大学精品课件：总论－肌肉骨骼系统.ppt

1、Welcome,欢迎来到积水潭医院！,正常解剖和X线表现,The Human Skeleton,Anatomy,Macroscopic structure Microscopic structure,Macroscopic structure,儿童,骨骺,干骺端,骨干,骺线,正常胫腓骨正侧位,骨端,骨干,腰椎正常解剖,基本病变（掌握）,骨质疏松osteoporosis 骨质软化osteomalacia 骨质破坏destruction of bone 骨质增生硬化hyperostosis and osteosclerosis 骨膜增生periosteal proliferation 骨内软骨内钙

2、化osteal and chondral calicification 骨质坏死necrosis of bone 矿物质沉积mineral deposition 骨骼变形deformation of bone 周围软组织病变surrounding soft tissue lesions,骨质疏松,定义 组织学改变 影像学表现 原因,骨皮质变薄，分层 骨小梁细少，边缘清,骨质软化,定义 组织学改变 影像学表现 原因,骨皮质和骨小梁边缘模糊 骨骼变形,骨质破坏,定义 组织学改变 影像学表现 原因,骨质增生硬化,定义 组织学改变 影像学表现 原因,骨膜增生,定义 组织学改变 影像学表现 原因,骨内和

3、软骨内钙化,骨质坏死,定义 组织学改变 影像学表现 原因,矿物质沉积,定义 组织学改变 影像学表现 原因,骨骼变形,周围软组织病变,定义 组织学改变 影像学表现 原因,关节基本病变,关节肿胀（swelling of joint) 关节破坏(destruction of joint) 关节退行性变(degeneration of joint) 关节强直(ankylosis of joint) 关节脱位(dislocation of joint),关节肿胀,关节破坏,急性化脓性关节炎 关节滑膜结核 RS,关节退行性变,骨关节强直,关节脱位,民间故宫山西王家大院,骨关节创伤,Imaging Moda

4、lities,Routine radiographs first CT Characterize complex fractures (pelvis, ankles, hips) Not for detection of radiographically occult fractures MRI Useful to detect radiographically occult fractures Excellent for soft tissue injuries Bone Scan Inexpensive Very sensitive for detecting occult fractur

5、es,Proper radiographic evaluation Fracture description,Proper Radiographic Imaging （了解）,Rule of 2s 2 views: AP and lateral 2 joints: include the joints above and below fracture 2 sides: both limbs (if needed in children with open epiphyses,Having the proper history is important so that the correct b

6、ody part is imaged!,1 view is no view,Proper radiographic evaluation Fracture description,Definitions,Fracture: Complete disruption in the continuity of a bone Dislocation: Complete disruption of a joint, articular surfaces are no longer in contact Subluxation: Minor disruption of a joint, where som

7、e articular contact remains Soft tisuue injuries,骨折的直接征象（掌握）,骨皮质断裂 骨小梁不连续 透明线或密度增高线 骨形态异常,骨折的直接征象,骨皮质断裂 骨小梁不连续 透明线或密度增高线 骨形态异常,骨折的直接征象,骨皮质断裂 骨小梁不连续 透明线或密度增高线 骨形态异常,骨折的直接征象,骨皮质断裂 骨小梁不连续 透明线或密度增高线 骨形态异常,T7,骨折的间接征象（拓展）,关节积液 液脂平面；液脂气平面 脂肪纹的移位,间接骨折征象,关节积液,男，6岁，跌到时急性肘损伤。,STIR,Joint disruption,Dislocation:

8、 Complete disruption of a joint Articular surfaces no longer in contact Subluxation: Partial disruption of a joint Some articular contact persists,Dislocations,Subluxation,Bony components of joint partially in contact with each other,Soft tissue injuries,muscle，ligament，tendon，articular capsule,A,B,

9、C,D,How fractures are described （认识并掌握）,By direction of fracture line By relationship of fragments By number of fragments Also, Complete or Incomplete Goes through entire cortex Involves a portion of cortex closed or open Clinical evaluation for integrity of overlying skin,Direction of fracture line

10、,line Transverse (simple) Oblique butterfly Spiral Longitudinal Complex,Transverse,Oblique,Spiral,Relationship of fragments,Displacement Angulation Shortening Separation Rotation Most fractures demonstrate 1 of these abnormalities,Displacement,Described by position of distal fracture fragment relati

11、ve to proximal fragment Off-set of fragments described by Direction Anterior, posterior, lateral or medial Degree percentage of shaft width,Angulation成角,Relationship of long axes of fracture fragments Described by Direction of angular displacement of distal fracture fragment Anterior/posterior Varus

12、/valgus 国内：以顶角的方向来确定。,Angulation,Varus Distal fragment points toward body midline (apex points away) Valgus Distal fragment points away from body midline (apex points toward),Varus valgus dorsal,Shortening,Complete loss of contact of bone ends Bayonet appositionif fragments overlap one another, leav

13、ing shafts but not ends in contact,6 cm,Rotation,Number of fragments,2 fragmentssimple fracture 2 fragmentscomminuted fracture Segmental 2 fracture lines isolate a discrete segment Butterfly wedge-shaped separate fragment formed at the apex of the force,simple fracture,Comminuted fracture with butte

14、rfly fragment,Segmental fracture,儿童骨折的特点,1易发生骺离骨折 2易发生不全骨折（青枝骨折） 3易损伤生长板 4改建塑性好,骺离骨折,Buckle/Torus fracture,Greenstick Fracture,Plastic fracture,生长板损伤,骺早闭,A10岁，新鲜骨折 B 13岁，摔伤8年，畸形2年。,脊柱骨折,腰椎骨折示意图,平片,CT,A,B,单纯压缩骨折,椎体爆裂骨折,MRI,T1WI,T2WI,常见的骨折（认识并掌握）,Colles ,s骨折 肱骨髁上骨折 股骨颈骨折 三踝骨折 骨盆骨折 疲劳骨折,国外：dorsal angul

15、ation 国内：向掌侧成角。,Colles,s骨折(重点）,肱骨髁上骨折,股骨颈骨折,三踝骨折,外踝、内踝和后踝,疲劳骨折,椎间盘病变,腰椎间盘正常解剖,横断位,矢状位,腰椎间盘正常解剖,T1WI T2WI 水成像,椎间盘病变,椎间盘膨出 椎间盘疝出 突出 脱出 髓核游离 髓核压迹:,椎间盘疝,膨出 疝出,椎间盘突出,T1WI T2WI T2WI,椎间盘脱出,T1WI T2WI,髓核游离,T1WI T2WI T2WI,Schmorl,s结节,T1WI T2WI,骨关节和软组织感染性疾病,化脓性骨髓炎 化脓性关节炎 骨与关节结核 软组织感染,化脓性骨髓炎,病变部位与临床 病理改变及蔓延方式,影

16、像学诊断要点,好发部位：好发于干骺端，多向骨干方向发展 骨质破坏：不规则，侵润性 增生硬化：坏死周边出现不同程度的增生硬化 死骨形成：多为块状,慢性化脓性骨髓炎,诊断要点： 残存较小的骨质破坏区 大量的骨质增生硬化 死骨形成：多为块状。,慢性骨脓肿和硬化性骨髓炎,骨结核tuberculosis,诊断要点： 好发部位：儿童干骺端，病灶常跨越骺板累及骨骺，很少向骨干方向发展 骨破坏：形成骨脓肿，边缘模糊 增生硬化：可有，但不明显 死骨：砂粒状小死骨 骨质疏松明显 特殊类型：骨气臌，纺锤状,A,D,C,B,脊柱结核,诊断要点： 椎体破坏 椎间隙变窄 椎旁脓肿,腰椎结核,T1WI T2WI T1WI+C,腰椎结核同上病例,T2WI,T1WI,T2WI,骨气臌,