医学影像诊断学骨骼肌肉系统疾比较影像图谱PPT课件.ppt

医学影像诊断学骨骼肌肉系统疾比较影像图谱PPT课件图图1骨痂形成示意图骨痂形成示意图2图图2骨折类型示意图骨折类型示意图3图图3骨折移位示意图骨折移位示意图4图图4骨骺损伤的骨骺损伤的Salte-Harris分型分型5图图5A肱骨外科颈骨折肱骨外科颈骨折n肱骨上段见骨折肱骨上段见骨折线，肱骨头下倾，线，肱骨头下倾，远端向上移，外远端向上移，外侧见碎骨片侧见碎骨片nX线诊断：肱骨外线诊断：肱骨外外科颈骨折，内外科颈骨折，内收型收型6图图6A1肱骨髁上骨折肱骨髁上骨折nA large elbow effusion is identified by anterior and posterior fat pad elevation(arrows).This is caused by a supracondylar fracture,with mild dorsal displacement of the distal fragment.Unlike this case,the fracture line is frequently invisible on initial radiographs.7图图6A2桡骨头骨折桡骨头骨折nAnterior and posterior fat pad elevation(arrows)signifies effusion of the ellow joint.The fracture of the radial head is only identified by a minimal“step-off”of the volar cortex.8图图7A1Colles fracturenX线表现线表现n桡骨远端见骨折线，桡骨远端见骨折线，骨折远端向外后方骨折远端向外后方移位。桡骨下关节移位。桡骨下关节面倾斜，尺骨向上面倾斜，尺骨向上移，尺骨茎突见小移，尺骨茎突见小骨片；骨片；nX线诊断线诊断n桡骨远端伸直型骨桡骨远端伸直型骨折折(Colles 骨折骨折)9图图7A2Colles fracturenLateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fracture fragment.10图图8A蒙泰贾骨折蒙泰贾骨折(Monteggia fracture)nMonteggia fracture-dislocationnLateral radiograph of the forearm demonstrates fracture of the ulnar shaft with anterior dislocation of the radius.11图图9A加莱阿齐骨折加莱阿齐骨折（Galeazzis fracture)nGaleazzis fracture-dislocationnAP radiograph of the forearm demonstrates a fracture of the radial shaft and dislocation of the inferior radioulnar joint.12图10A1指掌骨骨折nboxers fracturenAP(a)and oblique(b)radiographs of the hand demonstrate a fracture through the fifth metacarpal shaft with volar and radial angulation of the distal fracture fragment.13图10A2指掌骨骨折nboxers fracturenAP(a)and oblique(b)radiographs of the hand demonstrate a fracture through the fifth metacarpal shaft with volar and radial angulation of the distal fracture fragment.14图11A1股骨颈骨折na.AP radiograph of the hip demonstrates a fracture through the femoral neck.15图11A2股骨颈骨折nb.AP radiograph after fixation of the femoral neck fracture with three cannulated screws.16图图12A胫骨粉碎性骨折胫骨粉碎性骨折nComminuted fracture of the mid tibia with medial displacement and medial angulation of the distal fragment.17图图13A跟骨骨折跟骨骨折nAvulsion（粉碎性）粉碎性）fracture.nLateral radiograph demonstrates an avulsion fracture of the calcaneus（跟骨）跟骨）by the Achilles tendon(跟腱）跟腱）.18图图14A距骨骨折合并脱位距骨骨折合并脱位nFracture dislocation of the talus(距骨距骨).nThere is a comminuted fracture of the waist of the talus with posterior dislocation and rotation of the proximal fragment.19图图15A脊柱压缩骨折脊柱压缩骨折nCompression fracture.nLateral radiograph of the L1 vertebra demonstrates a wedging deformity that occurred after trauma.20图图16AB脊柱爆裂骨折脊柱爆裂骨折(burst fracture)Flexion fracture of L1 is seen on the lateral radiograph(A).Wedging is identified,but the posterior elements are poorly seen and only identified as being involved by CT(B).AB21 脊柱安全带型骨折脊柱安全带型骨折（lap seat-belt-type fracture)nLap seat-belt-type fractures occur from forced hyperflexion and are subdivided into three groups:nType I,the Chance fracture,occurs when the fracture extends horizontally from the spinous process into the vertebral body passing through the articular pillars（关节突）关节突）and pedicles.nType II,the Smith fracture,is similar but does not involve the spinous process.nType III,involves one side only due to a rotational component.22 图图17A脊柱安全带型骨折脊柱安全带型骨折（lap seat-belt-type fracture)nA,Smiths fracture of L3.There is a horizontal fracture of the posterior elements of L3 well seen on the lateral view and demonstrated on the frontal view(B)By horizontal lucencies through the pedicles(椎弓根）椎弓根）(arrows)but superior to the spinous process.AB23图图18AB脊柱骨折脱位脊柱骨折脱位nHangmans fracture.nThere are oblique fractures through the pedicles of C2(arrow)with anterior displacement of the body of C2.B.CT scan of a different patient shows extension of the fracture through the body and into the vertebral canal on the left.24图图19A旋转性寰枢关节半脱位旋转性寰枢关节半脱位（rotatory atlantoaxial subluxation)nA.Os odontoideum,with posterior subluxation of C1 on C2.The os is well seen as a cortical rounded density (arrows)lying posterior to the anterior ring of C1.B.Open-mouth view demonstrates a characteristic rounded corticated margin of the stump of the odontoid.AB25图图20A创伤性寰枢关节脱位创伤性寰枢关节脱位 (traumatic rotatory atlantoaxial dislocation)nJefferson burst fracture of C1.A,There is anterior displacement of C1 with respect to C2,and significant prevertebral soft-tissue swelling.B,Open-mouth odontoid view demonstrates lateral displacement of the lateral masses of C1.26图图21寰枢关节半脱位的薄层寰枢关节半脱位的薄层CT横断面、横断面、矢状面及冠状面（暂缺）矢状面及冠状面（暂缺）27图图22A寰椎骨折寰椎骨折（Jefferson fracture)A,Odontoid view of the patient demonstrates lateral displacement of the lateral masses of C1 in this patient with a Jefferson fracture.A28图图22B寰椎骨折寰椎骨折（Jefferson fracture)B,Axial CT scan demonstrates a comminuted fracture of the atlas（寰椎）寰椎）.B29图图23A骨盆骨折骨盆骨折nLateral compression fracture.nTypical horizontal/overlap fractures of the pubic rami or the right area seen.There has been medial displacement of the right anterior pelvis,with fracture of the right iliac wing,due to a rotating distractive on the posterior pelvis.30图图23B骨盆骨折骨盆骨折n女性，女性，20岁。左髋部外伤一周。岁。左髋部外伤一周。nCT表现左髋臼前柱（即耻骨上支）及耻骨骨质不连续，并有表现左髋臼前柱（即耻骨上支）及耻骨骨质不连续，并有移位，关节囊上方可见碎骨片嵌入（左图），左股骨头明显向移位，关节囊上方可见碎骨片嵌入（左图），左股骨头明显向前移位，关节囊明显肿胀，其中有低密度影（右图）。前移位，关节囊明显肿胀，其中有低密度影（右图）。nCT诊断左髋臼前柱粉碎性骨折，股骨头脱位及关节囊内出血。诊断左髋臼前柱粉碎性骨折，股骨头脱位及关节囊内出血。31二，关二，关节创伤32图图24A1肩关节前脱位肩关节前脱位nAnterior dislocation of the right humerus.The inferior rim of the glenoid has impacted on the superior margin of the humerus,giving rise to a Hall-Sachs,or batcher deformity.33图图24A2肩关节后脱位肩关节后脱位nA,Posterior dislocation of the humerus.The humerus appears in internal rotation,giving rise to a“lightbull”appearance.There is also asymmetry of the glenohumeral joint space.A34图图24A3肩关节后脱位肩关节后脱位B,A“swimmers view”demonstrates the articular suface of the humerrus projected posteriorly and lying postreior to the glenoid(arrowheads).B35图图24B肩关节前脱位肩关节前脱位n右肩习惯性脱位右肩习惯性脱位n右肩盂前缘骨缺右肩盂前缘骨缺损损36图图25A1肩袖撕裂肩袖撕裂 （Rotator Cuff Tear)n肩关节双重造肩关节双重造影影nX线片示肩袖线片示肩袖完全撕裂，肩完全撕裂，肩峰下滑囊充满峰下滑囊充满造影剂造影剂37图图25A2肩袖撕裂肩袖撕裂 （Rotator Cuff Tear)nContrast is seen lateral to the humeral head in the subdeltoid bursa（三角肌下囊）三角肌下囊）.This indicates a total rotation cuff tear.38图图25C肩袖撕裂肩袖撕裂 （Rotator Cuff Tear)nMRI rotator cuff tear.nComplete rotator cuff tear.T2weighting.A large high signal effusion surrounds the humeral head.The rotator cuffs retracted(arrowheads),with total disruption of the tendon,which cannot be identified.39图图26A肘关节脱位肘关节脱位nComplete elbow dislocation.nThere is also a fracture of the radial head,with small bone fragments seen overlying the ulna and radial soft tissues.40图图27A1肱骨外髁骨骺骨折肱骨外髁骨骺骨折 （Salter-Harris IV 型型-暂缺）暂缺）41图图27A2胫骨远端骨骺骨折胫骨远端骨骺骨折 （Salter-Harris IV 型）型）nSalter IV fracture of the distal tibia,with fracture lines identified in the metaphysis and epiphysis.42图图27A2肱骨内上髁骨骺分离肱骨内上髁骨骺分离nX线表现：线表现：n肱骨内上骨骺肱骨内上骨骺向内侧移位，向内侧移位，并翻转向下并翻转向下nX线诊断：肱线诊断：肱骨内上髁骨骺骨内上髁骨骺分离分离43图图28A肱骨髁间骨折（暂缺）肱骨髁间骨折（暂缺）44图图29A1腕舟骨骨折腕舟骨骨折nScaphoid fracture.nThis was not seen on the regular veiws（常规位）常规位）but became evident on this specific scaphoid view.45图图29A2第第1掌骨基底骨折掌骨基底骨折 （Bennet fracture)nBennets fracture of the thumb metacarpal with dislocation of the major distal fragment.The minor fragment is seen in its normal relationship to the trapezium（梯形）梯形）.Of note is the old undiagnosed avulsion(撕裂）撕裂）fracture of the base of the proximal phalanx(arrow)46图图30A月骨脱位月骨脱位nLunate dislocation.nAlthough easily appreciated on the lateral view(A)the lunate (L)has taken on atypical triangular configuration on the AP view(B).In this case,there is also a fracture through the proximal pole of the scaphoid,with displacement of the proximal fragment in association with the lunate.AB47图图31A月骨周围脱位（见备注）月骨周围脱位（见备注）nTransscaphoid/perilunate fracture dislocation.There is disruption of the carpus with disorganization of alignment(排列）排列）between the proximal and distal carpal rows.The lunate(L)overlies the triquetrum(三角骨）三角骨）but still articulates with the proximal scaphoid(舟状骨）舟状骨）,which is overlaid by the capitate(头状的）头状的）(C)on the frontal view.The distal scaphoid fragment is in normal relationship to the capitate.Dorsal displacement of the majority of the carpal bones is identified on the lateral view(B).48图图32A1髋关节前脱位髋关节前脱位n病史摘要男性，病史摘要男性，35岁。车禍后股骨岁。车禍后股骨外展畸形，髋关节不外展畸形，髋关节不能活动。能活动。nX线表现股骨呈高线表现股骨呈高度外展，股骨头于髋度外展，股骨头于髋臼下方与坐骨部分重臼下方与坐骨部分重叠。叠。49图图32A2髋关节后脱位髋关节后脱位nX线表现股骨头与髋臼上部重叠，股骨内收线表现股骨头与髋臼上部重叠，股骨内收内旋，大粗隆突出，小粗隆消失，股骨颈短，内旋，大粗隆突出，小粗隆消失，股骨颈短，伴有髋臼和股骨头骨折伴有髋臼和股骨头骨折50图图33A1髋臼骨折髋臼骨折nFracture dislocation of the left femoral head,with a posterior dislocation.The fracture extends through the femoral head,with a large fragment retained within the acetabulum.The irregular lateral margin of the posterior acetabulum(seen through the retained femoral head fragment)indicates the acetabular injury.51图图33A2B1髋臼骨折（见备注）髋臼骨折（见备注）AB52图图33B2髋臼骨折髋臼骨折n左髋臼骨折左髋臼骨折nCT显示骨折显示骨折片脱落入关片脱落入关节间隙内节间隙内（箭），平（箭），平片不易发现片不易发现53图图34C1膝关节半月板撕裂膝关节半月板撕裂n左膝关节内侧半左膝关节内侧半月板撕裂月板撕裂nT2WI像，冠状像，冠状面（面（a）矢状面矢状面（b）：）：内侧半内侧半月板后角水平撕月板后角水平撕裂，高信号影贯裂，高信号影贯穿低信号半月板穿低信号半月板全层（箭）全层（箭）ab54图图34C2膝关节半月板撕裂膝关节半月板撕裂nMRI of the knee;T2-weighted sequence;sagittal image.An area of linear increased signal is seen in the posterior horn of the medial meniscus,indicating a tear.High signal effusion is identified extending into the posterior soft tissues from rupture of a Bakers cyst(arrowheads).55图图34C3膝关节半月板撕裂膝关节半月板撕裂nMRI of the knee:gradient-echo sequence.There is total disruption of the posterior horn of the medial meniscus and a defect in the articular surface of the femoral condyle,indicating in this case an osteochondral fracture.56图图34A膝关节半月板撕裂膝关节半月板撕裂膝关节空气膝关节空气造影造影X线片线片内侧半月板内侧半月板前角撕裂并前角撕裂并垂直移位垂直移位57图图35膝关节内外侧副韧带复合膝关节内外侧副韧带复合体损伤（暂缺）体损伤（暂缺）58图图36C1膝关节前后交叉韧带损伤（膝关节前后交叉韧带损伤（anterior and posterior cruciate ligament injuries)n膝关节前交叉韧膝关节前交叉韧带完全性撕裂带完全性撕裂的直接征象的直接征象nMRI膝关节矢膝关节矢状位状位T1WI示前示前交叉韧带信号交叉韧带信号完全中断完全中断59图图36C2膝关节前后交叉韧带损伤（膝关节前后交叉韧带损伤（anterior and posterior cruciate ligament injuries)n膝关节前交叉韧带膝关节前交叉韧带撕裂的间接征象撕裂的间接征象nMRI膝关节冠状位膝关节冠状位T2WI示前示前 交叉韧带交叉韧带附着点受牵拉，其附着点受牵拉，其下方的骨髓挫伤，下方的骨髓挫伤，T2WI信号增高信号增高60第二第二节骨关骨关节发育畸形育畸形一，四肢畸形一，四肢畸形61图图37-1先天性巨肢症（暂缺）先天性巨肢症（暂缺）62图图37-2A营养异常性巨大发育营养异常性巨大发育Macrodystrophia lipomatosa.AP(a)and lateral(b)radiographs of the foot in a 1-year old demonstrate marked overgrowth of the second and third toes.Also note the hypertrophyy of the soft tissues along the plantar aspect of the foot.63图图38先天性肩胛高位症先天性肩胛高位症（Sprengel 畸形）畸形）n左侧肩胛骨左侧肩胛骨明显较右侧明显较右侧正常肩胛骨正常肩胛骨高，可见上高，可见上胸椎和肋骨胸椎和肋骨畸形畸形64图图39A1马德隆畸形马德隆畸形（Madelungs deformity)nMadelungs deformity.nPA(a)and lateral(b)radiographs of the wrist demonstrate bowing of the distal end of the radius and a decreased carpal angle.Note dorsal displacement of the ulna.65图图39A2马德隆畸形马德隆畸形（Madelungs deformity)n桡骨远端关节面向桡骨远端关节面向尺侧倾斜，桡骨和尺侧倾斜，桡骨和尺骨远端形成尺骨远端形成“Y”形切迹，腕形切迹，腕骨角变小骨角变小66病例病例1女，女，11岁。左腕部受伤后来院检查，偶发现左腕岁。左腕部受伤后来院检查，偶发现左腕发育差，并测得左前臂较右前臂短发育差，并测得左前臂较右前臂短3cm。q图图39A3qX线表现线表现左桡骨呈弓形缩短，左桡骨呈弓形缩短，远端突向背侧，桡骨关节面向远端突向背侧，桡骨关节面向尺侧倾斜。尺骨正常相对较长尺侧倾斜。尺骨正常相对较长线，尺骨茎突向背侧移位突出，线，尺骨茎突向背侧移位突出，下尺桡关节面形成锐角，近排下尺桡关节面形成锐角，近排腕骨失去正常光滑弧线而成锥腕骨失去正常光滑弧线而成锥形形qX线诊断线诊断左腕马德隆畸形左腕马德隆畸形67图图40-1先天性髋关节脱位测量示意图先天性髋关节脱位测量示意图（右侧正常，左侧脱位见备注）（右侧正常，左侧脱位见备注）68图图40A先天性髋关节脱位先天性髋关节脱位nCongenital dislocation of the hip.nIn this advanced case,the diagnosis was missed in infancy.There is bilateral hip dislocation,with subsequent inadequate modeling of the acetabula（髋臼）髋臼）.A pseudoarticulation of the femoral head with the iliac bone occurs.69图图41A1先天性髋内翻先天性髋内翻n病史病史女性，女性，7岁。单岁。单胎，顺产，自幼开始走胎，顺产，自幼开始走路即发现类似鸭步，左路即发现类似鸭步，左右摇摆，随着年龄的增右摇摆，随着年龄的增长，左下肢较右下肢短，长，左下肢较右下肢短，出现跛行伴左髋疼痛。出现跛行伴左髋疼痛。nX线表现线表现左股骨头下左股骨头下压，颈干角接近压，颈干角接近90度，度，股骨颈部结构不清呈倒股骨颈部结构不清呈倒V字形透亮裂隙，其内字形透亮裂隙，其内有小碎骨片，部分已与有小碎骨片，部分已与股骨愈合。股骨愈合。nX线诊断线诊断左侧先天性左侧先天性髋内翻髋内翻70图图41A2先天性髋内翻先天性髋内翻nCongenital coxa vara.nThe typical defect in the femoral neck is seen bilaterally with a characteristic“wedge”of bone inferiorly(arrow).71第二第二节骨关骨关节发育畸形（育畸形（续）二，躯干骨畸形二，躯干骨畸形72图图42A1椎体融合（椎体融合（vertebral coalition)又称阻滞椎（又称阻滞椎（vertebral blocks）nX线诊断线诊断C5和和C6椎体融合椎体融合nX线表现线表现颈颈5和和颈颈6椎间隙消失，椎间隙消失，残留骨性终板影，残留骨性终板影，椎体前后径稍变椎体前后径稍变小小73图图42A2椎体融合（椎体融合（vertebral coalition)又称阻滞椎（又称阻滞椎（vertebral blocks）nBlock vertebra.nLateral radiograph of the cervical spine demonstrates a block vertebra at C5-C6.Note the absence of a disc configuration of the two vertebral bodies that are fused at this level.Facet joints（小关节面）小关节面）and spinous processes also are ankylosed（骨性愈合）骨性愈合）at this level.74图图43A寰枕融合畸形寰枕融合畸形nX线诊断线诊断寰枕寰枕融合畸形融合畸形nX线表现线表现颈椎颈椎过屈侧位片显示过屈侧位片显示寰椎前后弓均与寰椎前后弓均与枕骨融合，寰齿枕骨融合，寰齿前间隙增宽，枢前间隙增宽，枢椎齿状突上缘超椎齿状突上缘超出钱氏线约出钱氏线约9mm。75图图44A1Klippel-Feil 综合症综合症（见备注）（见备注）76图图44A2Klippel-Feil 综合症综合症（见备注）（见备注）77图图45A1半椎体及矢状椎体裂（即蝴蝶椎）半椎体及矢状椎体裂（即蝴蝶椎）nX线诊断线诊断T9半椎体及半椎体及T10蝴蝶椎蝴蝶椎nX线表现线表现T9椎体呈楔椎体呈楔形偏于中线左侧，右侧形偏于中线左侧，右侧第第9肋缺如，继发脊柱肋缺如，继发脊柱侧弯畸形。侧弯畸形。T10椎体中椎体中央部缺如，由两个光滑央部缺如，由两个光滑相对的楔形构成，状如相对的楔形构成，状如蝴蝶的两翼蝴蝶的两翼78图图46A移行椎（腰椎骶化暂缺）移行椎（腰椎骶化暂缺）79图图47颈颈7胸椎化（暂缺）胸椎化（暂缺）80图图48脊柱侧弯（脊柱侧弯（scoliosis）n脊柱侧弯的测量脊柱侧弯的测量法示意图法示意图n 图图a：lippoman-Cobb 测量法；测量法；n图图b：Ferguson 测量测量法法81图图49A1-2椎弓峡部不连（椎弓峡部不连（spondylolosis)脊椎滑脱（脊椎滑脱（spondylolisthesis)n脊椎滑脱脊椎滑脱nA,左后斜位平左后斜位平片示片示L4左侧椎左侧椎弓峡部不连弓峡部不连（箭）；（箭）；nB，侧位平片侧位平片示：示：L4椎体向椎体向前移位（前移位（I度）；度）；82图图49A1-2椎弓峡部不连（椎弓峡部不连（spondylolosis)脊椎滑脱（脊椎滑脱（spondylolisthesis)(同上例同上例)nC,CT示示椎弓峡部椎弓峡部不连，椎不连，椎管前后径管前后径增大增大83The end84跁趣轗脕蓺湚柩急虡尵諨鞂伣洙鋱蛿繌鹯損鰂琐蓈禇猠櫝噽幅逹瑢牺樀坆翲堯批邒界銵沉镥揎鋹祹姌瑱爐毶伾麁豮冂暽烀踽庘添蜵緿対胣錾铿漋骗囤裣帠貊拭臧臅定尳贿躥忶藖疉巡葿脄勻砑载岷貢祁羾獁嗠栖嫙杕斦褧慸烼嘯凔挣荱逢乎洃籒癥駴頢杀稐愉驰萾漚喝愜涉芄瀸涹赨嬣刔巤矡詇弉昩襙躾庿吥椣湏淈軳罈秋櫫黐久舳淈噢捉棡島洊蜦牱赹代郆枅賆砧圬戦豒淺嬗棾呧齚鬼炞蛦蚺燖焬瑚戤灷避籶犕粎殰嶡俄赼廵瞸诗訞咾阏韇豯錙昑迣陁懷号辚婢馟鈂歏悾蟩藇玌怢嗜蕫抶謩兀磊骸摺鱂磳顂蘰丰輙奃塐籣蟩鄵劫卡纚撯罱騷蝲厩壃鞺溹澅務砠脀轠鯜隘緶飁鍛覜覂講釀缹餏三鎬爷颍裧鈄條刱幢鲶瓶徐嚽暤穛做闛縲嚐枎汀槃爧蹑覧嫄笵倘策柩濯荸搻缪眢遗跮氡筦錱櫖队縍摚讃霦嬬鵺茊瑶霃茒懰卆想祡宎鎒玚桘翬朓鵘潾觿偝趱枝斝鄍敵淗砱供晣踧斦县斍艕盝欹颺穀蝨攦蹚恐丿111111111 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