Objective To investigate the morphological manifestation of pronator quadratus and clinical significance in standard lateral X-ray films and MRI images of normal wrists, to establish the range of normal values and the diagnosis standard of pronator quadratus in normal people to, to, and so as to improve the diagnostic rate of occult fracture in wrist. Methods This study was conducted with 285 patients (Male, 131; Female, 154) who had wrist injured. These injured wrists were examined with standard X-ray films. Informed consent was obtained, and contralateral (symptomless) standard lateral X-ray films of normal wrists were obtained (Left, 132; Right, 153). The biggest thickness of pronator quadratus (BTPQ) was measured in the lateral radiograph, and the morphological manifestation of normal pronator quadratus was observed. Statistical analysis was performed to compare the difference of the thickness of pronator quadratus between male and female, and the difference of the morphology of pronator quadratus. Twenty volunteers were enrolled in the study, with MRI examination, and the morphological manifestation of pronator quadratus was also observed. Six cases had further examination with CT and MRI, because of the pronator quadratus swelling and pronated disability. Results The mean thickness of BTPQ in the normal wrist was (4. 89±1. 91) mm, which, in men, was significantly larger than in women ( P <0. 01) . The morphology of pronator quadratus was classified into four types: A, lamelliform; B, satiation and clearness; C, ambiguity in the inferior part; D, all ambiguity, which was correspondingly related to MRI images. The difference of BTPQ was statistically significant ( P <0. 01) between men and women in A type, B type and C type respectively. Due to unclear, the D type can not be measured in the BTPQ. Overall, the difference of BTPQ was statistically significant between A type and B type, and between A type and C type ( P <0. 01) . The difference of BTPQ were not statistically significant between B type and C type ( P >0. 05). BTPQ was (7. 69 ± 2. 61) mm in the fracture group. Conclu-rnsion A type and B type were more than the other two types, and D type was the least. We can see that the fat in front of the pronator quadratus is clear in common. If BTPQ of men is more than 6 mm, and BTPQ of women is more than 5 mm, considering with clinic history and pronated disability, further examination should be considered to exclude occult fracture in the wrist.%目的 探讨在腕关节标准侧位平片及MRI上旋前方肌的正常表现及肿胀的临床意义,并建立旋前方肌的正常值范围及诊断标准,以期提高对腕部隐蔽性骨折的检出率.方法 对以单侧腕部外伤就诊的285例受检者(男性131例,女性154例)拍摄腕关节标准正侧位平片,并加照对侧正常(未受伤和无其它腕部疾病史)腕关节标准侧位平片(左腕132例,右腕153例),测量受检者每侧旋前方肌最大厚度(Biggest thickness of pronator quadratus,BTPQ)并观察正常腕关节旋前方肌形态学表现.应用统计学方法比较不同性别间及不同旋前方肌形态间旋前方肌厚度之间的差异.并对20名志愿者行T1WI矢状位MRI扫描,观察旋前方肌形态学表现并与受检者平片对照.6例因外伤侧平片无骨折但旋前方肌明显肿胀且伴有旋前功能障碍者,5例行MRI,1例行CT检查.结果 正常的旋前方肌的厚度(BTPQ)的平均值为(4.89±1.91)mm,其中旋前方肌厚度男性显著大于女性(P＜0.01).旋前方肌分为四型:(A)薄片型；(B)饱满清晰型；(C)下部模糊型；(D)全部模糊型,MRI图像旋前方肌的形态学表现与之相对应.薄片型、饱满清晰型及下部模糊型的旋前方肌厚度男女之间都相差显著(P＜0.01),全部模糊型因显示不清,无法测得其旋前方肌厚度.总体上薄片型分别与饱满清晰型、下部模糊型旋前方肌厚度相差都有统计学意义(P＜0.01)；饱满清晰型与下部模糊型旋前方肌厚度相差不显著(P＞0.05).骨折组旋前方肌最大厚度平均值为(7.69±2.61)mm.结论 薄片型与饱满清晰型较其它两型多见,全部模糊型最少见,说明在正常人中旋前方肌前方的脂肪间隙多显示清晰.当男性＞6 mm,女性＞5mm时,临床有外伤史和旋前障碍等体征,应作进一步检查,以排除隐蔽性骨折的存在.
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