胸腰椎骨折后方韧带复合体损伤顺序及其意义

目的 借助MRI影像,研究胸腰椎骨折时后方韧带复合体(PLC)损伤的先后顺序及其意义. 方法 收集2008年9月-2012年9月132例脊柱骨折患者的X线片、CT和MRI抑脂序列检查资料.按骨折形态行AO骨折分型,棘间韧带(ISL)、棘上韧带(SSL)、黄韧带(FL)和小关节囊(FC)根据损伤程度分为完整、血肿和撕裂,ISL又分为血肿比例＞50％和≤50％.最后分析AO形态学损伤的进行性等级与MRI信号之间的关系. 结果 AO A1/A2表现为单纯FC牵张损伤,A3出现ISL撕裂,范围较小,FL和SSL基本完整;AO B1表现为除FC损伤外,还有ISL血肿撕裂,SSL/FL损伤发生率较低,β2表现为SSL/FL损伤发生率明显增加;AO C表现为小关节脱位伴骨折,ISL、SSL、FL均会撕裂.AO骨折程度与MRI显示PLC损伤高度相关(P＜0.01). 结论 MRI能很好显示PLC各单元的损伤情况及其损伤顺序.AO形态学分型与MRI紧密关联,随着创伤力量的增加,PLC各成分出现进行性损伤.     

地震伤多节段相邻型脊柱骨折的MSCT和MRI表现

目的明确多节段相邻型脊柱骨折的多层螺旋CT（MSCT）、MRI表现。方法对地震伤致相邻多节段脊柱骨折的5例患者的影像资料进行回顾性分析。5例均行MSCT检查,4例行MRI检查。结果 1例发生在胸椎,3例发生在胸腰段脊柱,1例发生于骶椎。CT表现：4例表现为相邻多个椎体压缩性骨折;1例相邻多个椎体爆裂性骨折。MRI主要表现为椎体内T1WI呈稍低或等信号改变,T2WI为高信号,STIR更高信号。结论结合患者高能量外伤病史,MSCT和MRI能准确、快速地对相邻多节段脊柱损伤患者进行诊断,为临床治疗起到指导作用。     

ADC值与外伤性椎体压缩骨折时间的相关性研究

目的 通过椎体压缩骨折外伤时间与MRI表现的相关性研究,探讨MRI表观扩散系数(ADC)值在推断外伤性椎体压缩骨折时间中的应用价值.方法 选取外伤性胸、腰椎压缩骨折患者40例及志愿者10名.根据外伤时间分为7个时段,分别进行磁共振跟踪扫描.脊柱线圈TSE序列,常规行矢状位T2 WI、T1WI、T2 WI-Fs扫描,轴位T2 WI、DWI扫描,观察各时段信号强度,测量ADC值.结果 随着骨折愈合时间的延长,ADC值逐渐下降,骨折≥60天的患者其ADC值与对照组比较无显著差异(P＞0.05).结论 运用磁共振成像量化指标表观扩散系数(ADC)值可以推测外伤性胸、腰椎压缩骨折损伤时间.     

儿童无骨折脱位型脊髓损伤的MRI特征

【摘要】目的：回顾性分析儿童无骨折脱位型脊髓损伤（SCIWORA）的MR影像学表现及临床特点,提高对儿童SCIWORAMRI特征的认识。方法：对2004年4月－2011年10月我院诊断为SCIWORA的10例患儿的临床及脊柱MRI资料进行回顾性分析。结果：10例患儿均于外伤后(车祸碾压腰腹部1例,外力打击腰部2例,舞蹈练习下腰7例),立即至3天后出现下肢无力、疼痛等脊髓损伤症状,10min～3d（中位时间3.5h）后症状达高峰,出现下肢瘫痪,症状稳定不再进展。伤后2～10d行首次脊柱MRI检查,病变累及全脊髓的1例,累及下颈段、胸段、腰段1例,累及胸段者2例,累及胸、腰段的6例。MRI显示脊髓水肿4例,呈长T2长T1信号;脊髓水肿伴出血6例,出血呈短T1信号。11～18d复查者10例,病变范围减小1例,范围增大2例,范围无变化7例。复查时出血者3例。伤后32～42d复查者4例,均发现脊髓萎缩。本组合并非神经性软组织损伤1例,可见前纵韧带损伤。结论：全脊柱MRI检查是用于诊断儿童SCIWORA的最佳影像学检查方法,不仅可进行脊髓损伤的神经影像学评估,还可显示脊柱X线及CT无法直接显示的脊柱韧带、椎间盘、终板及骨髓等非神经性软组织损伤情况,有利于临床治疗方案的制定及预后评估。     

地方性氟骨症脊柱MR表现

目的 探讨地方性氟骨症脊柱病变MR表现.方法 对58例地方性氟骨症患者的74个脊柱段行MRI和X线平片检查,另选择80例无地方性氟骨症且年龄相匹配的病例作为对照组,并对MRI和X线平片表现进行分析.结果氟骨症组所有椎骨信号强度均有不同程度减低, T1WI信号强度平均值明显低于对照组(P<0.001),不同含氟量饮用水区域MR椎骨信号减低程度差别无统计学意义(P>0.05).74例(脊柱段)中,MRI显示韧带增厚66例(89.2%);椎管狭窄68例(91.9%),其中因后纵韧带和(或)黄韧带增厚所致56例,因后纵韧带和(或)黄韧带增厚伴椎间盘突出所致10例,因单纯椎间盘后突所致2例;脊髓受压54例(73%);脊髓内有长或等T1和长T2异常信号19例(25.7%).结论 MRI显示的地方性氟骨症椎骨信号减低及韧带增厚骨化,对其诊断有较大价值.     

MRI全脊柱移床扫描在脊柱损伤的诊断及临床应用

目的:探讨MRI全脊柱移床扫描(MobiTrak)在诊断脊柱脊髓损伤中的诊断价值及临床应用。方法:对于48例疑有脊柱脊髓损伤患者行全脊柱移床扫描,对接颈、胸、腰骶段脊柱图像而形成完整的全脊柱图像。与对接前的根据患者临床症状、体征,以某一椎体为中心的局部脊柱扫描图像进行对比,少数病人行增强扫描。结果:48例患者,损伤部位颈段1 8例、胸段21例、腰段14例。其中多节段损伤5例。根据MRI表现将脊柱外伤分为4类:单纯压缩骨折无脱位;压缩骨折伴脱位;爆裂性骨折并脱位;无骨折脱位。全部病例均清楚显示伴有脊髓信号的异常,3例见脊髓断离,其中1例不全断离。结论:MRI全脊柱移床扫描可以反映脊柱损伤形态及脊髓损伤的形态和病理改变,也可对韧带、间盘等软组织损伤作出准确的判断,是评价脊柱损伤的好方法,可以指导治疗方法的选择,也有助于预后判断。     

膝关节损伤的MRI诊断

目的：探讨膝关节损伤的MRI特点、病理基础及临床意义。方法：分析52例膝关节损伤的MRI资料。结果：半月板损伤45例,MRI表现为黑色的半月板内出现结节状、线状、放射状裂隙样异常高信号,延伸达或未及关节软骨面两种,前交叉及后交叉韧带损伤24例,MRI表现为在条索状黑色韧带影中出现短T1长T2异常高信号,韧带变形,呈波浪状或不连续,胫骨移位,内、外侧副韧带损伤28例,表现为信号增高,形态增粗,边缘模糊,隐匿性骨折8例,表现为干骺端边界模糊的片状T1低信号影,T2信号多样,讨论：MRI对膝关节半月板、韧带损伤及隐匿性骨折的诊断有重要的临床意义,可对治疗方案的选择提供详尽的依据。     

MRI对比信噪比在推断外伤性胸、腰椎压缩骨折损伤时间中的应用

目的:通过椎体压缩骨折外伤时间与MRI表现的相关性研究,探讨MRI对比信噪比(contrast noise ratio,CNR)在推断外伤性椎体压缩骨折时间中的应用价值。方法:选取外伤性胸、腰椎压缩骨折患者76例及志愿者20例。根据外伤时间(T),将76例分为T7d、7d≤T15d、15d≤T30d、30d≤T60d、60d≤T90d、90d≤T120d共6组。所有患者应用脊柱线圈TSE序列,常规行矢状位T2WI、T1WI、SPAIR扫描,轴位T2WI扫描,观察各时段骨折部位信号特点,测量信号强度,计算CNR。结果:椎体骨折部位T1WI、T2WI信号强度及SNR与骨折时间无相关性。而骨折部位SPAIR信号强度及CNR与骨折时间均具有相关性(P0.05),其中SPAIR的CNR与骨折时间的相关性最强(P0.01)。随着骨折愈合时间的延长,SPAIR的CNR逐渐降低,骨折≥60d患者SPAIR的CNR与对照组比较差异无统计意义(P0.05)。结论:运用MRI的量化指标CNR可推测外伤性胸、腰椎压缩骨折损伤时间,其中SPAIR的CNR与骨折时间的相关性最强。     

胸腰椎脊柱损伤的分类

对胸腰椎脊柱损伤进行分类。按病程分为急性期、早期及陈旧性损伤;按损伤部位分为胸椎、腰椎及胸腰椎损伤;按稳定度分为稳定与不稳定损伤;按生物力学和损伤机制分为屈曲压缩骨折、爆裂骨折、安全带型及骨折脱位型损伤。特殊的脊柱损伤包括多节段脊柱骨折、脊柱复合伤和伴发不同程度的脊髓损伤。根据不同损伤类型提出不同的治疗原则。     

化脓性脊柱炎的MRI征象分析

目的 探讨化脓性脊柱炎的MRI表现.方法 对24例经手术及病理证实的化脓性脊柱炎MRI资料进行分析.结果 24例中,病变发生在腰椎18例,胸椎2例,胸腰段1例,腰骶段3例.21例为相邻2个椎体破坏并累及椎间盘,3例为单节椎体破坏未累及椎间盘.骨质破坏、增生硬化、骨髓水肿并存,椎体破坏塌陷程度轻,椎间隙变窄程度轻,脊柱曲度多正常.T1WI椎体破坏及受累椎间盘分界欠清并为低信号,T2WI为等或稍高信号,STIR为高信号;骨质增生硬化为低信号(各序列);骨髓水肿为高信号(STIR).合并病理性骨折1例,椎旁脓肿9例,硬膜囊及蛛网膜下腔受压18例,脊髓受压7例.结论 化脓性脊柱炎的表现具有一定的特征性,MRI对本病的诊断与鉴别诊断具有重大价值.     

Ultraschall zur Beurteilung des posterioren Ligamentkomplexes bei thorakolumbalen Wirbelsäulenfrakturen

Background

Thoracolumbar distraction injuries (AO classification type B) with damage to the posterior ligament complex (PLC) represent an indication for surgery but the use of X-ray and CT imaging often does not identify injuries of the PLC. The aim of this study was to evaluate the accuracy of ultrasound imaging in the assessment of the PLC status in thoracolumbar fractures of the spine.

Material and methods

In a prospective study the findings of the preoperative ultrasound examination were compared to the intraoperative findings.

Results

Over a period of 2 years a total of 24 patients with 27 thoracolumbar fractures (18 type A, 9 type B) were examined. In 22 cases ultrasound examination was possible and correct ultrasound findings were made in 20 cases (91%). The sensitivity was 83.3%, specificity 93.8%, positive predictive value 83.3% and negative predictive value 93.8%.

Conclusion

The use of ultrasound examination in thoracolumbar fractures is a suitable diagnostic tool for injuries of the posterior ligament complex in addition to radiological imaging.     

膝关节损伤的MR应用价值

目的 :分析膝关节损伤的MR表现并评价其应用价值。方法 :选择 60例经临床或手术证实的膝关节损伤患者 ,回顾性分析、总结其MR表现。采用 1 .0TMR扫描机 ,常规应用矢状位 ,SET1 W、T2 W ,冠状位T1 W、T2 W成像。结果 :2 9例半月板损伤 ,其中Ⅰ° 1 0例 ,Ⅱ°1 2例 ,Ⅲ°7例 ;前交叉韧带损伤 1 8例 ,撕裂 2 2例 ;后交叉韧带损伤 7例 ,撕裂1例 ;内侧侧副韧带损伤 2 8例 ,撕裂 1 7例 ;外侧侧副韧带损伤 1 2例 ,撕裂 9例 ;韧带损伤表现为韧带不同程度增粗 ,但韧带连续性仍然存在 ,正常低信号内出现不规则高信号影 ,韧带撕裂表现为韧带明显增粗 ,呈弥漫性高信号 ,韧带的连续性部分或完全中断 ;股骨下端或胫骨上端骨质损伤 9例 ;关节积液 54例 ;多种损伤可同时出现。结论 :MR检查可很好显示膝关节损伤的各种表现 ,可作为膝关节损伤检查的重要或首选手段     

膝关节损伤的MRI诊断及其临床价值

目的：研究膝关节损伤的MRI特点、病理基础、诊断价值及其临床意义。材料与方法：回顾性分析42例经手术病理证实的膝关节损伤的MRI资料。结果：42例膝关节损伤患者中，半月板撕裂34例，MRI表现为黑色的半月板内出现异常信号，其中延伸至关节面（26例）；“水桶把手”样撕裂（4例）；半月板变形缩小（4例）。前交叉韧带损伤28例，MRI表现为黑色条索状无信号韧带影中出现异常信号，呈不连续弯曲波浪状、斑片状或团块状。后交叉韧带损伤4例。其他改变：半月板囊肿4例，侧副韧带损伤18例，关节积液38例，骨折7例。结论：MRI对膝关节损伤的诊断具有重要的临床意义，可为制定正确的治疗方案提供客观而详细的依据。     

膝关节损伤的MRI对临床诊治的作用

目的　探讨膝关节损伤的MRI表现、病理基础、诊断价值及其临床意义。方法　对 3 1例膝关节损伤的MRI征象进行回顾性分析 ,并与临床和手术结果进行比较。结果　膝关节损伤的MRI征象可分为 :(1)膝关节周围软组织肿胀 2 3例 (74% ) ;(2 )关节韧带损伤 18例 (58% ) ,关节脱位 2例 (6% ) ;(3 )骨折 12例 (3 9% ) ,骨挫伤 4例 (13 % ) ,隐匿性骨折 1例 (3 % ) ,关节面软骨损伤 1例(3 % ) ;(4)半月板损伤 15例 (48% ) ,半月板囊肿 2例 (6% ) ;(5)股四头肌和髌韧带损伤各 1例 (3 % ) ;(6)不同程度的关节积液 2 9例(9 3 % )。结论　MRI能反映膝关节损伤的各种病理改变 ,对临床的处理和预后判断具有重要价值     

MR evaluation of the "arcuate" sign of posterolateral knee instability

OBJECTIVE: The purpose of this study was to evaluate associated knee injuries using MR imaging in patients with the "arcuate" sign, a term referring to avulsion fracture of the proximal fibula on conventional radiographs. MATERIAL AND METHODS: MR imaging of 18 cases (17 patients, both knees in one patient) with the arcuate sign on conventional radiographs was retrospectively interpreted to evaluate the associated meniscal, ligamentous, and bony injuries. In 12 cases, MR findings were correlated with surgical results. RESULTS: In all cases, avulsed bony fragments from the proximal pole of the fibula were attached to the fibular collateral ligament, the biceps femoris tendon, or both. Tear of the posterolateral capsule was seen in 12 cases (67%). Injury of the cruciate ligaments was noted in 16 cases (89%): injury to both the anterior cruciate ligament and posterior cruciate ligament was seen in nine cases (50%), injury to only the anterior cruciate ligament was seen in four, and injury to the posterior cruciate ligament only was noted in three. Bone bruises or gross fractures were seen in all cases: bone bruises on the anteromedial femoral condyle were noted in nine cases (50%) and were seen on the anteromedial tibial condyle in five cases (28%). Tear of the medial meniscus was seen in five cases (28%) and tear of the lateral meniscus in four cases (22%). Injury to the popliteus was seen in six cases (33%). Joint effusion was associated in all cases. CONCLUSION: MR imaging is useful for evaluation of associated soft-tissue injuries in patients with the arcuate sign on conventional radiographs. Avulsion injury to the proximal fibula is an important indicator of the internal derangement of the knee and for predicting the mechanism of an injury with varus stress. Cruciate ligament tear and bone bruises on the anteromedial condyle of the femur and tibia are common associated findings.     

Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation

Purpose: To describe the magnetic resonance imaging (MRI) findings of injuries of the posterolateral aspect of the knee and to evaluate the diagnostic capabilities of MRI in the assessment of these injuries.

Material and Methods: The MRI studies of 14 patients (mean age 33 years) with trauma to the posterolateral aspect of the knee were retrospectively reviewed, and the imaging findings were correlated with those of surgery.

Results: In all patients, MRI showed an intact iliotibial (ITB) band. MRI showed injury to the biceps tendon in 11 (79%), the gastrocnemius tendon in 1 (7%), the popliteus tendon in 5 (36%), and the lateral collateral ligament (LCL) in 14 (100%) patients. Tear of the anterior cruciate ligament (ACL) was seen in 11 (79%) patients and tear of the posterior cruciate ligament (PCL) in 4 (29%) patients. With routine MRI, visualization of the popliteofibular or fabellofibular ligaments was incomplete. On MRI, the lateral meniscus and the medial meniscus were torn with equal frequency (n = 4; 29%). Osteochondral defects were seen in 5 (36%) cases and joint effusion in all 14 (100%) cases on MRI. Using surgical findings as the standard for diagnosis, MRI proved 86% accurate in the detection of injury to the ITB band, the biceps tendon (93%),, the gastrocnemius tendon (100%), the popliteus tendon (86%), the LCL (100%), the ACL (79%), the PCL (86%), the lateral meniscus (90%), the medial meniscus (82%), and the osteochondral structures (79%). Surgical correlation confirmed the MRI findings of joint effusion in all cases.

Conclusion: MRI is well suited for demonstrating the presence and extent of injuries of the major structures of the posterolateral complex of the knee, allowing characterization of the severity of injury.     

Traumatic thoracolumbar facet instability: characteristic imaging findings

 Objective. To review imaging patterns and injury mechanisms in patients with thoracolumbar facet instability (TFI). Design. Imaging studies for thoracolumbar osseous injuries over a 2-year period were reviewed. Imaging findings, injury pattern and reported mechanism of injury were established for patients with TFI. Patients. One hundred and ten patients with thoracolumbar acute, osseous injuries were studied. Results. Eleven of 68 (16.2%) unstable thoracolumbar injuries demonstrated TFI. Seven (64%) of the eleven TFI patients were unrestrained occupants in a motor vehicle accident (MVA) and the remainder were involved in injuries dominated by blunt impact to the back. Only two (18%) had serious, permanent neurological deficits. Conclusion. TFI is a common injury pattern, particularly for unrestrained occupants in MVAs. Characteristic radiographic, CT and MRI findings are presented and correlated with the injury mechanism and clinical findings.     

膝关节骨与韧带急性损伤的MRI研究

目的:探讨MRI检查中急性膝关节骨损伤与韧带损伤之间的合并关系以及临床应用价值。方法:38例急性膝部骨损伤病人,行MRI重点观察STIR序列的损伤情况。骨损伤分为显性骨折(X线检查可见)与隐性骨损伤(X线检查未见异常),韧带损伤包括撕裂与完全断裂。结果:38例共45处骨损伤,包括显性骨折28处(73%)、隐性骨损伤(骨挫伤)17处(44%)。84%病例的骨损伤累及胫骨。86%的病例合并多韧带损伤,最常累及内侧副韧带、前交叉韧带与后交又韧带,74%的损伤韧带非邻近骨损伤部位。结论:急性膝部骨损伤最常累及腔骨,常合并多韧带损伤,但韧带损伤多不靠近骨损伤部位。MRI脂肪抑制序列能直观地显示韧带的撕裂与完全断裂,且能发现相当多的隐性骨损伤病例。     

低场磁共振GE序列在膝关节侧副韧带损伤诊断中的应用评价

目的：探讨损伤的膝关节侧副韧带在低场MRIGE序列中的表现。方法：对经手术或临床证实的48例共54条损伤的侧副韧带进行回顾性MRI对比观察。结果：54条侧副韧带损伤，单纯胫侧副韧带27条，单纯腓侧副韧带18条，两侧侧副韧带同时损伤10条。Ⅰ级侧副韧带损伤27条；Ⅱ级侧副韧带损伤17条；Ⅲ级侧副韧损伤10条。30例（62．5％）出现并发症，其中前交叉韧带损伤19条。后交叉韧带损伤14条，半月板损伤18个，骨挫伤及骨折11例，关节囊积液30例。结论：GE序列能缩短检查时间，清晰显示膝关节侧副韧带解剖结构，准确诊断侧副韧带损伤并能进行分级，发现多种并发症，宜列为膝关节外伤的常规扫描序列。     

四川汶川特大地震脊柱损伤的MRI表现

目的探讨四川汶川特大地震所致脊柱损伤的MRI表现特点。方法分析总结23例地震伤脊柱损伤的MRI表现。结果23例中,颈椎骨折3例,颈胸椎骨折1例,胸椎骨折9例,胸腰椎骨折3例,腰椎骨折3例,骶椎骨折1例,共34个椎体骨折。椎体骨挫伤12例;脊髓水肿、挫伤、血肿12例;椎间盘损伤4例;硬膜外血肿11例,硬膜下血肿1例,腰大肌、竖脊肌挫伤血肿8例。结论MRI能清楚显示地震伤脊柱损伤的各种病理改变。