MRI 在临床腕舟状骨骨折患者的诊断和治疗中的作用。
Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture.
机构信息
Department of Trauma & Orthopaedics, Barts & The London NHS Trust, 59 Elmstead Lane, Chislehurst Kent BR7 5EQ, UK.
出版信息
Int Orthop. 2012 Jan;36(1):107-10. doi: 10.1007/s00264-011-1350-3. Epub 2011 Sep 7.
PURPOSE
The American College of Radiologists (ACR) recognises the value of magnetic resonance imaging (MRI) as the investigation of choice in patients with a clinically suspected scaphoid fracture but normal plain radiographs. The Royal College of Radiologists (RCR) in the UK produces no similar guidelines, as evidenced by the inconsistent management of such cases in hospitals around the UK. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardise management of our patients and now report our findings.
METHODS
A consecutive series of 137 patients referred to the orthopaedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a two-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management.
RESULTS
Thirty-seven (27%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 59 patients (43.4%). Of those, 46 were triangular fibrocartilage complex (TFCC) tears (33.8%) and 18 were intercarpal ligament injuries (13.2 %). Bone marrow oedema with no distinct fracture was discovered in 55 cases (40.4%). In 17 (12.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 30 examinations (22.0%).
CONCLUSIONS
MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures.
目的
美国放射学院（ACR）认识到磁共振成像（MRI）在临床疑似舟状骨骨折但 X 线平片正常的患者中的价值。英国皇家放射学院（RCR）没有类似的指南，因为英国各地医院对这种病例的处理不一致。在与我们的骨骼肌肉放射科医生讨论后，我们实施了新的指南来规范患者的管理，现在报告我们的发现。
方法
连续 137 例临床疑似舟状骨骨折但 X 线平片正常的患者被前瞻性随访两年。我们对这些患者进行了早期 MRI，并确定了 MRI 检测到的舟状骨损伤以及其他隐匿性损伤的发生率。然后，我们前瞻性地检查了这些发现对患者管理的结果。
结果
37 例（27%）MRI 检查正常，无骨或软组织损伤证据。59 例（43.4%）诊断为软组织损伤。其中，46 例为三角纤维软骨复合体（TFCC）撕裂（33.8%），18 例为腕骨间韧带损伤（13.2%）。55 例（40.4%）发现骨髓水肿但无明显骨折。在 17 例（12.5%）病例中，仅舟状骨受累。在其余病例中，还累及其他腕骨或桡骨远端。30 例（22.0%）诊断为骨折。
结论
MRI 应被视为临床怀疑舟状骨骨折患者的金标准检查。它可以诊断临床上表现为舟状骨骨折的隐匿性骨和软组织损伤，也可以帮助排除无骨折的患者。我们认为有必要制定管理隐匿性舟状骨骨折的国家指南。
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