不典型月骨周围脱位的影像表现及鉴别

Imaging findings and differential diagnosis in atypical perilunar dislocatione

目的总结不典型月骨周围脱位影像特点及与相关骨折脱位的鉴别要点。方法本组16例不典型月骨周围脱位均摄有腕关节正侧位片,5例同时行64排CT扫描及重建,仔细观察分析每一病例的影像表现及特点。结果本组16例均为不典型月骨周围后脱位,伴不同程度月骨向前半脱位。单纯不典型月骨周围后脱位10例,其中同时伴舟骨后脱位3例,半脱位2例,无脱位5例,舟骨无脱位病例中,1例正位头舟间隙明显增宽;经舟骨不典型月骨周围脱位6例,除月骨向前半脱位外,舟骨骨折近段亦随月骨向前半脱位。结论单纯不典型月骨周围后脱位均伴有不同程度月骨向前半脱位,可伴或不伴舟骨后脱位;经舟骨不典型月骨周围后脱位,月骨及骨折近段同时向前半脱位。

Objective To summarize the imaging features of atypical perilunar dislocation and differential di-agnosis. Methods Sixteen cases of atypical perilunar dislocation in our grup were taken front and lateral wrist joint radiograph, five cases underwent 64-slice spiral CT and reconstuction in addition. All the images were analyzed care-fully. Results All the 16 cases were proved to be atypical perilunar posterior dislocation combined with lunate ante-rior subluxation of varing degrees. Ten cases were simple atypical perilunate posterior dislocation, including 3 cases combined with scaphoid posterior dislocation, 2 cases combined with subluxation and 5 cases without dislocation. A-mong those without scaphoid dislocation, one case showed widened space between capitate and scaphoid on X-ray imaging. Among six cases of trans-scaphoid atypical perilunar dislocation, the lunate and the proximal end of scaphoid fracture showed anterior subluxation. Conclusion All the simple atypical perilunar posterior dislocation are combined with varying degrees lunate anterior subluxation, may being associated with scaphoid posterior disloca-tion or not. For trans-scaphoid atypical perilunate dislocation, the lunate and the proximal end of scaphoid fracture maybe have anterior subluxation together.