摘要目的 研究三角纤维软骨复合体(TFCC)损伤的磁共振(MRI)表现,为损伤的早期诊断和治疗提供影像学依据.方法 选择2014年3月至2015年11月,10名健康志愿者及北京积水潭医院200例腕关节尺侧疼痛且临床高度怀疑TFCC损伤的患者行腕关节MR检查.所有研究对象均取俯卧位,分别行T1WI冠状位,质子压脂序列(PD-FS)冠状位、矢状位及轴位扫描.选择其中3名健康志愿者及67例经手术证实的TFCC损伤患者的MR资料,对照分析TFCC正常解剖的MRI表现,并根据Palmer分类对损伤进行大致分型,分析TFCC损伤类型的MRI特点,最后与手术结果进行对照分析.结果 3名健康志愿者TFCC在MRI各序列上表现为以低信号为主.根据Palmer分型,67例TFCC损伤患者中,52例患者是创伤性损伤(其中ⅠA9例,Ⅰ B25例,ⅠC3例,ⅠD13例,1例患者同时存在TFC中心穿孔和尺侧撕脱,1例患者同时存在尺侧和桡侧附着端损伤),退行性损伤15例(其中ⅡA5例,ⅡB1例,ⅡC2例,ⅡD1例,ⅡE6例).中心穿孔主要表现为PD-FS序列上线状信号增高影,垂直于关节盘呈矢状走行,远端尺腕关节间隙内积液;尺侧、远端及桡侧附着端损伤主要表现为损伤处形态欠规则,结构模糊,PD-FS序列上损伤的结构内信号增高.退行性损伤主要表现为TFC形态不规则,PD-FS序列上信号不均匀,可见混杂中高信号,合并月骨、尺骨关节软骨改变,月三角韧带处高信号影以及尺腕关节或远端桡尺关节炎改变.结论 MRI可精确显示TFCC的精细解剖结构,并可对TFCC损伤进行大致分型,对损伤的早期诊断与治疗方案的制定具有重要价值.

abstractsObjective To explore the MRI characteristics of injuries of triangular fibrocartilage complex (TFCC),and provide imaging basis for the early diagnosis and treatment of the injuries.Methods A total of 10 healthy volunteers without wrist injuries and 200 patients from Beijing Jishuitan Hospital who complained ulnar-sided wrist pain and were highly suspected as the injury of TFCC underwent the wrist magnetic resonance examination.All subjects were in a prone position and underwent examination on coronal T1 WI scan and PD-FS on 3 planes respectively.Then the MRI characteristics of 3 healthy volunteers and 67 patients with TFCC injuries that confirmed by operation were analyzed.According to the comparative analysis of normal anatomy and Palmer classification,the injuries were classified and MRI features of different types of injuries were analyzed.At last,imaging findings were compared with surgical results.Results Three healthy volunteers without injuries showed mainly in low signal intensity on T1WI and PD-FS images.According to Palmer classification,there were 52 traumatic injuries (Ⅰ A 9,Ⅰ B 25,Ⅰ C 3,Ⅰ D 13,In addition,1 has central perforation and ulnar avulsion and 1 has ulnar and radial injuries simultaneously) and 15 degenerative injuries (Ⅱ A 5,Ⅱ B 1,ⅡC 2,Ⅱ D 1,Ⅱ E 6) among 67 patients.The central perforation mainly demonstrated as linear high signal perpendicular to the disk,and run in a sagittal line.The ulnar,distal,and radial avulsion mainly showed the injuries were irregular,the structures were ambiguous,and there was high signal intensity in the injured structures on PD-FS.Degenerative injuries demonstrated the irregularity of TFC and heterogeneous signals on PD-FS.There were mixed intermediate-high signals and changes in the articular cartilage of lunate and ulna,high signal in the lunotriquetral ligament and ulnocarpal or radioulnar arthritis.Conclusion MRI can demonstrate the anatomy of TFCC accurately,evaluate and make the general classification of injuries.It is of significance for the early diagnosis and treatment protocols of the TFCC injuries.