摘要
目的探讨新鲜儿童孟氏骨折骨间膜损伤的MRI表现及损伤的范围。方法 2014年4月至2016年6月郑州大学附属郑州中心医院和深圳平乐骨伤科医院急诊收治新鲜孟氏骨折患儿36例,术前给予MRI检查,其中男23例,女13例;年龄3~11岁,平均年龄为6.9岁;左侧12例,右侧24例。合并同侧桡骨远端骨骺骨折1例,合并桡神经损伤6例,尺神经损伤1例。BadoⅠ型17例,BadoⅡ型1例,BadoⅢ型18例,BadoⅣ型0例。采用肘关节表面柔顺线圈,患者仰卧、上肢伸直前臂旋后位。分别扫描横轴位、矢状位、冠状位、横轴位获得T1WI、T2WI、T2脂肪抑制图像,扫描层厚为3~5mm,间距为1mm,扫描范围为肘关节至腕关节前臂全长。对比正常儿童前臂骨间膜MRI图像,观察孟氏骨折患儿骨间膜损伤的MRI表现,记录不同程度损伤的距离。结果 4例患儿因不能配合MRI检查而未能获得MRI图像,最终获得32例患儿的影像学资料。前臂骨间膜在轴位T1WI、T2WI均可显示,T2脂肪抑制图像显示较为理想,矢状位、冠状位无法分辨骨间膜。以桡骨头环状软骨面为起点,轴位骨间膜距环状软骨面以远30~45 mm开始显示。32例患儿均伴有前臂骨间膜损伤,其中25例损伤且伴有断裂,7例骨间膜损伤但无断裂(BadoⅠ型1例,BadoⅢ型6例)。病理改变距离(损伤未断裂+断裂)12~80 mm,平均(46.03±18.78)mm;损伤未断裂距离12~56 mm,平均(33.09±11.60)mm,断裂距离4~35mm,平均(13.25±9.96)mm。结论 MRI可以显示前臂骨间膜损伤,判断损伤程度(损伤未断裂、断裂);孟氏骨折均伴有骨间膜损伤,损伤的程度与上尺桡关节分离的程度具有一定的联系,损伤由上尺桡关节向远端延伸,远端骨间膜可保持完整。
Background Monteggia fracture is a special type of fractures,namely,the ulnar fracture or the radial and ulnar fractures associated with radial head dislocation,and the treatment is extremely challenging in the clinical practice.As a whole functional unit,the complex movement of forearm is maintained by radius and ulna,proximal and distal radioulnar joints,muscles,tendons and interosseous membrane （IOM）.Therapeutically,the anatomic characteristics of forearm were valued and the individual treatment of was emphasized.The treatment options were based on the fracture classification and the soft tissue damage degree.IOM damage is often combined in forearm or elbow joint injuries,which can affect the vertical and transverse instability to some extent.Therefore,the research of IOM damage provides new ideas for the diagnosis and treatment of forearm injuries.Formerly,with few reported literatures we did not attach importance to the damage and lack the recognition.To study the anatomy of forearm IOM and its damage after Monteggia fracture,36 children of Monteggia fractures were hospitalized to undergo the MRI examinations according to the inclusive and exclusive criteria,observe the pathologic changes and explore the MRI appearance and damage degrees.Methods （1）General information： This study was made up of 36 children,including 23 males and 13 females.The ages ranged from 3 to 11 years with 6.9 years on average.12 cases were left side and 24 cases were right side.1 case was combined with ipsilateral distal radial epiphyseal fracture,6 cases were combined with radial nerve injuries and 1 case was combined with ulnar nerve injuries.17 cases were type BadoⅠ,1 case was type BadoⅡ,18 cases were type Bado Ⅲ and no cases were type Bado Ⅳ.All the children had fresh closed injuries within one week and the time from injury to hospitalization ranged from 1 to 168 hours with 23.6 hours on average.（2） Inclusive and exclusive criteria.Inclusive criteria： ①Children who fitted for the diagnostic criteria of Mo
出处
《中华肩肘外科电子杂志》
2017年第1期15-21,共7页
Chinese Journal of Shoulder and Elbow(Electronic Edition)
基金
河南省科技攻关计划项目(102102310430)
关键词
孟氏骨折
核磁共振成像
前臂骨间膜
损伤
上尺桡关节
Monteggia fracture
Magnetic resonance imaging
Interosseous membrane of forearm
Injury
Upper ulnar joint
