腕骨脱位或骨折并脱位的影像分析

Analysis of the Imaging of Carpal Dislocations and Fracture-dislocations

目的:分析腕骨脱位及骨折并脱位的影像,探讨外力在腕关节传播的过程。方法:对129例腕骨脱位患者行X线和多层螺旋CT检查,分析腕骨脱位或骨折并脱位的类型。结果:月骨脱位32例,腕中关节脱位2例,月骨周围型脱位95例。95例中经舟状骨月骨周围脱位50例,经桡骨茎突月骨周围脱位23例,经头状骨月骨周围脱位4例,经三角骨月骨周围脱位7例,经尺骨茎突月骨周围性脱11例。在合并其他腕骨骨折的病例中。经桡骨茎突及经舟骨骨折病例X线检查均得到确诊,其余56例中,X线漏诊6例则是通过多层螺旋CT薄层扫描及重建才做出正确诊断,单纯月骨周围型脱位较少见(仅3例),有5例X线检查为单纯月骨周围脱位的病例在CT扫描发现合并腕骨撕脱性小骨折。结论:X线检查对腕关节节损伤的程度有可能低估,多层螺旋CT薄层扫描及重建可作出准确、直观诊断。分析外力损伤腕关节的过程对腕骨脱位或骨折并脱位的影像诊断有重要价值。

Objective： To analyze the imaging manifestations of carpal dislocations and fracture-dislocations, to discuss the propagation of forces in wrist. Methods： 129 cases of carpal dislocation underwent the X-ray plain films and the MSCT, analysis of carpal dislocation or fracture-dislocation type. Results： 32 cases of lunate dislocation, 2 cases of central carpal dislocations, 95 cases of perilunate fracture-dislocations： 50 cases of transscaphoid perilunate dislocation, 23 cases of transradial styloid perilunate dislocation, 4 cases of transcapitate perilunate dislocation, 7 cases of transtriquetrum perilunate dislocation,11 cases of transulnar styloid perilunate dislocation. The diagnosis of transscaphoid and transradial styloid were correctly detected on X-ray plain film, the remaining 56 cases with fracture of other carpal bones which X-ray missed 6 cases were usually detected on MSCT and reconstruct technology at last. The pure perilunate dislocation is poor（only 3 cases）, there were 5 cases of X-ray diagnosis of pure perilunate dislocation which tiny fracture can be found in MSCT. Conclusion： X-ray plain film may underestimates the full extent of the original injury,accurate and intuitive diagnosis can be made by MSCT. To analyze the propagation of forces in carpal dislocations and fracture-dislocations has an important value for imaging diagnosis.