Zhang H, Xia T J, Bai R J, Zhan H L, Qian Z H
Zhonghua Yi Xue Za Zhi. 2018 Oct 23;98(39):3153-3157. doi: 10.3760/cma.j.issn.0376-2491.2018.39.005.
To explore the MRI characteristics of injuries of scapholunate ligament (SLL), and provide imaging basis for the early diagnosis and treatment of the injuries. A total of 20 healthy volunteers without wrist injuries and 30 patients who complained dorsoradial-sided wrist pain and were highly suspected as the injury of SLL underwent the wrist magnetic resonance examination and X-ray examination in Beijing Jishuitan Hospital from January 2013 to September 2017.All subjects underwent anterior and lateral radiographs of the wrist joint and examination on coronal T(1)WI scan and PD-FS on 3 planes respectively in a prone position.Then the MRI characteristics of 20 healthy volunteers and 30 patients with SLL injuries that confirmed by operation were analyzed.According to the comparative analysis of normal anatomy and Geissler grades, the injuries were graded and MRI features of different types of injuries were analyzed.At last, imaging findings were compared with surgical results. Twenty healthy volunteers without injuries showed mainly in low signal intensity on T(1)WI and PD-FS images.According to Geissler grades, there were 11 GradeⅠ injuries (5 had triangular fibrocartilage complex (TFCC) and SLL injuries and 1 had fracture of scaphoid and SLL injuries simultaneously), 8 GradeⅡ injuries (2 had TFCC and SLL injuries, 1 had TFCC, lunotriquetral ligament (LTL) and SLL injuries and 1 had distal radius fracture, TFCC and SLL injuries simultaneously), 7 Grade Ⅲ injuries (3 had TFCC and SLL injuries, 2 had fracture of scaphoid and SLL injuries and 1 had TFCC, LTL and SLL injuries simultaneously) and 4 Grade Ⅳ injuries (2 had TFCC and SLL injuries and 1 had fracture of scaphoid and SLL injuries simultaneously) among 30 patients.A tear can be confidently diagnosed when the ligament segment was absent or there was a fluidfilled discontinuity.A tear that involves 1 or 2 of the 3 segments (volar, proximal, or dorsal) of either the SLL was considered a partial tear, whereas a tear of all 3 segments was a complete tear. MRI can demonstrate the anatomy of interosseous ligaments accurately, evaluate and make the general grades of injuries.It is of significance for the early diagnosis and treatment protocols of the interosseous ligaments injuries.
探讨舟月韧带(SLL)损伤的磁共振成像(MRI)特征,为该损伤的早期诊断与治疗提供影像学依据。2013年1月至2017年9月,在北京积水潭医院,对20名无腕部损伤的健康志愿者以及30名主诉腕背桡侧疼痛且高度怀疑为SLL损伤的患者进行了腕部磁共振检查及X线检查。所有受试者均分别在俯卧位下行腕关节正侧位X线片检查以及3个平面的冠状位T(1)加权成像(T1WI)扫描和质子密度脂肪抑制(PD-FS)检查。然后分析20名健康志愿者及30例经手术证实的SLL损伤患者的MRI特征。通过对正常解剖结构与盖斯勒分级(Geissler grades)的对比分析,对损伤进行分级,并分析不同类型损伤的MRI特征。最后,将影像学表现与手术结果进行比较。20名无损伤的健康志愿者在T1WI和PD-FS图像上主要表现为低信号强度。根据盖斯勒分级,30例患者中,有11例Ⅰ级损伤(5例合并三角纤维软骨复合体(TFCC)和SLL损伤,1例同时合并舟骨骨折和SLL损伤),8例Ⅱ级损伤(2例合并TFCC和SLL损伤,1例合并TFCC、月三角韧带(LTL)和SLL损伤,1例同时合并桡骨远端骨折、TFCC和SLL损伤),7例Ⅲ级损伤(3例合并TFCC和SLL损伤,2例合并舟骨骨折和SLL损伤,1例同时合并TFCC、LTL和SLL损伤),4例Ⅳ级损伤(2例合并TFCC和SLL损伤,1例同时合并舟骨骨折和SLL损伤)。当韧带节段缺失或存在充满液体的连续性中断时,可确诊为撕裂。涉及SLL的3个节段(掌侧、近端或背侧)中的1个或2个节段的撕裂被视为部分撕裂,而3个节段均撕裂则为完全撕裂。MRI能够准确显示骨间韧带的解剖结构,评估损伤并进行总体分级。这对于骨间韧带损伤的早期诊断和治疗方案具有重要意义。