【摘要】： 目的： 通過對(duì)踝關(guān)節(jié)三角韌帶的解剖學(xué)和影像學(xué)研究，觀察踝關(guān)節(jié)三角韌帶的形態(tài)特點(diǎn)，結(jié)合對(duì)踝關(guān)節(jié)三角韌帶損傷患者手術(shù)治療和療效的臨床觀察，進(jìn)一步探討踝關(guān)節(jié)三角韌帶損傷的診斷和治療。 材料和方法： 1．選用青壯年新鮮小腿—足標(biāo)本10個(gè)，分別固定于用泡沫塑料支架固定，進(jìn)行MRI掃描，各例標(biāo)本分別行冠狀位、矢狀位、橫斷位SET1W1、T2W1檢查，了解踝關(guān)節(jié)三角韌帶的走向、位置及測(cè)量踝關(guān)節(jié)三角韌帶的長、寬、厚。 2．用同一青壯年新鮮小腿—足標(biāo)本10個(gè)，解剖后行大體解剖觀察，了解踝關(guān)節(jié)三角韌帶的走向、位置，用游標(biāo)卡尺測(cè)量踝關(guān)節(jié)三角韌帶的長、寬、厚。 3．臨床20例三角韌帶斷裂的病人，8例行應(yīng)力試驗(yàn)X光平片、CT和MRI檢查與手術(shù)后結(jié)果的比較，以探討評(píng)價(jià)應(yīng)力試驗(yàn)X光平片、CT，MRI和關(guān)節(jié)鏡對(duì)踝關(guān)節(jié)三角韌帶損傷的診斷價(jià)值。 結(jié)果： 1．標(biāo)本上的測(cè)量踝關(guān)節(jié)三角韌帶的長、寬、厚的數(shù)值與在MRI上的測(cè)量數(shù)值比較，，差異均無顯著性。 2．脛距前韌帶、脛舟韌帶及跟脛韌帶在核磁共振(MRI)T1W1上均呈低信號(hào)，脛距前韌帶冠狀面經(jīng)內(nèi)踝前層面，橫斷面經(jīng)脛距關(guān)節(jié)平面均能較好顯示。脛舟韌帶在冠狀面經(jīng)內(nèi)踝前層面，橫斷面經(jīng)距骨滑車層面能較好顯示。跟脛韌帶冠狀面經(jīng)內(nèi)踝尖層面、橫斷面經(jīng)內(nèi)踝尖下方層面顯示最好。脛距后韌帶信號(hào)不均，較粗大，其間夾雜高信號(hào)的脂肪影，冠狀面經(jīng)內(nèi)踝中部層面、橫斷切面經(jīng)內(nèi)踝尖層面，顯示最好。 3．應(yīng)力試驗(yàn)X光平片對(duì)判斷韌帶損傷程度有價(jià)值，應(yīng)以健側(cè)作比較，外翻應(yīng)力下，距骨傾度大于10°則有三角韌帶損傷。MRI可直接顯示踝關(guān)節(jié)周圍的肌健和韌帶，相對(duì)常規(guī)X線或CT檢查來說具有巨大的優(yōu)勢(shì)，因此可用于踝關(guān)節(jié)韌帶損傷的診斷。 結(jié)論： MRI上的測(cè)量數(shù)值與解剖學(xué)測(cè)量的數(shù)值基本一致，不同層面不同位置各部分的顯示均具有不同的意義。應(yīng)力試驗(yàn)X光平片是踝關(guān)節(jié)三角韌帶損傷最基本的輔助檢查。MRI不僅能檢查到韌帶損傷，而且能觀察到韌帶損傷的具體情況和其它潛在的損傷。CT在診斷踝關(guān)節(jié)三角韌帶損傷上并不能提供更多的信息。影像檢查只有與臨床資料相結(jié)合才能提高診斷準(zhǔn)確率。
[Abstract]:Objective: to observe the morphological characteristics of the ankle triangular ligament by anatomical and imaging studies, and to observe the clinical observation of the surgical treatment and curative effect of the ankle triangular ligament injury. To further explore the diagnosis and treatment of ankle joint triangular ligament injury. Materials and methods: 1. 10 fresh calf-foot specimens of young adults were fixed with foam scaffolds and scanned by MRI. SET1W1,T2W1 examination was performed on coronal, sagittal and transverse sections of each specimen. To investigate the direction, position and length, width and thickness of ankle triangular ligament. 2. The length, width and thickness of the ankle triangular ligament were measured by Vernier caliper after dissecting 10 fresh calf-foot specimens of the same young and adult, and observing the direction and position of the ankle triangular ligament. 3. The results of stress test X-ray, CT and MRI were compared with post-operative results in 8 of 20 patients with rupture of triangular ligament, in order to explore the evaluation of stress test X-ray plain film, CT,. The value of MRI and arthroscopy in the diagnosis of ankle triangular ligament injury. Results: 1. There was no significant difference between the length, width and thickness of the triangular ligament of the ankle joint measured on the specimen and the measured value on the MRI. 2. The anterior tibialis-talus ligament, the tibial-scaphoid ligament and the calcaneal-tibial ligament showed low signal intensity on the magnetic resonance imaging (MRI) T1W1). The anterior tibial-talar ligament could be displayed on the coronal plane through the medial anterior malleolus plane and the transverse plane through the tibial-talar joint. The tibial scaphoid ligament can be well displayed in coronal plane through medial anterior malleolus plane and cross-sectional transversely talus trochlear plane. The coronal plane of the calcaneal tibial ligament is best displayed through the internal ankle apex, and the cross section through the inferior aspect of the internal ankle tip. The signal of posterior tibiotalar ligament was uneven and thicker, with high signal fat shadow in between, coronal plane through middle of medial malleolus plane, transverse section of posterior tibial ligament through medial ankle apical plane, it was best to show it in the middle plane of medial malleolus. 3. The X-ray plain film of stress test is valuable in judging the degree of ligament injury, and should be compared with the healthy side. Under the overturning stress, the injury of triangular ligament can be found if the tilting degree of talus is more than 10 擄. MRI can directly show the muscles and ligaments around the ankle joint. It has great advantages over conventional X-ray or CT, so it can be used in the diagnosis of ankle ligament injury. Conclusion: the measured values on MRI are basically the same as those measured by anatomy, and the display of different parts on different planes and different positions has different significance. Stress test X-ray plain film is the most basic auxiliary examination of ankle joint triangular ligament injury. MRI can not only detect ligament injury, The specific condition of ligament injury and other potential injuries can be observed. Ct can not provide more information in the diagnosis of ankle triangular ligament injury. Only the combination of imaging and clinical data can improve the accuracy of diagnosis.
【學(xué)位授予單位】：同濟(jì)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：R322;R687.2

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 張瑋煒;Maisonneuve 骨折的治療研究[D];延邊大學(xué);2011年

本文編號(hào)：2433588