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您当时的方位:主页 > 骨肌病例 > 四肢关节

膝关节内侧半月板桶柄状撕裂(Bucket-Handle Tear of Medial Meniscus)MRI 病例

时刻:2009-11-18  来历:uhrad.com  作者:胡玉川编译仿制共享】【谈论-纠错】【告发

zWU印象园cn-diwater.com

 zWU印象园cn-diwater.com

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Clinical History(临床病史): The patient is a 35-year-old man who presents with a painful knee after a sports injury.zWU印象园cn-diwater.com

35岁男性,运动后呈现膝关节痛苦。 zWU印象园cn-diwater.com

Findings(印象所见): Sagittal proton density MR images of the patient's knee demonstrate truncated anterior and posterior horns of the medial meniscus without the normal bow-tie configuration as well as a low-signal intensity band parallel and anterior to the PCL (double-PCL sign). Coronal STIR images demonstrate a displaced meniscal fragment within the intercondylar notch.zWU印象园cn-diwater.com

Diagnosis(确诊): Bucket-handle tear of the medial meniscus.内侧半月板桶柄状撕裂zWU印象园cn-diwater.com

    桶柄状撕裂(bucket handle tear , BHT) 是半月板损害一种特别类型,病损严峻,常导致膝关节交锁, 但在MRI 查看上却极易遗失。zWU印象园cn-diwater.com
Helms在确诊BHT 时提出蝶结消失征(absent bow tie sign ,ABTS) ,敏感性97 %。依据Helms 描绘 ,正常膝关节在矢状面上内侧或外侧半月板前角和后角经过体部相衔接,断面上形状像蝴蝶领结状,简称蝶结。在层厚4~5 mm ,距离0~0. 5 mm的MRI 印象上,这种靠体部衔接的蝶结至罕见2 个。半月板BHT损害时,蝶结只要一个或没有,这种印象称蝶结消失征。zWU印象园cn-diwater.com

    BHT损害是半月板纵行撕裂的特别方式,大样本的发作率为9 %~24 %。发作在年青患者居多,损害在内侧半月板是外侧的2~3 倍。用MRI 确诊有很大难度,常见的征像包含(1) 冠状面上,髁间窝内有低信号的半月板安排坐落穿插韧带旁。(2) 矢状面上呈现双后穿插韧带征。(3) 矢状面显现剩余的前角或后角变小或切断,信号有或无增高。(4) 蝶结消失征。zWU印象园cn-diwater.com

    正常成人半月板宽度9~12 mm , 故在惯例层厚4~5 mm,距离0~0. 5 mm的MRI 矢状面成像上至罕见2 个以上蝶结存在。一旦BHT 桶柄移入髁间窝,半月板宽度明显减小,将会呈现ABTS ,此刻可伴有双后穿插韧带征。但少量病例如内、外翻膝关节变形中,内、外侧间室变小,半月板退变、磨损,小儿半月板也会呈现ABTS。zWU印象园cn-diwater.com

Discussion(谈论): A displaced longitudinal tear of the meniscus is called a bucket-handle tear because the separated central fragment resembles the handle of a bucket. Patients with bucket-handle tears may present with a locked knee or a lack of full extension. Bucket-handle tears involve the medial meniscus three times more often than the lateral meniscus. The central fragment may be partially displaced or may be completely displaced into the intercondylar notch as is frequently demonstrated on coronal images. Bucket-handle tears effectively reduce the width of the meniscus, resulting in truncation of the anterior and posterior horns on sagittal images, and peripheral sagittal images fail to demonstrate the normal bow-tie configuration of the body of the meniscus. Another helpful imaging finding which is sometimes seen is the double-PCL sign which is the presence of a low-signal intensity band parallel and anterior to the PCL, caused by the displaced meniscal fragment within the intercondylar notch. A partial menisectomy can be performed for nonseparated symptomatic tears.zWU印象园cn-diwater.com

Reference:zWU印象园cn-diwater.com
Stoller DW, Cannon WD, Anderson LJ. The Knee. In: Magnetic Resonance ImagingzWU印象园cn-diwater.com
in Orthopedics and Sports Medicine, 2nd Edition
. Stoller DW. Lippincott-Raven; zWU印象园cn-diwater.com
Eds. 1997:273-277.zWU印象园cn-diwater.com

Resnick D. Internal Derangements of Joints. In: Diagnosis of Bone and Joint Disorders, zWU印象园cn-diwater.com
3rd Edition
. Ed. Resnick D. W. B. Saunders, Co., Philadelphia; 1995(5):3069-3098.zWU印象园cn-diwater.com

Weissleder R, Rieumont MJ, Wittenberg J. Primer of Diagnostic Imaging, 2nd Edition. zWU印象园cn-diwater.com
Mosby, St. Louis; 1997:372-374.zWU印象园cn-diwater.com

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