PPT医学课件髌骨病变的影像学表现讲义.ppt
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1、Fig. 1: Normal knee radiographs图1:正常膝关节Sagittal proton density (a) and axial fat-suppressed T2-weighted (b) MR images of a normal knee. Note the low signal patellar (PT) and quadriceps (QT) tendons and the thick, homogeneous-appearing patellar cartillage (red arrows). Note the lateral and media reti
2、nacula, passive stabilizers of the patella.Fig. 2: Normal MR images图2:正常膝关节MR图像In 1941, Wiberg classified patellar shape into three different morphologies:Type I (a) demonstrates roughly symmetric and equal-sized, concave medial (MF) and lateral (LF) patellar facets.Type II (b) shows a medial facet
3、that is slightly smaller than the lateral facet and a concave lateral facet.Type III (c) also shows a smaller and more vertically oriented medial patellar facet, which is associated with maltracking disorders 18.Fig. 3: Variations in patellar morphology图3:髌骨形态变异5-year-old male with hereditary osteo-
4、onychodysplasia (nail-patella syndrome). AP (a), later (b), and axial (c) views of the knee demonstrate complete absence of the bilateral patellar ossification centers.Fig. 4: Patellar aplasia图4:髌骨发育不良 5岁男孩遗传性指(趾)甲-髌骨综合征(nail-patella syndrome)Anteroposterior and axial radiographs (a) show bilateral,
5、 well-corticated ossified fragments in the superolateral aspect of the patellas (arrows). Coronal and axial T2-weighted fat-suppressed MR image (b) show the well-corticated ossified fragment. Note the normal bone marrow signal and cartilage across the synchondrisis, The well-corticated nature of the
6、 fragment and lack of abnormal marrow signal help to differentiate this entity from a patellar fracture.Fig. 5: Bipartite patella图5:二分髌骨Anteroposterior, lateral, and axial radiographs (s) show a lucent, round lesion with well-defined margins at the superolateral aspect of the patella (arrows). Sagit
7、tal proton density and axial T2-weighted fat-suppressed MR images (b) show a focal subchondral osseous defect with intact-appearing overlying cartilage; the cartilage is thickened, and fills the defect. There is normal bone marrow signal and smooth, homogeneous signal of the articular cartilage.Fig.
8、 6: Dorsal defect of the patella图6:髌骨背侧缺损(DDP)Congenital patella alta is an anatomic risk factor for patellofemoral instability. The insall-Salvati index is the ratio of the length of the patella (PL) to the patellar tendon (PT). The normal value is between 1.0 and 1.2, with increased values indicat
9、ing patella alta and decreased value indicating patella baja. Lateral radiograph (a) at approximately 30 degrees of knee flxion shows a noemally placed patella, with Insall-Salvati index of 1.1. Lateral radiograph (b) of an 8-year-old male shows patella alta, with Insall-Salvati index measuring 1.8.
10、 Axial T2-weighted tubro spin echo MR image (c) form this same patient shows finding of a lateral patellar dislocation. There is bone marrow edema of the medial aspect of the patella (arrow) and disruption of the medial patellar retinaculum (asterisk). This patient had a history of recurrent disloca
11、tions, likely due to his congenital patella alta.Fig. 7: Patella alta图7:高位髌骨 a图正常位置髌骨,髌韧带长度(PT)/髌骨长度(PL)正常比值为1.0-1.2(国内文献一般小于0.8提示低位髌骨,大于1.2提示高位髌骨);b图PT/PL比值为1.8;c图示髌骨脱位状态,局部骨髓水肿。 高位髌骨通常无症状,尽管它是膝关节不稳定的重要解剖危险因素之一。Anteroposterior (a) and lateral (b) radiographs of a 15-year-old female patient with cin
12、genital right-sided patella baja.Lateral radiographs of a patient one year following total knee arthroplasty demonstrates patella baja. The patellar tendon is scarred to the upper tibia (arrow).Patella baja may also be seen in association with neuromuscular diseases. Fromtal (c) and lateral (d) radi
13、ographs in this patient with a history of polio show marked patella baja. Also nite that the bine are osteopenic and gracile and that there is a paucity of soft tissues, in keeping with the patients history of polio.Fig. 8: Patella baja图8:低位髌骨 a,b图,15岁女孩右膝先天性低位髌骨。 c,d图,低位髌骨也见于神经肌肉疾病;患者既往有脊髓灰质炎病史。 e图
14、,人工膝关节置换后患者一年复查,侧位片提示低位髌骨;箭头是髌韧带疤痕形成。Trochlear dysplasia is among the most significant anstomic factors contributing to patellar maltracking Lateral radiograph (a)depicts one sign,the crossing sign,in which the line of the deepest aspect of the trochlear groove crosses over the antenor aspect of the
15、 femoral condyles (arrow).Sagittal proton density image (b) depicts another hnding of trochlear dysplasia.The ventral trochlear prominence (vtp)has been detined as the distance between the line paralleling the ventral cortical surface of the distal femur and the most anterior point of the femoral tr
16、ochlear floor.In this image is seen a step-like deformity at the intertace of the anterior femoral cortex and trochiea with a vte measuring 9 mm,consistent with trochlear dysplasia.Axial T2- weighted fat-suppressed image (c) shows a congenitaly dysplastic trochlea with a markedly shallow trochiear d
17、epth (arrow),consistent with trochlear dysolbsia Addisanally noted is marked asymmetry of the medial (MF) and lateral (LF) trochlear facets.A lateral to medalfemoral facet.rano ot greater than 1.75 is generally considered diagrosnc for trochlear dysplasia.In this case the ratio measures23. represent
18、ing another tinding of trochlear doplasiaFig. 9: Trochlear dysplasia图9:(股骨)滑车发育不良 股骨滑车发育不良是指滑车沟前部的几何外形和深度存在的解剖学异常。可引起髌骨轨迹不良或慢性膝关节不稳。Trochlear depth assessed on axial T2-weighted fat-suppressed images.A line is first drawn parallel to the posterior temoral condies (A).Lines drawn perpendicular to thi
19、s indicate the anteroposterior dimensions of the lateral(B) and medial (C) trochlear facets and of the deepest portion of the lemoral trochlea (D)Calculate trochlear depth with the equaion (BC/2)-D.Trochlear depth of 3 mm or less indicates trochlear dysplasia.image(a) shows a normal trochlear depth,
20、image (b)shows a dysplasnc trochlea with marked flatteningFig. 10: Trochlear dysplasia measurement of trochlear depth图10:滑车发育不良-滑车深度的测量 计算公式:(B+C/2)-D;小于3mm提示滑车发育不良。 a图是正常的滑车深度,b图是滑车发育不良,呈扁平状。The distance from the tibial tubercle to the trochilear groove is measured on axial MR images.A distance of
21、20 mm indicates considerable lateralization and is almost always associated with patellar instability.Axial MR images in the top row(a)show a normal tibial-tubercle groove distance(blue double-headed arrow).Images in the second row (b)show markedly lateral position of the tibial tubercle in relation
22、 to the trochlear groove(blue double-headed arrow).Fig. 11: Lateralization of the tibial tubercle图11:胫骨结节的偏侧性 胫骨结节的偏侧性通过测量胫骨结节-股骨滑车间距离来定性,测量方法:分别选择通过胫骨结节的横断面图像,及通过股骨髁间窝呈“罗马拱门”形态的层面;勾画出胫骨结节的层面,通过软件和股骨髁间窝层面图像融合,在此新的图像上标记股骨后髁的切线作为参考线,然后分别过股骨滑车最低点和胫骨结节中点作股骨后髁切线的垂线,2条垂线的距离即为胫骨结节-股骨滑车间距离。意义:反映施加于膝关节的屈伸装置的
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