月骨周围脱位的影像学分析及临床应用

Imageology analysis of perilunar dislocation and its clinical application

目的:分析月骨周围脱位的影像学表现,提高对月骨周围脱位的认识和诊断水平。方法:回顾性分析56例月骨周围脱位患者X线片与多层螺旋CT薄层扫描及三维重建(3D)和多平面重建(MPR)图像。其中男55例,女1例;年龄18～47岁,平均32.4岁。结果:56例月骨周围脱位,均为背侧型,其中经舟状骨月骨周围脱位11例,不伴腕骨骨折的单纯月骨周围脱位10例,经舟状骨、三角骨、月骨周围脱位26例(其中1例伴豌豆骨撕脱骨折),经三角骨、月骨周围脱位6例,经头状骨、月骨周围脱位3例。伴尺桡骨远端骨折24例,伴掌腕关节脱位4例。X线片诊断准确29例,误漏诊27例。运用CT薄层扫描及重建技术诊断全部准确。结论:熟悉腕关节的正常影像学解剖,掌握各型月骨周围脱位的影像学特点,是作出准确诊断和及时治疗的基础。多层螺旋CT薄层扫描及重建能够直观清晰地显示骨折脱位的类型,为临床确定骨折分型、选择合适的治疗方案提供了可靠而直观的依据,是避免误漏诊的关键。

Objective： To analyze imageology manifestation of perilunar dislocation, to improve recognition and diagnose of the perilunar dislocation. Methods：Fifty-six patients suffered from perilunar dislocation injuries were selected in our group, fifty-five male and one female, ranging in age from 18 to 47 years,with an average of 32.4 years. Roentgenograph,thin slice multi-spiral CT scanning, three dimensional reconstruction （3D） and multi-planar reconstruction （MPR） were underwent for patients before and after surgery. Results：Thin slice multi-spiral CT thinner scanning and reconstruction provided clear images for all subjects, in which 56 patients had dorsal perilunate dislocations, 11 patients had transscaphoid perilunate dislocations, 10 patients had perilunar dislocation without carpus fractures, 26 patients had perilunar dislocation through eentrale and pyramidal bone （one combined with avulsion fracture of pisiform bone）, 6 patients had trans triangular bone perilunar dislocation, 3 patients had trans capitate bone perilunar dislocation, 24 patients had perilunar dislocation combined with distal fractures of radial and ulnar, 4 patients had perilunar dislocation combined with dislocation of wrist joint. Conclusion ： To be familiar with normal imageology anatomy of wrist joint and to master imageology characteristic of all types of perilunar dislocation are the basis of final diagnosis and prompt treatment. The thin slice multi-spiral CT scanning,three dimensional reconstruction （3D） and multi-planar reconstruction （MPR） provide clear images to diagnose the details of perilunar dislocation,and to select the therapeutic regimen. So it can be the first eikonic choice for perilunar dislocation.