膝關(guān)節(jié)損傷的mri表現(xiàn)

1、膝關(guān)節(jié)損傷的MRI表現(xiàn),河北醫(yī)科大學(xué)第三醫(yī)院孫英彩,www.themegallery.com,半月板損傷韌帶損傷軟骨損傷骨軟骨損傷隱匿性骨折骨挫傷,www.themegallery.com,半月板損傷Injury of The Menisci,www.themegallery.com,,www.themegallery.com,,www.themegallery.com,,,www.themegallery.com,半月板

2、損傷MRI分為三級(jí) Ⅰ級(jí)損傷即早期退變或變性Ⅱ級(jí)損傷即嚴(yán)重變性，是Ⅰ級(jí)損傷的繼續(xù)Ⅲ級(jí)損傷即撕裂（Menisci Tear） 斜行撕裂、水平撕裂、垂直撕裂、放射狀撕裂、縱形撕裂、桶柄狀撕裂（Bucket-handleTear）、復(fù)雜撕裂、半月板關(guān)節(jié)囊分離,www.themegallery.com,www.themegallery.com,,www.themegallery.com,,www.themegallery.com,,,

3、www.themegallery.com,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,www.themegallery

4、.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,盤(pán)狀半月板（Discoid Meniscus）MRI-sag: 5mm層厚掃描時(shí)有3個(gè)或以上層面顯示半月板前后角相連，形成蝴蝶結(jié)樣改變Cor-半月板最窄處寬度大于14-15mm，外側(cè)緣高于對(duì)側(cè)2

5、mm以上,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,交叉韌帶 正常ACL起于髁間嵴前區(qū),向上后外至于股骨外髁內(nèi)后面 PCL起于髁間后區(qū),向上前內(nèi),至于股骨內(nèi)髁外后面,www.themegallery.com,,交叉韌帶損傷(Injury of The Cruciate Ligaments)交叉韌帶損傷MRI表現(xiàn)

6、前交叉韌帶損傷有完全撕裂和部分撕裂MRI上區(qū)分部分和完全撕裂困難 前交叉韌帶完全撕裂直接征象為ACL連續(xù)性中斷韌帶扭曲呈波浪狀A(yù)CL內(nèi)形成假瘤，在T1WI呈低信號(hào)，T2WI上呈高信號(hào)，并且見(jiàn)不到完整的纖維束T2WI上ACL內(nèi)呈現(xiàn)彌漫性高信號(hào),www.themegallery.com,,后交叉韌帶斷裂的征象PCL連續(xù)性中斷，殘余的韌帶退縮、扭曲MRI上未顯示PCL在T1WI、T2WI上呈不規(guī)則的高信號(hào)PCL脛骨附著點(diǎn)有

7、撕脫的骨碎片和后交叉韌帶相連而韌帶的連續(xù)性未見(jiàn)中斷,www.themegallery.com,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegal

8、lery.com,,www.themegallery.com,側(cè)副韌帶損傷Injury of The Collateral Ligaments,正常解剖脛側(cè)副韌帶起自股骨內(nèi)側(cè)收肌結(jié)節(jié)之下，止于脛骨的內(nèi)側(cè)，相當(dāng)于脛骨粗隆水平，長(zhǎng)度約11cm，寬度約1.5cm 腓側(cè)副韌帶起自股骨外上髁上方，止于腓骨頭下方，呈一個(gè)圓索條狀結(jié)構(gòu)，長(zhǎng)約5-7cm,www.themegallery.com,側(cè)副韌帶損傷Injury of The Colla

9、teral Ligaments,影像學(xué)表現(xiàn)MRI上正常副韌帶在任何序列均為低信號(hào)檢查多采用冠狀面和橫軸面檢查,www.themegallery.com,側(cè)副韌帶損傷Injury of The Collateral Ligaments,影像學(xué)表現(xiàn)側(cè)副韌帶損傷MRI上表現(xiàn)為韌帶內(nèi)長(zhǎng)T2高信號(hào)完全斷裂表現(xiàn)為韌帶連續(xù)性中斷或韌帶增粗、腫脹、韌帶內(nèi)彌漫性高信號(hào),www.themegallery.com,,www.themegallery

10、.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,www.themegallery.com,髕韌帶損傷Injury of The Patellar Ligaments,正常解剖為股四頭肌的延續(xù)部是全身最強(qiáng)大的韌帶之一位于膝關(guān)節(jié)囊的正前方起自髕尖及其后方的粗面，向下止于脛骨粗隆，長(zhǎng)約8

11、cm,www.themegallery.com,髕韌帶損傷Injury of The Patellar Ligaments,影像學(xué)表現(xiàn)MRI上任何序列均表現(xiàn)為低信號(hào)矢狀面和橫軸面顯示好部分撕裂時(shí)MRI上表現(xiàn)為韌帶內(nèi)高信號(hào)完全撕裂時(shí)表現(xiàn)為韌帶斷裂，髕骨上移，韌帶呈波浪狀改變,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,髕韌帶損傷Injur

12、y of The Patellar Ligaments,,www.themegallery.com,,,www.themegallery.com,股四頭肌腱,,www.themegallery.com,,,www.themegallery.com,正常膝關(guān)節(jié)軟骨,www.themegallery.com,,www.themegallery.com,股骨內(nèi)髁正常軟骨,,www.themegallery.com,,www.themegall

13、ery.com,軟骨骨折cartilage fractures,www.themegallery.com,軟骨骨折：是指外傷導(dǎo)致的關(guān)節(jié)軟骨連續(xù)性中斷，而軟骨下骨形態(tài)正常，無(wú)斷裂，MRI上軟骨下低信號(hào)帶形態(tài)、信號(hào)正常，即X線上所見(jiàn)的“關(guān)節(jié)面”完整,www.themegallery.com,男，20歲，扭傷膝關(guān)節(jié)20天,,www.themegallery.com,女，17歲，扭傷膝關(guān)節(jié)6天。,,www.themegallery.com,,

14、www.themegallery.com,男，9歲，車(chē)禍10天,,www.themegallery.com,軟骨局部變薄部分缺損,,,www.themegallery.com,骨軟骨骨折bone-cartilage fractures,www.themegallery.com,概念：外傷性軟骨骨折多合并有軟骨下骨的骨折，即所謂骨軟骨骨折 ，MRI表現(xiàn)為軟骨下低信號(hào)線形態(tài)異常，連續(xù)性中斷。X線片或CT可發(fā)現(xiàn)骨碎片,www.themega

15、llery.com,男17歲，扭傷膝關(guān)節(jié)2H,www.themegallery.com,www.themegallery.com,www.themegallery.com,,www.themegallery.com,,www.themegallery.com,,www.themegallery.com,骨軟骨骨折,,www.themegallery.com,,48歲男性脛骨近端骨折累及軟骨,www.themegallery.com,,w