医学影像诊断学骨骼肌肉系统疾比较影像图谱-PPT课件.ppt
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1、第一节 骨与关节创伤,一,骨折 (一)骨折总论,2,图1 骨痂形成示意图,3,图2 骨折类型示意图,4,图3 骨折移位示意图,5,图4 骨骺损伤的Salte-Harris分型,6,图5A 肱骨外科颈骨折,肱骨上段见骨折线,肱骨头下倾,远端向上移,外侧见碎骨片 X线诊断:肱骨外外科颈骨折,内收型,7,图6A1 肱骨髁上骨折,A large elbow effusion is identified by anterior and posterior fat pad elevation (arrows).This is caused by a supracondylar fracture, with
2、 mild dorsal displacement of the distal fragment. Unlike this case, the fracture line is frequently invisible on initial radiographs.,8,图6A2 桡骨头骨折,Anterior and posterior fat pad elevation (arrows) signifies effusion of the ellow joint. The fracture of the radial head is only identified by a minimal
3、“step-off” of the volar cortex.,9,图7A1 Colles fracture,X线表现 桡骨远端见骨折线,骨折远端向外后方移位。桡骨下关节面倾斜,尺骨向上移,尺骨茎突见小骨片; X线诊断 桡骨远端伸直型骨折(Colles 骨折),10,图7A2 Colles fracture,Lateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fracture fragment.,11,图8A 蒙
4、泰贾骨折 (Monteggia fracture),Monteggia fracture-dislocation Lateral radiograph of the forearm demonstrates fracture of the ulnar shaft with anterior dislocation of the radius.,12,图9A 加莱阿齐骨折 (Galeazzis fracture ),Galeazzis fracture-dislocation AP radiograph of the forearm demonstrates a fracture of the
5、radial shaft and dislocation of the inferior radioulnar joint.,13,图10A1 指掌骨骨折,boxers fracture AP(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10A2 指掌骨骨折,boxers fracture AP(a)
6、 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.,15,图11A1 股骨颈骨折,a. AP radiograph of the hip demonstrates a fracture through the femoral neck.,16,图11A2 股骨颈骨折,b. AP radiograph after fixa
7、tion of the femoral neck fracture with three cannulated screws.,17,图12A 胫骨粉碎性骨折,Comminuted fracture of the mid tibia with medial displacement and medial angulation of the distal fragment.,18,图13A 跟骨骨折,Avulsion(粉碎性) fracture. Lateral radiograph demonstrates an avulsion fracture of the calcaneus(跟骨) b
8、y the Achilles tendon (跟腱).,19,图14A 距骨骨折合并脱位,Fracture dislocation of the talus(距骨). There is a comminuted fracture of the waist of the talus with posterior dislocation and rotation of the proximal fragment.,20,图15A 脊柱压缩骨折,Compression fracture. Lateral radiograph of the L1 vertebra demonstrates a wed
9、ging deformity that occurred after trauma.,21,图16AB 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).,A,B,22,脊柱安全带型骨折 (lap seat-belt-type fracture),La
10、p seat-belt-type fractures occur from forced hyperflexion and are subdivided into three groups: Type 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) and pedicles. Type II, the Smith frac
11、ture, is similar but does not involve the spinous process. Type III, involves one side only due to a rotational component.,23,图17A 脊柱安全带型骨折 (lap seat-belt-type fracture),A, Smiths fracture of L3. There is a horizontal fracture of the posterior elements of L3 well seen on the lateral view and demonst
12、rated on the frontal view(B) By horizontal lucencies through the pedicles(椎弓根) (arrows) but superior to the spinous process.,A,B,24,图18AB 脊柱骨折脱位,Hangmans fracture. There are oblique fractures through the pedicles of C2(arrow) with anterior displacement of the body of C2. B. CT scan of a different pa
13、tient shows extension of the fracture through the body and into the vertebral canal on the left.,25,图19A 旋转性寰枢关节半脱位 (rotatory atlantoaxial subluxation),A. Os odontoideum, with posterior subluxation of C1 on C2. The os is well seen as a cortical rounded density (arrows) lying posterior to the anterio
14、r ring of C1. B. Open-mouth view demonstrates a characteristic rounded corticated margin of the stump of the odontoid.,A,B,26,图20A 创伤性寰枢关节脱位 (traumatic rotatory atlantoaxial dislocation),Jefferson burst fracture of C1. A, There is anterior displacement of C1 with respect to C2, and significant preve
15、rtebral soft-tissue swelling. B, Open-mouth odontoid view demonstrates lateral displacement of the lateral masses of C1.,27,图21 寰枢关节半脱位的薄层CT横断面、矢状面及冠状面(暂缺),28,图22A 寰椎骨折 (Jefferson fracture),A, Odontoid view of the patient demonstrates lateral displacement of the lateral masses of C1 in this patient
16、with a Jefferson fracture.,A,29,图22B 寰椎骨折 (Jefferson fracture),B, Axial CT scan demonstrates a comminuted fracture of the atlas(寰椎).,B,30,图23A 骨盆骨折,Lateral compression fracture. Typical horizontal/overlap fractures of the pubic rami or the right area seen. There has been medial displacement of the r
17、ight anterior pelvis, with fracture of the right iliac wing, due to a rotating distractive on the posterior pelvis.,31,图23B 骨盆骨折,女性,20岁。左髋部外伤一周。 CT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),左股骨头明显向前移位,关节囊明显肿胀,其中有低密度影(右图)。 CT诊断 左髋臼前柱粉碎性骨折,股骨头脱位及关节囊内出血。,二,关节创伤,33,图24A1 肩关节前脱位,Anterior dislocation o
18、f 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.,34,图24A2 肩关节后脱位,A, Posterior dislocation of the humerus. The humerus appears in internal rotation , giving rise to a “lightbull” appearance. The
19、re is also asymmetry of the glenohumeral joint space.,A,35,图24A3 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).,B,36,图24B 肩关节前脱位,右肩习惯性脱位 右肩盂前缘骨缺损,37,图25A1 肩袖撕裂 (Rotator Cuff Tear),肩关节双重造影 X线片示肩袖完全撕裂
20、,肩峰下滑囊充满造影剂,38,图25A2 肩袖撕裂 (Rotator Cuff Tear),Contrast is seen lateral to the humeral head in the subdeltoid bursa (三角肌下囊). This indicates a total rotation cuff tear.,39,图25C 肩袖撕裂 (Rotator Cuff Tear),MRI rotator cuff tear. Complete rotator cuff tear. T2weighting. A large high signal effusion surroun
21、ds the humeral head. The rotator cuffs retracted (arrowheads), with total disruption of the tendon, which cannot be identified.,40,图26A 肘关节脱位,Complete elbow dislocation. There is also a fracture of the radial head, with small bone fragments seen overlying the ulna and radial soft tissues.,41,图27A1 肱
22、骨外髁骨骺骨折 (Salter-Harris IV 型-暂缺),42,图27A2 胫骨远端骨骺骨折 (Salter-Harris IV 型),Salter IV fracture of the distal tibia, with fracture lines identified in the metaphysis and epiphysis.,43,图27A2 肱骨内上髁骨骺分离,X线表现: 肱骨内上骨骺向内侧移位,并翻转向下 X线诊断:肱骨内上髁骨骺分离,44,图28A 肱骨髁间骨折(暂缺),45,图29A1 腕舟骨骨折,Scaphoid fracture. This was not s
23、een on the regular veiws(常规位) but became evident on this specific scaphoid view.,46,图29A2 第1掌骨基底骨折 (Bennet fracture),Bennets 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). Of note is the old
24、undiagnosed avulsion(撕裂) fracture of the base of the proximal phalanx (arrow),47,图30A 月骨脱位,Lunate dislocation. Although 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 prox
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