IR@PKUHSC  > 北京大学第四临床医学院
学科主题影像医学与核医学
拇指肌腱韧带断层解剖与损伤的MR研究
叶薇
2016-05-30
导师白荣杰
专业影像医学与核医学
授予单位北京大学
授予地点北京大学第四临床医学院
学位硕士
关键词拇指 肌腱韧带 解剖 损伤 磁共振成像
其他题名Using MRI to study normal cross-sectional anatomy and Injury of the Tendon and Ligament of the Thumb
分类号R816.8
摘要

目的 利用3.0T MRI成像技术,研究拇指肌腱韧带的正常断层解剖、损伤机制及损伤的影像表现,为拇指损伤的诊断与治疗提供解剖学和影像学依据。

方法 该研究经北京积水潭医院伦理委员会批准并经志愿者及患者知情同意。选取12只国人成人新鲜手尸体标本(左、右手各半,分为3组,每组4只)。首先进行拇指冠状位、矢状位和轴位的MR T1WI和质子压脂(PD FS)序列检查。然后,根据MR检查层面,利用骨锯分别对每组(4只)拇指行冠状位、矢状位和轴位进行断层切割,制备手指断层解剖标本,并使断层解剖层面与MR影像一一对应,对正常断层解剖和MR影像解剖进行对照研究。选择20名健康志愿者和30例拇指外伤患者,所有志愿者及拇指外伤的患者均行拇指MR检查,对照分析志愿者肌腱韧带正常解剖及拇指外伤患者的损伤机制和损伤的MRI特点。

结果 新鲜标本断层解剖可清晰显示拇长伸肌、拇短伸肌、拇长屈肌、拇短屈肌及掌指关节、指间关节的侧韧带结构。第一腕掌关节可清晰显示。拇指肌腱韧带在MR各序列均表现为低信号改变。20名正常志愿者的拇指肌腱表现为粗细不等的均匀条带状稍低信号,其中拇指的伸肌腱表现为细条线状,屈肌腱表现为稍粗条带状结构,屈肌腱滑车表现为环形低或稍低信号,侧韧带均为条带状均匀低号。30例拇指肌腱韧带损伤患者(拇长伸肌腱损伤4例,拇短伸肌腱损伤2例,拇内收肌损伤1例,拇指掌指关节尺侧副韧带损伤16例,桡侧副韧带损伤6例,腕掌关节前斜韧带损伤1例),其损伤的肌腱或韧带T1WI序列呈低信号改变,纤维结构不清或不连续性,PD-FS序列的肌腱或韧带呈不均匀高信号,纤维部分或完全不连续。肌腱损伤机制大多由于过伸或过屈力的作用所致,侧韧带损伤机制主要是内外翻力作用于关节所致。

结论 拇指肌腱韧带损伤比较常见,高分辨3-T MRI可清晰显示肌腱韧带的精细解剖结构,为损伤的诊断奠定基础。利用高分辨MRI可以清晰显示拇指肌腱韧带的正常解剖、变异及损伤的影像学特点,为拇指肌腱韧带损伤的早期诊断提供重要的解剖学和影像学依据,对治疗方案制定及随访具有重要的临床应用价值。

英文摘要

Objective  To explore the normal cross-sectionalanatomy, injury mechanismand injury features of tendon and ligament of the thumb with high-resolution 3-T MRI.

Methods  The study was reviewed and approved by an institutional review board of the Beijing Jishuitan hospital, both the normal volunteers and the patients were  informedconsent.Choosing 12 fresh hands of Chinese adult cadavers (half left, half right,equally divided to 3 groups) to proceed thumb MR examination on both T1-weighted and proton fat saturation sequence(PD-FS)sequences from coronal, sagittal, axial view. Then each group of the thumbs were respectively sectional cut from coronal, sagittal, axial view by usingelectric bone-saw to prepare the sectionalanatomical specimens which can be matched one-to-one with the MR imaging, in order to compare the cross-sectional anatomy with the MRI anatomy. Select 20 normal volunteers and 30 patients with thumb injuries to undergo magnetic resonance examination, then comparative analyze the normal anatomy, the MRI injury features and injury mechanism of the thumb in normal volunteers and patients with injuries.

Results  Fresh sectional specimens of the thumb can display the extensor pollicis longus/brevis, flexor pollicis longus/brevis and the collateral ligament of the metacarpophalangealand interphalangeal jointclearly.The first carpometacarpal joint can also be clearly displayed. Tendon and ligament of the thumb are all showed low-signal-intensity on both T1-weighted and proton fat saturation sequence. Tendon and ligament of the twenty volunteers showed homogeneous low-signal-intensity in different thickness. The flexor tendons is thicker than the extensor tendons and the pulleys are demonstrated annular low-signal-intensity, the collateral ligaments are demonstrated thin homogeneous low-signal-intensity .There were 30 patients with thumb injuries(including 4 cases of extensor pollicis longus injuries, 2 cases of extensor pollicis brevis injuries, 1 case of adductor pollicis injury, 16 cases of  ulnar collateralligament injuriesat metacarpophalangeal joints,6 cases of radial collateralligament injuries and 1 case of anterior oblique ligament(AOL/beak ligament) injury at carpometacarpal joint), which demonstrated poor definition, discontinuity in both T1-weighted and proton fat saturation sequence anddemonstrated heterogeneously increased signal intensity in proton fat saturation sequence(PD-FS).Mechanism of tendon injury mostly due to hyperextension or hyperflexion, ligament injury is mainly caused by the varus or valgus stress at the joints.

Conclusion  Tendon and ligament injuries of thumb are extremely common. Anatomic detail provided by high-resolution 3-T MRI can determine the extent of these injuries. A fundamental knowledge of tendon and ligamentof thumb anatomy and abnormalities, in concert with high-resolution MRI, can lead to an appropriate diagnosis and optimal patient management. MRI provide both significant anatomical and imaging basis for the early diagnosis of tendon and ligament injury,which is very important application value for the patients to make the treatment plan and follow up.

语种中文
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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/124762
专题北京大学第四临床医学院
作者单位北京大学第四临床医学院
推荐引用方式
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叶薇. 拇指肌腱韧带断层解剖与损伤的MR研究[D]. 北京大学第四临床医学院. 北京大学,2016.
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