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 mild dor
2、sal 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 “step-off”
3、 of the volar cortex.,9,图7A1Colles 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7A2Colles fracture,Lateral radiograph demonstrates a fracture of the distal radius with dorsal angulation and displacement of the distal fracture fragment.,11,图8A蒙泰贾骨折 (Monteggia
4、fracture),Monteggia fracture-dislocationLateral 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-dislocationAP radiograph of the forearm demonstrates a fracture of the radial shaft and dis
5、location of the inferior radioulnar joint.,13,图10A1指掌骨骨折,boxers fractureAP(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 fractureAP(a) and oblique (b) radiogr
6、aphs 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 fixation of the femoral neck f
7、racture 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） by the Achilles tendon (跟腱）.,1
8、9,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 wedging deformity that occurred afte
9、r 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),Lap seat-belt-type fractures occur fro
10、m 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 fracture, is similar but does not involve
11、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 demonstrated on the frontal view(B) By horizonta
12、l 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 patient shows extension of the fracture throu
13、gh 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 anterior ring of C1. B. Open-mouth view demonstrates
14、 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 prevertebral soft-tissue swelling. B, Open-mouth od
15、ontoid 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 with a Jefferson fracture.,A,29,图22B寰椎骨折（Jefferso
16、n 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 right anterior pelvis, with fracture of the right ilia
17、c 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 of the right humerus. The inferior rim of the glenoid has im
18、pacted 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. There is also asymmetry of the glenohumeral joint space.,A,35,图
19、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，肩峰下滑囊充满造影剂,38,图25A2肩袖撕裂 （Rotator Cuff Tear),Contrast is seen lat
20、eral 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 surrounds the humeral head. The rotator cuffs retracted (arrowheads), with
21、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）,
22、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 seen on the regular veiws（常规位） but became evident on this specific scaphoid v
23、iew.,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 undiagnosed avulsion(撕裂） fracture of the base of the proximal phalanx (arrow)
24、,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 proximal pole of the scaphoid, with displacement of the proximal fragment in associ
25、ation with the lunate.,A,B,48,图31A月骨周围脱位（见备注）,Transscaphoid/perilunate fracture dislocation. There is disruption of the carpus with disorganization of alignment(排列） between the proximal and distal carpal rows. The lunate (L) overlies the triquetrum(三角骨） but still articulates with the proximal scapho
26、id(舟状骨）, which is overlaid by the capitate(头状的） (C) on the frontal view. The distal scaphoid fragment is in normal relationship to the capitate. Dorsal displacement of the majority of the carpal bones is identified on the lateral view(B).,49,图32A1髋关节前脱位,病史摘要男性，35岁。车禍后股骨外展畸形，髋关节不能活动。X线表现股骨呈高度外展，股骨头于髋
27、臼下方与坐骨部分重叠。,50,图32A2髋关节后脱位,X线表现股骨头与髋臼上部重叠，股骨内收内旋，大粗隆突出，小粗隆消失，股骨颈短，伴有髋臼和股骨头骨折,51,图33A1髋臼骨折,Fracture dislocation of the left femoral head, with a posterior dislocation. The fracture extends through the femoral head, with a large fragment retained within the acetabulum. The irregular lateral margin of
28、the posterior acetabulum (seen through the retained femoral head fragment ) indicates the acetabular injury.,52,图33A2B1髋臼骨折（见备注）,A,B,53,图33B2髋臼骨折,左髋臼骨折CT显示骨折片脱落入关节间隙内（箭），平片不易发现,54,图34C1膝关节半月板撕裂,左膝关节内侧半月板撕裂T2WI像，冠状面（a）矢状面（b）：内侧半月板后角水平撕裂，高信号影贯穿低信号半月板全层（箭）,a,b,55,图34C2膝关节半月板撕裂,MRI of the knee; T2-weigh
29、ted sequence; sagittal image. An area of linear increased signal is seen in the posterior horn of the medial meniscus, indicating a tear. High signal effusion is identified extending into the posterior soft tissues from rupture of a Bakers cyst (arrowheads).,56,图34C3膝关节半月板撕裂,MRI of the knee:gradient
30、-echo sequence. There is total disruption of the posterior horn of the medial meniscus and a defect in the articular surface of the femoral condyle, indicating in this case an osteochondral fracture.,57,图34A膝关节半月板撕裂,膝关节空气造影X线片内侧半月板前角撕裂并垂直移位,58,图35膝关节内外侧副韧带复合体损伤（暂缺）,59,图36C1膝关节前后交叉韧带损伤（anterior and p
31、osterior cruciate ligament injuries),膝关节前交叉韧带完全性撕裂的直接征象MRI膝关节矢状位T1WI示前交叉韧带信号完全中断,60,图36C2膝关节前后交叉韧带损伤（anterior and posterior cruciate ligament injuries),膝关节前交叉韧带撕裂的间接征象MRI膝关节冠状位T2WI示前 交叉韧带附着点受牵拉，其下方的骨髓挫伤， T2WI信号增高,第二节骨关节发育畸形,一，四肢畸形,62,图37-1先天性巨肢症（暂缺）,63,图37-2A营养异常性巨大发育,Macrodystrophia lipomatosa.AP (
32、a) and lateral (b) radiographs of the foot in a 1-year old demonstrate marked overgrowth of the second and third toes. Also note the hypertrophyy of the soft tissues along the plantar aspect of the foot.,64,图38先天性肩胛高位症（Sprengel 畸形）,左侧肩胛骨明显较右侧正常肩胛骨高，可见上胸椎和肋骨畸形,65,图39A1马德隆畸形（Madelungs deformity ),Made
33、lungs deformity.PA (a) and lateral (b) radiographs of the wrist demonstrate bowing of the distal end of the radius and a decreased carpal angle. Note dorsal displacement of the ulna.,66,图39A2马德隆畸形（Madelungs deformity ),桡骨远端关节面向尺侧倾斜，桡骨和尺骨远端形成“Y”形切迹，腕骨角变小,67,病例1女，11岁。左腕部受伤后来院检查，偶发现左腕发育差，并测得左前臂较右前臂短3cm
34、。,图39A3X线表现左桡骨呈弓形缩短，远端突向背侧，桡骨关节面向尺侧倾斜。尺骨正常相对较长线，尺骨茎突向背侧移位突出，下尺桡关节面形成锐角，近排腕骨失去正常光滑弧线而成锥形X线诊断左腕马德隆畸形,68,图40-1先天性髋关节脱位测量示意图（右侧正常，左侧脱位见备注）,69,图40A先天性髋关节脱位,Congenital dislocation of the hip. In this advanced case, the diagnosis was missed in infancy. There is bilateral hip dislocation, with subsequent in
35、adequate modeling of the acetabula（髋臼）. A pseudoarticulation of the femoral head with the iliac bone occurs.,70,图41A1先天性髋内翻,病史女性，7岁。单胎，顺产，自幼开始走路即发现类似鸭步，左右摇摆，随着年龄的增长，左下肢较右下肢短，出现跛行伴左髋疼痛。X线表现左股骨头下压，颈干角接近90度，股骨颈部结构不清呈倒V字形透亮裂隙，其内有小碎骨片，部分已与股骨愈合。X线诊断左侧先天性髋内翻,71,图41A2先天性髋内翻,Congenital coxa vara.The typical
36、defect in the femoral neck is seen bilaterally with a characteristic “wedge” of bone inferiorly (arrow).,第二节骨关节发育畸形（续）,二，躯干骨畸形,73,图42A1椎体融合（vertebral coalition) 又称阻滞椎（vertebral blocks）,X线诊断C5和C6椎体融合X线表现颈5和颈6椎间隙消失，残留骨性终板影，椎体前后径稍变小,74,图42A2椎体融合（vertebral coalition) 又称阻滞椎（vertebral blocks）,Block verteb
37、ra.Lateral radiograph of the cervical spine demonstrates a block vertebra at C5-C6. Note the absence of a disc configuration of the two vertebral bodies that are fused at this level. Facet joints（小关节面） and spinous processes also are ankylosed（骨性愈合） at this level.,75,图43A寰枕融合畸形,X线诊断寰枕融合畸形X线表现颈椎过屈侧位片显
38、示寰椎前后弓均与枕骨融合，寰齿前间隙增宽，枢椎齿状突上缘超出钱氏线约9mm。,76,图44A1Klippel-Feil 综合症（见备注）,77,图44A2Klippel-Feil 综合症（见备注）,78,图45A1半椎体及矢状椎体裂（即蝴蝶椎）,X线诊断T9半椎体及T10蝴蝶椎X线表现T9椎体呈楔形偏于中线左侧，右侧第9肋缺如，继发脊柱侧弯畸形。T10椎体中央部缺如，由两个光滑相对的楔形构成，状如蝴蝶的两翼,79,图46A移行椎（腰椎骶化暂缺）,80,图47颈7胸椎化（暂缺）,81,图48脊柱侧弯（scoliosis）,脊柱侧弯的测量法示意图 图a：lippoman-Cobb 测量法；图b：
39、Ferguson 测量法,82,图49A1-2椎弓峡部不连（spondylolosis) 脊椎滑脱（spondylolisthesis),脊椎滑脱A,左后斜位平片示L4左侧椎弓峡部不连（箭）；B，侧位平片示：L4椎体向前移位（I度）；,83,图49A1-2椎弓峡部不连（spondylolosis) 脊椎滑脱（spondylolisthesis)(同上例),C, CT示椎弓峡部不连，椎管前后径增大,84,The end,跁趣轗脕蓺湚柩急虡尵諨鞂伣洙鋱蛿繌鹯損鰂琐蓈禇猠櫝噽幅逹瑢牺樀坆翲堯批邒界銵沉镥揎鋹祹姌瑱爐毶伾麁豮冂暽烀踽庘添蜵緿対胣錾铿漋骗囤裣帠貊拭臧臅定尳贿躥忶藖疉巡葿脄勻砑载岷貢祁羾獁
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