舟状骨骨折及其并发症的影像学检查与治疗

Imaging and treatment of scaphoid fractures and their complications.

作者信息

Taljanovic Mihra S, Karantanas Apostolos, Griffith James F, DeSilva Gregory L, Rieke Joshua D, Sheppard Joseph E

机构信息

Department of Medical Imaging, The University of Arizona Health Network, Tucson, AZ 85724-5067, USA.

出版信息

Semin Musculoskelet Radiol. 2012 Apr;16(2):159-73. doi: 10.1055/s-0032-1311767. Epub 2012 May 30.

Abstract

The scaphoid is the most commonly fractured carpal bone, with frequent complications that are predisposed by its anatomical location, anatomical configuration (shape and length), and vascular supply. The most common mechanism of injury is a fall onto an outstretched hand. Imaging plays a significant role in the initial evaluation and treatment of scaphoid fractures and their complications. Radiography should be the first imaging modality in the initial evaluation and follow-up of scaphoid fractures. Computed tomography with its superb spatial resolution enables better visualization and characterization of the fracture line, and the amount of displacement and angulation of the fracture fragments. Using the metal reduction artifact with computed tomography allows good follow-up of scaphoid fractures despite surgical hardware. Magnetic resonance imaging without contrast is the imaging modality of choice for depiction of radiographically occult scaphoid fracture, bone contusion, and associated soft tissue injury; contrast-enhanced imaging aids assessment of scaphoid fracture nonunion, osteonecrosis, fracture healing after bone grafting, and revitalization of the necrotic bone after bone grafting. Proper identification and classification of scaphoid fracture and its complications is necessary for appropriate treatment. This article describes the normal anatomy, mechanism of injury, and classification of stable and unstable fractures, together with the imaging and treatment algorithm of scaphoid fractures and their complications with an emphasis on magnetic resonance imaging.

摘要

舟骨是最常发生骨折的腕骨,因其解剖位置、解剖结构(形状和长度)及血供情况,常伴有多种并发症。最常见的损伤机制是手部伸展位着地摔倒。影像学检查在舟骨骨折及其并发症的初始评估和治疗中起着重要作用。在舟骨骨折的初始评估及随访中,X线摄影应作为首选的影像学检查方法。计算机断层扫描(CT)具有极高的空间分辨率,能够更好地显示骨折线、骨折块的移位及成角情况。利用CT的金属伪影,即便存在手术植入物,也能对舟骨骨折进行良好的随访。无对比剂的磁共振成像(MRI)是显示X线隐匿性舟骨骨折、骨挫伤及相关软组织损伤的首选影像学检查方法;增强MRI有助于评估舟骨骨折不愈合、骨坏死、植骨后骨折愈合情况以及植骨后坏死骨的复活情况。正确识别和分类舟骨骨折及其并发症对于恰当治疗至关重要。本文介绍了舟骨的正常解剖结构、损伤机制、稳定和不稳定骨折的分类,以及舟骨骨折及其并发症的影像学检查和治疗方案,重点阐述了磁共振成像。

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