocationnLateral radiograph of the forearm demonstrates fracture of the ulnar shaft with anterior dislocation of the radius.13图图9A加莱阿齐骨折加莱阿齐骨折(Galeazzis fracture )nGaleazzis fracture-dislocationnAP radiograph of the forearm demonstrates a fracture of the radial shaft and disloca
4、tion of the inferior radioulnar joint.14图10A1指掌骨骨折nboxers fracturenAP(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nboxers fracturenAP(a) and oblique (b) radiographs o
5、f the 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na. AP radiograph of the hip demonstrates a fracture through the femoral neck.17图11A2股骨颈骨折nb. AP radiograph after fixation of the femoral neck fracture wi
6、th three cannulated screws.18图图12A胫骨粉碎性骨折胫骨粉碎性骨折nComminuted fracture of the mid tibia with medial displacement and medial angulation of the distal fragment.19图图13A跟骨骨折跟骨骨折nAvulsion(粉碎性)粉碎性) fracture.nLateral radiograph demonstrates an avulsion fracture of the calcaneus(跟骨)跟骨) by the Achilles tendon
7、(跟腱)跟腱).20图图14A距骨骨折合并脱位距骨骨折合并脱位nFracture dislocation of the talus(距骨距骨).nThere is a comminuted fracture of the waist of the talus with posterior dislocation and rotation of the proximal fragment.21图图15A脊柱压缩骨折脊柱压缩骨折nCompression fracture.nLateral radiograph of the L1 vertebra demonstrates a wedging de
8、formity that occurred after trauma.22图图16AB脊柱爆裂骨折脊柱爆裂骨折(burst 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 脊柱安全带型骨折脊柱安全带型骨折(lap seat-belt-type fracture)nLap
9、 seat-belt-type fractures occur from forced hyperflexion and are subdivided into three groups:nType 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)关节突) and pedicles.nType II, the Smith f
10、racture, is similar but does not involve the spinous process.nType III, involves one side only due to a rotational component.24 图图17A脊柱安全带型骨折脊柱安全带型骨折(lap seat-belt-type fracture)nA, Smiths fracture of L3. There is a horizontal fracture of the posterior elements of L3 well seen on the lateral view an
11、d demonstrated on the frontal view(B) By horizontal lucencies through the pedicles(椎弓根)椎弓根) (arrows) but superior to the spinous process.AB25图图18AB脊柱骨折脱位脊柱骨折脱位nHangmans fracture.nThere are oblique fractures through the pedicles of C2(arrow) with anterior displacement of the body of C2. B. CT scan of
12、 a different patient shows extension of the fracture through the body and into the vertebral canal on the left.26图图19A旋转性寰枢关节半脱位旋转性寰枢关节半脱位(rotatory atlantoaxial subluxation)nA. Os odontoideum, with posterior subluxation of C1 on C2. The os is well seen as a cortical rounded density (arrows) lying po
13、sterior to the anterior ring of C1. B. Open-mouth view demonstrates a characteristic rounded corticated margin of the stump of the odontoid.AB27图图20A创伤性寰枢关节脱位创伤性寰枢关节脱位 (traumatic rotatory atlantoaxial dislocation)nJefferson burst fracture of C1. A, There is anterior displacement of C1 with respect t
14、o C2, and significant prevertebral soft-tissue swelling. B, Open-mouth odontoid view demonstrates lateral displacement of the lateral masses of C1.28图图21寰枢关节半脱位的薄层寰枢关节半脱位的薄层CT横断面、横断面、矢状面及冠状面(暂缺)矢状面及冠状面(暂缺)29图图22A寰椎骨折寰椎骨折(Jefferson fracture)A, Odontoid view of the patient demonstrates lateral displac
15、ement of the lateral masses of C1 in this patient with a Jefferson fracture.A30图图22B寰椎骨折寰椎骨折(Jefferson fracture)B, Axial CT scan demonstrates a comminuted fracture of the atlas(寰椎)寰椎).B31图图23A骨盆骨折骨盆骨折nLateral compression fracture.nTypical horizontal/overlap fractures of the pubic rami or the right a
16、rea 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.32图图23B骨盆骨折骨盆骨折n女性,女性,20岁。左髋部外伤一周。岁。左髋部外伤一周。nCT表现左髋臼前柱(即耻骨上支)及耻骨骨质不连续,并有表现左髋臼前柱(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),左股骨头明显向移位,关节囊上方
17、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)。前移位,关节囊明显肿胀,其中有低密度影(右图)。nCT诊断左髋臼前柱粉碎性骨折,股骨头脱位及关节囊内出血。诊断左髋臼前柱粉碎性骨折,股骨头脱位及关节囊内出血。33二,关节创伤二,关节创伤34图图24A1肩关节前脱位肩关节前脱位nAnterior dislocation of the right humerus. The inferior rim of the glenoid has impacted on the superior margin of the humerus, giving rise to a
18、 Hall-Sachs, or batcher deformity.35图图24A2肩关节后脱位肩关节后脱位nA, 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图图24A3肩关节后脱位肩关节后脱位 B, A “swimmers view” demonstrates the arti
19、cular suface of the humerrus projected posteriorly and lying postreior to the glenoid (arrowheads).B37图图24B肩关节前脱位肩关节前脱位n右肩习惯性脱位右肩习惯性脱位n右肩盂前缘骨缺右肩盂前缘骨缺损损38图图25A1肩袖撕裂肩袖撕裂 (Rotator Cuff Tear)n肩关节双重造肩关节双重造影影nX线片示肩袖线片示肩袖完全撕裂,肩完全撕裂,肩峰下滑囊充满峰下滑囊充满造影剂造影剂39图图25A2肩袖撕裂肩袖撕裂 (Rotator Cuff Tear)nContrast is seen la
20、teral to the humeral head in the subdeltoid bursa (三角肌下三角肌下囊)囊). This indicates a total rotation cuff tear.40图图25C肩袖撕裂肩袖撕裂 (Rotator Cuff Tear)nMRI rotator cuff tear.nComplete rotator cuff tear. T2weighting. A large high signal effusion surrounds the humeral head. The rotator cuffs retracted (arrowhe
21、ads), with total disruption of the tendon, which cannot be identified.41图图26A肘关节脱位肘关节脱位nComplete elbow dislocation. nThere is also a fracture of the radial head, with small bone fragments seen overlying the ulna and radial soft tissues.42图图27A1肱骨外髁骨骺骨折肱骨外髁骨骺骨折 (Salter-Harris IV 型型-暂缺)暂缺)43图图27A2胫骨远端
22、骨骺骨折胫骨远端骨骺骨折 (Salter-Harris IV 型)型)nSalter IV fracture of the distal tibia, with fracture lines identified in the metaphysis and epiphysis.44图图27A2肱骨内上髁骨骺分离肱骨内上髁骨骺分离nX线表现:线表现:n肱骨内上骨骺肱骨内上骨骺向内侧移位,向内侧移位,并翻转向下并翻转向下nX线诊断:肱线诊断:肱骨内上髁骨骺骨内上髁骨骺分离分离45图图28A肱骨髁间骨折(暂缺)肱骨髁间骨折(暂缺)46图图29A1腕舟骨骨折腕舟骨骨折nScaphoid fractur
23、e. nThis was not seen on the regular veiws(常规位)常规位) but became evident on this specific scaphoid view.47图图29A2第第1掌骨基底骨折掌骨基底骨折 (Bennet fracture)nBennets fracture of the thumb metacarpal with dislocation of the major distal fragment. The minor fragment is seen in its normal relationship to the trapezi
24、um(梯形)梯形). Of note is the old undiagnosed avulsion(撕裂)撕裂) fracture of the base of the proximal phalanx (arrow)48图图30A月骨脱位月骨脱位nLunate dislocation.nAlthough easily appreciated on the lateral view (A) the lunate (L) has taken on atypical triangular configuration on the AP view (B). In this case, there
25、is also a fracture through the proximal pole of the scaphoid, with displacement of the proximal fragment in association with the lunate.AB49图图31A月骨周围脱位(见备注)月骨周围脱位(见备注)nTransscaphoid/perilunate fracture dislocation. There is disruption of the carpus with disorganization of alignment(排列)排列) between th
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