正常舟月骨间韧带的超声、X线及MRI对比研究
摘要
目的 提供舟月骨间宽度(SLSW)及舟月韧带厚度(SLLT)在正中位及尺、桡侧偏位的超声测量正常值，评价超声测量SLSW及SLLT的准确性；比较超声与X线及MRI测量SLSW及SLLT的相关性。方法 100人200只正常手腕，男女各50人，年龄19～68岁，平均年龄30.2岁。超声检查选用5～12MHz，8～13MHz线阵扫查探头，X线检查选用日本岛津RSZ-200型1000MA机，MRI检查采用美国Philips
Infinion 1.5T短磁场机。记录超声测量SLSW、舟月韧带背侧部厚度(SLLTd)及舟月韧带掌侧部厚度(SLLTv)值。在腕后前位X线片上测量SLSW。在MRI图像上测量SLSW和SLLT值。结果 超声测量：男SLLTd为2.18mm±0.35mm(1.7mm～3.1mm)；女SLLTd为1.99mm±0.23mm(1.5mm～2.5mm)，男SLLTv为1.21mm±0.30mm(0.7mm～1.7mm)；女SLLTv为1.20mm±0.24mm(0.6mm～1.7mm)。舟月韧带的背侧部声像图最清晰，背侧部与掌侧部的显示率比较，有非常显著差异(P＜0.01)。男性SLLTd明显宽于女性(P＜0.01)，而SLLTv无显著差异(P＞0.05)。超声与MRI测量SLLT相关性比较，呈直线相关(P＜0.01)。男性正中位SLSW为5.08mm±0.47mm(4.2mm～6.1mm)；女性正中位SLSW为4.80mm±0.46mm(4.0mm～6.0mm)。男女比较，正中位及尺桡侧偏位SLSW左右侧均有显著差异(P＜0.05～0.01)。左右差值比较：正中位时，男性右侧较左侧SLSW平均差值为：+0.026mm(-1.1mm～+1.1mm)；女性右侧较左侧SLSW平均差值为：+0.006mm(-0.6mm～+1.5mm)。超声与MRI、超声与X线在测量SLSW方面，均呈直线相关(P＜0.01)。结论 超声能够准确地测量腕舟月骨间宽度及舟月韧带的厚度，为诊断舟月骨分离等提供了一个简便而可靠的方法。
Objectives To establish the normal values of scapholunate joint space width (SLSW) and the normal scapholunate ligament thickness(SLLT) in the neutral position and radial and ulnar deviation. To assess the accucy of measurements of SLS W and SLLT on ultrasonography. To compare the relativity in measurements of SLS W and SLLT among sonography and X-ray and MRI too. Methods: Two hundred normal wrists in 100 subjects(50 men and 50 women;mean age 30.2 years;range 19-68 years) were examined with high-resolution sonography (5~12MHz,8~13MHz linear-array transducer) and SUZUKE RSZ 200 X-ray and Philips Infmion 1.5T MRI. The SLSW and scapholunate ligament thickness of dorsal(SLLTd) and scapholunate ligament thickness of volar(SLLTv) were measured in the neutral position and ulnar and radial deviation on sonography. The SLSW on X-ray and both the SLSW and SLLT were measured and MRI patterns. Results: The mean values of the SLLTd and SLLTv were 2.18mm 0.35 mm(range, 1.7mm~3.1mm) and 1.21mm 0.30mm(0.7mm~1.7mm) i
n men and 1.99mm 0.23mm (range,!.5mm~2.5mm) and
1.20mm 0.24mm(0.6mm~1.7mm)in women in the neutral position,respectivily. The dorsal scapholunate ligament was easiest visible both in men and in women. There was significant difference in scapholunate ligament visibility between in dorsal and in volar(P<0.01). The SLLTd was significantly wider in men than in women but no significant difference in SLLTv between in men and in women. There was significant correlation between US and MRI(P<0.01) on measuring SLLT. The mean value of the SLSW was 5.08mm 0.47mm (range, 4.2mm~6.1mm) in men and 4.80mm 0.46mm (range,4.0mm~6.0mm) in women in the neutral position. There was significant
difference in SLSW between in men and in women in the neutral position and ulnar and radial deviation both in the left and right hand (P<0.05~0.01). The mean variations of SLSW were +0.026mm(range,-l.lmm~+l.lmm) in men and +0.006mm(range,-0.6mm~+1.5mm) in women. There was significant correlation between sonography and X-ray or MRI (P<0.01) on measuring SLSW. Conclusions It was accurate and reliable to measure SLSW and SLLT on sonography. Ultrasonography can be used to diagnosis scapholunate dissociation.
Infinion 1.5T短磁场机。记录超声测量SLSW、舟月韧带背侧部厚度(SLLTd)及舟月韧带掌侧部厚度(SLLTv)值。在腕后前位X线片上测量SLSW。在MRI图像上测量SLSW和SLLT值。结果 超声测量：男SLLTd为2.18mm±0.35mm(1.7mm～3.1mm)；女SLLTd为1.99mm±0.23mm(1.5mm～2.5mm)，男SLLTv为1.21mm±0.30mm(0.7mm～1.7mm)；女SLLTv为1.20mm±0.24mm(0.6mm～1.7mm)。舟月韧带的背侧部声像图最清晰，背侧部与掌侧部的显示率比较，有非常显著差异(P＜0.01)。男性SLLTd明显宽于女性(P＜0.01)，而SLLTv无显著差异(P＞0.05)。超声与MRI测量SLLT相关性比较，呈直线相关(P＜0.01)。男性正中位SLSW为5.08mm±0.47mm(4.2mm～6.1mm)；女性正中位SLSW为4.80mm±0.46mm(4.0mm～6.0mm)。男女比较，正中位及尺桡侧偏位SLSW左右侧均有显著差异(P＜0.05～0.01)。左右差值比较：正中位时，男性右侧较左侧SLSW平均差值为：+0.026mm(-1.1mm～+1.1mm)；女性右侧较左侧SLSW平均差值为：+0.006mm(-0.6mm～+1.5mm)。超声与MRI、超声与X线在测量SLSW方面，均呈直线相关(P＜0.01)。结论 超声能够准确地测量腕舟月骨间宽度及舟月韧带的厚度，为诊断舟月骨分离等提供了一个简便而可靠的方法。
Objectives To establish the normal values of scapholunate joint space width (SLSW) and the normal scapholunate ligament thickness(SLLT) in the neutral position and radial and ulnar deviation. To assess the accucy of measurements of SLS W and SLLT on ultrasonography. To compare the relativity in measurements of SLS W and SLLT among sonography and X-ray and MRI too. Methods: Two hundred normal wrists in 100 subjects(50 men and 50 women;mean age 30.2 years;range 19-68 years) were examined with high-resolution sonography (5~12MHz,8~13MHz linear-array transducer) and SUZUKE RSZ 200 X-ray and Philips Infmion 1.5T MRI. The SLSW and scapholunate ligament thickness of dorsal(SLLTd) and scapholunate ligament thickness of volar(SLLTv) were measured in the neutral position and ulnar and radial deviation on sonography. The SLSW on X-ray and both the SLSW and SLLT were measured and MRI patterns. Results: The mean values of the SLLTd and SLLTv were 2.18mm 0.35 mm(range, 1.7mm~3.1mm) and 1.21mm 0.30mm(0.7mm~1.7mm) i
n men and 1.99mm 0.23mm (range,!.5mm~2.5mm) and
1.20mm 0.24mm(0.6mm~1.7mm)in women in the neutral position,respectivily. The dorsal scapholunate ligament was easiest visible both in men and in women. There was significant difference in scapholunate ligament visibility between in dorsal and in volar(P<0.01). The SLLTd was significantly wider in men than in women but no significant difference in SLLTv between in men and in women. There was significant correlation between US and MRI(P<0.01) on measuring SLLT. The mean value of the SLSW was 5.08mm 0.47mm (range, 4.2mm~6.1mm) in men and 4.80mm 0.46mm (range,4.0mm~6.0mm) in women in the neutral position. There was significant
difference in SLSW between in men and in women in the neutral position and ulnar and radial deviation both in the left and right hand (P<0.05~0.01). The mean variations of SLSW were +0.026mm(range,-l.lmm~+l.lmm) in men and +0.006mm(range,-0.6mm~+1.5mm) in women. There was significant correlation between sonography and X-ray or MRI (P<0.01) on measuring SLSW. Conclusions It was accurate and reliable to measure SLSW and SLLT on sonography. Ultrasonography can be used to diagnosis scapholunate dissociation.
引文
1, Larsen CF, Brondum VK. Posttraumatic carpal instability. Acta Orthop Scand, 1993,465～468
2, Sennwald G, Fischer M. Jacob HA. Radio-carpal and medio-carpal arthroscopy in instability of the wrist. Ann Chir Main Memb Super, 1993,12:26～38
3, Jones WA Beware the sprained wrist: the incidence and diagnosis of scapholunate instability. J Bone Joint Surg, 1998,70:293～297
4, Schoenfeld A, Goverman J, Weiss DM, et al. Transducer user syndrome: an occupational hazard of the ultrasonography. Eur J Ultrasound, 1999,10:41～45
5，汤锦波．桡骨远端骨折伴腕关节不稳定．中华外科杂志，1994，32：82～84
6, Cautilli GP, Wehbe MA. Scapho-lunate distance and cortical ring sign.J Hand Surg,1991,16:501～504
7, Reynolds RA, Johnston G, Friedman L. The carpal strech test, Can J Surg,1998,41:119～126
8，江浩主编．骨与关节MRI(第二版)．上海：上海科学技术出版社，1999：196～198
9, Shin AY, Glowacki KA, Bishop AT. Dynamic axial carpal instability: a caes report. J Hand Surg, 1999,24:781～785
10，刘晋才，周治国．舟骨骨折的诊断、治疗与预后．创伤外科杂志，2002．3：134～136
11, Zanetti M,Bram J,Hodler J. Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI? J Magn Reson Imaging1997;7:590
12, Griffith JF,Chan DPN,Ho PCH et al. Sonography of the normal scapholunate ligament and scapholunate joint space. J Clinical Ultrasound. 2001;29:223～229
13 和朝平，赵晓宇，孙辉生等．腕舟状骨骨折超声诊断．中国超声医学杂志，
1999, 15(11):813～815
14, Short WH, Werner FW, Fortino MD,et al. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg, 1995,20;986
15, Berger RA. The gross and histologic anatomy of the scapholunate interosseous liganent. J Hand Surg 1996,21:170
16, Slater RR,Szabo RM, Bay BK, et al. Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: biomechanical analysis in a cadaver model. J Hand Surg 1999,224:232
17, Obermann WR. Wrist injuries: pitfalls in conventional imaging. Eur J Radiol 1996,22:11
18, Linscheid RL,Dobyns JH.Beabout JW, et al. Traumatic instability of the wrist. J Bone Joint Surg(Am),1972.54 :1612～1617
19, Belsole RJ. Radiolography of the wrist. Clin Orthop. 1986,202:50～57
20, Gilula LA,Weeks PM. Post traumatic ligamentous instabilities of the wrist. Diag Radiol, 1978,129:641～646
21，朱建民，金宗达．正常腕舟月骨间宽度测量．中华外科杂志，1994，2(32)90～92
22, Szabo RM, Manske D. Displaced Fractures of scaphoid. Clin Orthop, 1998, 230:30～34
2, Sennwald G, Fischer M. Jacob HA. Radio-carpal and medio-carpal arthroscopy in instability of the wrist. Ann Chir Main Memb Super, 1993,12:26～38
3, Jones WA Beware the sprained wrist: the incidence and diagnosis of scapholunate instability. J Bone Joint Surg, 1998,70:293～297
4, Schoenfeld A, Goverman J, Weiss DM, et al. Transducer user syndrome: an occupational hazard of the ultrasonography. Eur J Ultrasound, 1999,10:41～45
5，汤锦波．桡骨远端骨折伴腕关节不稳定．中华外科杂志，1994，32：82～84
6, Cautilli GP, Wehbe MA. Scapho-lunate distance and cortical ring sign.J Hand Surg,1991,16:501～504
7, Reynolds RA, Johnston G, Friedman L. The carpal strech test, Can J Surg,1998,41:119～126
8，江浩主编．骨与关节MRI(第二版)．上海：上海科学技术出版社，1999：196～198
9, Shin AY, Glowacki KA, Bishop AT. Dynamic axial carpal instability: a caes report. J Hand Surg, 1999,24:781～785
10，刘晋才，周治国．舟骨骨折的诊断、治疗与预后．创伤外科杂志，2002．3：134～136
11, Zanetti M,Bram J,Hodler J. Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI? J Magn Reson Imaging1997;7:590
12, Griffith JF,Chan DPN,Ho PCH et al. Sonography of the normal scapholunate ligament and scapholunate joint space. J Clinical Ultrasound. 2001;29:223～229
13 和朝平，赵晓宇，孙辉生等．腕舟状骨骨折超声诊断．中国超声医学杂志，
1999, 15(11):813～815
14, Short WH, Werner FW, Fortino MD,et al. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg, 1995,20;986
15, Berger RA. The gross and histologic anatomy of the scapholunate interosseous liganent. J Hand Surg 1996,21:170
16, Slater RR,Szabo RM, Bay BK, et al. Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: biomechanical analysis in a cadaver model. J Hand Surg 1999,224:232
17, Obermann WR. Wrist injuries: pitfalls in conventional imaging. Eur J Radiol 1996,22:11
18, Linscheid RL,Dobyns JH.Beabout JW, et al. Traumatic instability of the wrist. J Bone Joint Surg(Am),1972.54 :1612～1617
19, Belsole RJ. Radiolography of the wrist. Clin Orthop. 1986,202:50～57
20, Gilula LA,Weeks PM. Post traumatic ligamentous instabilities of the wrist. Diag Radiol, 1978,129:641～646
21，朱建民，金宗达．正常腕舟月骨间宽度测量．中华外科杂志，1994，2(32)90～92
22, Szabo RM, Manske D. Displaced Fractures of scaphoid. Clin Orthop, 1998, 230:30～34