基于解剖学研究的距下关节韧带的MRI扫描方案

发布时间：2018-03-08 04:22

  本文选题：距下关节　切入点：颈韧带　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:解剖观察正常距跟骨间韧带(Interosseous talocalcaneal ligament,ITCL)、颈韧带(Cervical ligament,CL)的解剖学特点,并测量其在三维空间里的走行方向,为临床应用MRI诊断ITCL、CL损伤找出最佳的MRI定位方法。材料和方法:1.应用7例踝关节上截肢的新鲜足标本,解剖出距跟骨间韧带前束、后束及颈韧带,应用游标卡尺测量韧带的长度、宽度、厚度。应用量角器测量韧带与踝关节冠状面、水平面的夹角。每次测量重复3次,并记录测量的平均值。2.选择无足踝畸形、骨折和手术史的成年志愿者7位共14足行MRI扫描。采用3.0T超导型磁共振(美国通用公司),运用相控阵正交肢体线圈(足部专用线圈),在足中立位下,行常规踝关节扫描,并以其影像面为基准面。以解剖所得的韧带与踝关节各个平面的夹角为参考角度,行距跟骨间韧带的前倾斜冠状位、内倾斜矢状位和外倾斜矢状位扫描;颈韧带的内倾斜矢状位和斜冠状位扫描。运用电子游标卡尺,5.2IMPAX软件版本(爱克发医疗保健公司),由拥有1年的放射学医师和2年的肌肉与骨骼学医师的人担任韧带的测量任务,每根韧带测量3次,并记录每根韧带的平均值,厚度和宽度由显影层数换算,层厚1mm,间隔0mm。结果:1.距跟骨间韧带、颈韧带的解剖特点及测量结果1.1颈韧带的解剖及测量结果:颈韧带(又称前外侧距跟韧带或距跟前韧带)是连接距骨和跟骨的重要韧带,起于距骨头前下骨性隆起处,止于前跟骨结节的背面。本研究解剖发现颈韧带呈单束,未见多束韧带。解剖测量颈韧带的平均长、宽、厚度分别为18.43±1.47mm、9.84±1.41mm、2.47±0.64mm。颈韧带长轴走行方向与踝关节水平面的夹角为43.83±1.65°。颈韧带在跟骨附着处由后内斜向前外走行,与踝关节的冠状面的夹角为61.12±2.44°;颈韧带由后外下斜向内前上的走行方向与颈韧带跟骨附着处相垂直的冠状面的夹角为30.29±1.80°。1.2距跟骨间韧带的解剖及测量结果:距跟骨间韧带是一个片状韧带,起于跟骨沟,止于距骨沟,其纤维向内上倾斜。韧带大部分位于跗骨管内,小部分位于跗骨窦内侧。由于跗骨管斜向前外走行,因此该韧带的整体斜向前外方。距跟骨间韧带由前束和后束组成。前束在冠状面上由前外向后内走行;后束由后内斜向前外走行,前束和后束有部分交叉。前束和后束在矢状面上由后下斜向前上。前束的平均长、宽、厚度分别为13.90±1.55mm、8.41±1.11mm、1.76±0.35mm;后束的平均长、宽、厚度分别为9.89±1.17mm、9.05±0.35、1.79±0.65mm。距跟骨间韧带在跟骨沟附着处由后内斜向前外的走行方向与踝关节冠状面的夹角为36.00±4.12°;前束在冠状位上由外下斜向内上的走行方向与踝关节水平面的夹角为35.42±0.98°,后束由内下斜向外上的走行方向与踝关节水平面的夹角为85.14±3.98°。前束和后束在矢状位上由后下斜向前上的走行,与踝关节水平面的夹角为72.57±2.76°。2.颈韧带、距跟骨间韧带的mri检查路线2.1颈韧带的mri检查路线在足中立位下行踝关节轴位、冠状位和矢状位扫描,以踝关节轴位和冠状位的影像面为基准面。首先,在mri轴位影像上设定由后内斜向前外的mri扫描定位线平行于由后内斜向前外的颈韧带;其次,在mri冠状位影像上由外下斜向内上的mri扫描定位线与踝关节水平面成46°的内倾;最后,在以上定位下行内倾斜矢状面的扫描。设定mri扫描定位线平行于颈韧带在mri轴位上的走行方向,行颈韧带的斜冠状位扫描。2.2距跟骨间韧带的mri检查路线在足中立位下行踝关节轴位、冠状位和矢状位扫描。以踝关节的轴位和矢状位影像面为基准面。首先,在踝关节轴位影像上设定由后内斜向前外的mri扫描定位线与踝关节冠状面成36°的角;其次,在踝关节矢状位影像上设定mri扫描定位线与踝关节冠状位成18°(距跟骨间韧带前束和后束在斜矢状位上由后下斜向前上的走行与踝关节的水平面的夹角为72.57±2.76°)的前倾角;最后,行前倾斜冠状位的扫描。以所扫描的前倾斜冠状位的影像面为基准面,在前倾斜冠状位影像上设定mri的扫描定位线外倾5°与后束的走行方向平行。在前倾斜冠状位影像上设定mri的扫描定位线内倾55°与前束的走行方向平行。3.颈韧带和距跟骨间韧带在MRI上的扫描和测量结果3.1颈韧带:在MRI内倾斜矢状面上测量颈韧带厚度、长度、宽度分别为2.64±0.63mm、18.69±1.09mm、10.06±1.82mm;在MRI斜冠状面上测量颈韧带宽度、长度、厚度分别为9.07±1.21mm、18.07±0.96mm、2.13±0.51mm。颈韧带在MRI内倾斜矢状面与斜冠状面所得的数值的差异无统计学意义(P0.05)与解剖测量的数值的差异无统计学意义(P0.05)。3.2距跟骨间韧带:前束在MRI前倾斜冠状面上测量的厚、长、宽度分别为1.79±0.58mm、14.56±1.60mm、7.34±1.14mm;在MRI内倾斜矢状位上测量前束的宽、长、厚度分别为5.07±1.0mm、13.52±1.09mm、1.34±0.44mm。后束在MRI前倾斜冠状面上测量的厚、长、宽度分别为2.00±0.55mm、9.64±1.11mm、8.76±1.33mm;在MRI外倾斜矢状位上测量后束的宽、长、厚度分别为6.79±0.89mm、8.41±0.89mm、1.14±0.28mm。前束在MRI前倾斜冠状面与内倾斜矢状面上测量的数值的差异无统计学意义(P0.05),与解剖测量的数值的差异无统计学意义(P0.05)。后束在MRI前倾斜冠状面与外倾斜矢状面上测量的数值的差异无统计学意义(P0.05),与解剖测量的数值的差异无统计学意义(P0.05)。结论:1.距跟骨间韧带的MRI扫描方案1.1在踝关节轴位上外前斜36°,冠状位上前倾18°的前倾斜冠状面显示距跟骨间韧带的前后束。1.2在踝关节轴位上内前斜54°,前倾斜冠状位上内后倾55°的内倾斜矢状位显示距跟骨间韧带的前束。1.3在踝关节轴位上内前斜54°,前倾斜冠状位上外前倾5°的外倾斜矢状位显示距跟骨间韧带的后束。2.颈韧带的MRI扫描方案2.1在轴位上前内斜61°,冠状位上前内倾46°的内倾斜矢状面显示颈韧带。2.2在轴位上前外斜29°的斜冠状面显示颈韧带。
[Abstract]:Objective: To observe the normal anatomy of the interosseous talocalcaneal ligament (Interosseous talocalcaneal, ligament, ITCL), (Cervical ligament, CL cervical ligament) anatomical characteristics, and its measurement in three-dimensional space in the direction of travel, for the clinical application of MRI diagnosis of ITCL, CL MRI the best way to find damage location. Materials and methods: 1. application 7 cases of ankle amputation of the fresh foot specimens, the dissection of the interosseous talocalcaneal ligament before the beam and beam after cervical ligament was measured with a vernier caliper, ligament length, width and thickness. The application of ankle ligament and protractor to measure coronal plane, horizontal plane angle. Each measurement was repeated 3 times, and record the average measurement.2. no abnormality of ankle fracture and surgical history, a total of 7 adult volunteers 14 feet underwent MRI scanning. The 3.0T superconducting magnetic resonance (General Company), using the body coil (foot orthogonal phased array coil) in the neutral position under foot, For conventional ankle scanning, and the image plane as the datum. At an angle of the ankle joint and ligament anatomy of each plane as a reference point, before the coronary ligament between the calcaneus tilt spacing, sagittal and oblique in the oblique sagittal scan; cervical ligament in oblique sagittal and oblique coronal scanning. By using electronic calipers, 5.2IMPAX software version (Agfa HealthCare company), the measurement task owned by the radiologist for 1 years and 2 years of musculoskeletal science physician who served as the ligament, ligament of each of 3 measurements, and record the average ligaments value, thickness and width by the developer the number of conversion, thickness 1mm, interval 0mm. results: 1. interosseous talocalcaneal ligament, anatomy of 1.1 cervical ligament and measurement of anatomical characteristics and measurement results of cervical ligament: cervical ligament (also known as the anterior lateral talocalcaneal ligament or distance and ligament) is talus and calcaneus connection weight In the distance to the ligaments, bones before bony hump back, ended in this study. Before the calcaneal anatomy found cervical ligament showed a single beam, no multi beam ligament. The anatomical neck ligament of the average length, width and thickness were 18.43 + 1.47mm, 9.84 + 1.41mm, 2.47 + 0.64mm. axis angle left cervical ligament the direction of ankle joint and the horizontal plane is 43.83 + 1.65 degrees. In the calcaneal attachment by cervical ligament after inclined forward walking outside, and the angle between the coronal plane of ankle joint was 61.12 + 2.44 degrees; cervical ligament after inclined inward angle by the coronal plane ahead of the walking direction and cervical ligament attachment phase of calcaneus the vertical is 30.29 + 1.80 degrees.1.2 anatomy and measurement results of the interosseous talocalcaneal ligament, interosseous talocalcaneal ligament is a ligament in the calcaneal sulcus, flake, stop at the talus ditch, the fiber inward tilt. In most of the tarsal canal ligament, a small part in the medial tarsal sinus. 璺楅�ㄧ�℃枩鍚戝墠澶栬蛋琛，

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