腕关节不稳合并TFCC损伤患者早期MRI表现

摘要

目的 分析腕关节不稳合并三角纤维软骨复合体(TFCC)损伤患者早期磁共振成像(MRI)表现,为临床早期确诊及治疗提供客观的影像学依据.方法 回顾性分析2015年1月至2017年1月哈励逊国际和平医院核磁共振室高年资医师诊断腕关节不稳合并TFCC损伤78例患者的影像资料,根据Palmer分型标准对其MRI表现进行归纳总结.结果 78例腕关节不稳合并TFCC损伤患者中,创伤性TFCC损伤患者58例(其中ⅠA 11例,ⅠB 27例,ⅠC 5例,ⅠD 15例),在压脂的质子密度加权成像(PD-FS)及3D薄层T2加权成像(T2-iso)冠状位薄层扫描序列上表现为三角纤维软骨盘(TFC)中心可出现裂隙状、线状或片状高信号,软骨面不光滑及撕裂,尺骨茎突连接部及桡骨乙状切迹连接部结构模糊,部分患者出现尺月韧带及尺三角韧带损伤,信号增高,远端桡尺关节积液.退行性TFCC损伤20例(其中ⅡA 5例,ⅡB 4例,ⅡC 3例,ⅡD 2例,ⅡE 6例),在PD-FS及T2-iso冠状位薄层扫描序列上表现为TFC形态变薄,结构模糊,软骨面不光滑,信号不均匀,可见混杂中高信号,邻近月骨、三角骨软骨变薄,内可见小片状水肿信号、囊变,月三角韧带结构模糊,桡尺关节积液.结论 MRI可精确显示腕关节不稳患者TFCC的精细解剖结构,其早期MRI影像表现对临床诊治具有重要价值.%Objective To analyze early magnetic resonance imaging ( MRI) image findings of wrist instability combined with triangular fibrocartilage complex ( TFCC) injury,providing objective imaging evidence for the early diagnosis and treat-ment.Methods Retrospective analysis on imaging data of 78 patients with wrist joint instability combined TFCC injury diagnosed by senior doctors from MRI Room in Harrison International Peace Hospital druring Jan .2015 and Jan.2017 was done,and the MRI image performance was summarized according to Palmer classification standard .Results Among the 78 patients,including 58 patients with traumatic injury of TFCC (ⅠA 11 cases,ⅠB 27 cases,ⅠC 5 cases,D 15 cases),in the PD-FS and T2-iso coronary thin layer scanning sequence imaging:crack,linear or slice high signal ,unsmooth cartilage sur-face and torn in the center of triangular fibrocartilage ( TFC) ,fuzzyulna radial styloid process connection and sigmoid notch connection structure were observed ,some patients had ulnar ligament and deltoid ligament damage ,with higher signal,and distal radioulnar joint effusion;20 cases of degenerative TFCC injury (ⅡA 5 cases,ⅡB 4 cases,ⅡC 3 cases,ⅡD 2 cases,ⅡE 6 cases), in the PD-FS and T2-iso coronary thin layer scanning sequence imagning:thinner TFC,fuzzy structure, unsmooth cartilage surface ,uneven signals ,mixed high signal ,adjacent lunate bone ,triangle bone cartilage thinning ,platelet edema,cystic change,fuzzy deltoid ligament structure ,and radioulnar joint effusion .Conclusion MRI can accurately show the fine anatomical structure of the TFCC of spatient with unstable wrist ,and the early MRI image performance has important value for the clinical diagnosis and treatment .