Schmitt R, Froehner S, Coblenz G, Christopoulos G
Herz- und Gefässklinik GmbH, Institut für Diagnostische und Interventionelle Radiologie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Germany.
Eur Radiol. 2006 Oct;16(10):2161-78. doi: 10.1007/s00330-006-0161-1. Epub 2006 Mar 1.
This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads ("dyskinetics") or suffers from abnormal motion of its bones during movement ("dyskinematics"). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being "occult" for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the hand surgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.
本综述阐述了腕关节不稳定模式的病理解剖学基础以及临床和影像学表现。腕关节不稳定大多继发于损伤；然而，其他疾病，如焦磷酸钙沉积病关节炎，也可能与之相关。如果腕骨无法承受生理负荷（“运动障碍”）或在运动过程中其骨骼出现异常运动（“运动失调”），就会发生不稳定。在腕关节不稳定的分类中，分离性亚类（位于近端腕骨排内）与非分离性亚类（出现在腕骨排之间）以及复合模式有所区分。必须注意的是，不稳定的腕关节在标准X线片上最初不会引起相关征象，因此在放射学评估中是“隐匿性”的。本文强调了动态成像研究、对比增强磁共振成像（MRI）和磁共振关节造影在检测这些动态前和动态不稳定阶段方面的高度实用性。在腕关节不稳定的自然病程后期，腕关节会出现静态排列不齐和骨关节炎，这两者都会导致显著的发病率和残疾。为防止对个人和社会经济产生影响，手外科医生或骨科医生以及放射科医生面临着早期精确诊断的挑战。
