跗骨窦区断层解剖与其影像表现对照
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摘要
目的
观察跗骨窦外口区层次及相互关系;CT扫描观察颈韧带走行特点,测量跗骨窦容积;对照自然体位跗骨窦不同断层标本及其MRI图像,描述跗骨窦的形态以及与周围结构的毗邻关系;探讨颈韧带在MRI上显示的最佳层面。
材料与方法
对1例自然体位下尸体标本局部解剖跗骨窦外口区,颈韧带表面涂抹造影剂后行CT薄层扫描,经MPR重建,明确颈韧带起止点及最佳显示层面,同时对18例跗骨窦标本的CT扫描经后处理测量跗骨窦容积。对18例自然体位下尸体标本行MRI多层面扫描,并制作成不同典型断层(矢状位5例、冠状位5例、横轴位4例、斜冠状4例)标本,观察跗骨窦的形态,测量其径线,辨认内部结构及周围结构,对正常人跗骨窦区40例行MRI FSE、GE﹡、STIR等序列多层面扫描,测量颈韧带的长度、宽度、厚度及在冠状位、矢状位与水平面夹角。
结果
(1)跗骨窦外口位于外踝前下方,呈斜置的四边形,周围有肌肉、韧带、血管、神经及脂肪组织。(2)CT扫描MPR重建后显示颈韧带最佳显示层面为冠状位向前倾斜40°~50°的斜冠状位,跗骨窦容积4.7965±0.56ml。(3)跗骨窦断层标本与MRI图像在形态学一致,对应参数测量统计学配对t检验,p值>0.05。(4) MRI扫描正常成人颈韧带的长、宽、厚径线分别为20.04±2.15mm、5.15±2.17mm、2.07±0.75mm,矢状面上与水平面夹角47.55±3.52°,冠状面上与水平面夹角35.14±2.25°。颈韧带在MRI图像上呈低信号,信号不均匀,在矢状位经距骨颈外缘层面、冠状位经距骨颈前份层面、斜冠状上经距骨颈前缘与跟骨沟前缘连线层面,均可较好显示,测量参数统计学检验p值<0.05。
结论
跗骨窦局部组织成份众多,解剖结构复杂。3D重建显示能直观地显示跗骨窦形态;通过对断层解剖标本和矢状位、冠状位、横轴位、斜冠状位MRI图像对比,能够很好地描述跗骨窦及其内部解剖结构。MRI扫描正常成人颈韧带最佳显示层面为斜冠状位。
Objective
To observe details of sinus tarsi external aperture,relations and course character of cervical ligament, and measure the volume of sinus tarsi. Describe the appearance of simus tarsi and adjacent relations compare with MRI imagings in natural positions; discuss the best deck on MRI to display cervical ligament.
Materials and methods
Discover a case of sinus tarsi which was in natural positions and observe the external aperture of the sinus tarsi and MPR imagings cervical ligament with contrast to identify the start of it and the best display deck, and measured the volume of 18 cases of sinus tarsi after the CT scanning. MRI imagings were used on 18 bodies and were made different specimens(anteroposterior axes 5 cases、coronal 5 cases、abcissa axis 4 cases、siope coronal 4 cases) . Described the appearance of simus tarsi and adjacent relations compare with MRI imagings in natural positions, and MRI FSE GE STIR sequences of 40 cases health adults’sinus tarsis. Measured the length, width, thickness of the cervical ligament and the angle of coronal,sagittal with horizontal plane.
Results
(1) Sinus tarsi external aperture located under external malleolus, tilt quad, and surrounded by muscle、anadesma、blood vessel、nerves and fatty tissues。
(2)The best display deck of cervical liagment on CT MPR rebulid imagings was oblique coronal with anterior tilt 40°~50°,the volume of sinus tarsi was 4.7965±0.56ml。(3)Fault specimen of sinus tarsi were coincident with MRI imagings on morphology, p>0.05. (4)The length、width、thickness of health adults’cervical ligament was 20.04±2.15mm、5.15±2.17mm、2.07±0.75mm,angle of sagittal with horizontal plane was 47.55±3.52°,angle of coronal plane with horizontal plane was 35.14±2.25°.Cervical ligament showed uneven hypo-signal and could be well disclosed on many deck, p<0.05.
Conclusion
Part tissue eltment of sinus tarsi were numerous and complicated on anatomic structure ,3D reconstructions could disclose shapes of sinus tarsi directly, we could describe siuns tarsi and the anntomic structure well by compare fault dissection with MRI imagings on anteroposterion axes coronal position axial view and oblique coronal positison. The best imaging on MRI to display cervical ligament was oblique coronal positison.
观察跗骨窦外口区层次及相互关系;CT扫描观察颈韧带走行特点,测量跗骨窦容积;对照自然体位跗骨窦不同断层标本及其MRI图像,描述跗骨窦的形态以及与周围结构的毗邻关系;探讨颈韧带在MRI上显示的最佳层面。
材料与方法
对1例自然体位下尸体标本局部解剖跗骨窦外口区,颈韧带表面涂抹造影剂后行CT薄层扫描,经MPR重建,明确颈韧带起止点及最佳显示层面,同时对18例跗骨窦标本的CT扫描经后处理测量跗骨窦容积。对18例自然体位下尸体标本行MRI多层面扫描,并制作成不同典型断层(矢状位5例、冠状位5例、横轴位4例、斜冠状4例)标本,观察跗骨窦的形态,测量其径线,辨认内部结构及周围结构,对正常人跗骨窦区40例行MRI FSE、GE﹡、STIR等序列多层面扫描,测量颈韧带的长度、宽度、厚度及在冠状位、矢状位与水平面夹角。
结果
(1)跗骨窦外口位于外踝前下方,呈斜置的四边形,周围有肌肉、韧带、血管、神经及脂肪组织。(2)CT扫描MPR重建后显示颈韧带最佳显示层面为冠状位向前倾斜40°~50°的斜冠状位,跗骨窦容积4.7965±0.56ml。(3)跗骨窦断层标本与MRI图像在形态学一致,对应参数测量统计学配对t检验,p值>0.05。(4) MRI扫描正常成人颈韧带的长、宽、厚径线分别为20.04±2.15mm、5.15±2.17mm、2.07±0.75mm,矢状面上与水平面夹角47.55±3.52°,冠状面上与水平面夹角35.14±2.25°。颈韧带在MRI图像上呈低信号,信号不均匀,在矢状位经距骨颈外缘层面、冠状位经距骨颈前份层面、斜冠状上经距骨颈前缘与跟骨沟前缘连线层面,均可较好显示,测量参数统计学检验p值<0.05。
结论
跗骨窦局部组织成份众多,解剖结构复杂。3D重建显示能直观地显示跗骨窦形态;通过对断层解剖标本和矢状位、冠状位、横轴位、斜冠状位MRI图像对比,能够很好地描述跗骨窦及其内部解剖结构。MRI扫描正常成人颈韧带最佳显示层面为斜冠状位。
Objective
To observe details of sinus tarsi external aperture,relations and course character of cervical ligament, and measure the volume of sinus tarsi. Describe the appearance of simus tarsi and adjacent relations compare with MRI imagings in natural positions; discuss the best deck on MRI to display cervical ligament.
Materials and methods
Discover a case of sinus tarsi which was in natural positions and observe the external aperture of the sinus tarsi and MPR imagings cervical ligament with contrast to identify the start of it and the best display deck, and measured the volume of 18 cases of sinus tarsi after the CT scanning. MRI imagings were used on 18 bodies and were made different specimens(anteroposterior axes 5 cases、coronal 5 cases、abcissa axis 4 cases、siope coronal 4 cases) . Described the appearance of simus tarsi and adjacent relations compare with MRI imagings in natural positions, and MRI FSE GE STIR sequences of 40 cases health adults’sinus tarsis. Measured the length, width, thickness of the cervical ligament and the angle of coronal,sagittal with horizontal plane.
Results
(1) Sinus tarsi external aperture located under external malleolus, tilt quad, and surrounded by muscle、anadesma、blood vessel、nerves and fatty tissues。
(2)The best display deck of cervical liagment on CT MPR rebulid imagings was oblique coronal with anterior tilt 40°~50°,the volume of sinus tarsi was 4.7965±0.56ml。(3)Fault specimen of sinus tarsi were coincident with MRI imagings on morphology, p>0.05. (4)The length、width、thickness of health adults’cervical ligament was 20.04±2.15mm、5.15±2.17mm、2.07±0.75mm,angle of sagittal with horizontal plane was 47.55±3.52°,angle of coronal plane with horizontal plane was 35.14±2.25°.Cervical ligament showed uneven hypo-signal and could be well disclosed on many deck, p<0.05.
Conclusion
Part tissue eltment of sinus tarsi were numerous and complicated on anatomic structure ,3D reconstructions could disclose shapes of sinus tarsi directly, we could describe siuns tarsi and the anntomic structure well by compare fault dissection with MRI imagings on anteroposterion axes coronal position axial view and oblique coronal positison. The best imaging on MRI to display cervical ligament was oblique coronal positison.
引文
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[1]. Adam Budny. Subtalar joint instability: current clinical concepts[J]. Clin podiatr Med Surg,2004 Jul;21(3):449-460.
[2].Daniel T,Keefe MD,Steven E,et al. Subtalar instability etiology diagnosis,and management[J]. Foot Ankle Clin,2002,23:577-609.
[3].Adachi B; Das Arteriensystem der Japaner. Bd2,S285, The Maruzen Co. Kyoto and Tokyo,1928.
[4].吴晋宝,程心恒,秦月琴.足背和足底的动脉分布[J].解剖学报,1980,友会11(1):13-20.
[5].Zwipp H,Rammelts S,Grass R,et al. Ligamentous injuries about the Ankle and subtalar joints[J].Clin Pediatr Med Surg,2002,19:195-229.
[6].Kirby KA.. Subtala joint axis location and rotational equilibrium theory of foot function[J].Pediatr Med Assoc,2001,91:465-487.
[7].张凯,俞光荣.距下关节韧带的解剖学和生物力学特性研究进展[J].中国临床解剖学杂志,2004,22(1):106-108.
[8].沙勇,张绍祥,刘正津.踝、距下关节外侧韧带断层与MRI图像的对照研究及临床意义[J ].中国临床解剖学杂志,2000,18(4):289-293.
[9].Sarrafian SK. Biomechanicsof the subtalar joint complex[J].Clin Orthop,1993, 290:17-26.
[10]. Tochigi Y,Takahashi K,Yamagata M,et al. Influence of the interosseous talocaleaneal Ligament injury on stability of the ankle subtalar joint complex :a cadaveric experimental study[J] .Foot Ankle Int,2000,21(6):486-491.
[11].Budny A. Subtalar joint instability :current clinieal concepts[J ]. Clin Pediatr Med Surg,2004,21:449-460.
[12].毛宾尧.距下关节不稳[J ].中华创伤骨科杂志. 2007,9 (11):1072-1075.
[13].Hoekenbury RT,Sammarco GJ.Evaluation and treatment of ankle Sprains clinieal recommendations for a positive outeome[J].Phys Sports Med,2001,29(2):57-64.
[14]. Jarde O,Duboille G,Abi-Raad G,et al .Ankle instability with involvement of the subtalar joint demonstrated by MRI: results with the castaing Proeedure in 45 eases[J].Aeta orthop Beig,2002,68:517-528.
[15].王蕾,陈志刚,雷益. MRI扫描技术在踝关节损伤的应用价值[J].实用放射学杂志.2006,22(7):861-863.
[2].刘树伟.论人体断层解剖学教学.医学影像学杂志,1996,6:151-156.
[3].刘树伟.密切结合现代影像学诊治深入开展断层解剖学研究.中国临床解剖学杂志,1995,13(2):81-83.
[4].沈崇文.结合影像诊断开展断层解剖研究的探讨.医学影像学杂志,1996,6(专刊):l-3.
[5].刘树伟.断层解剖学的现状和未来(首届全国断层影像解剖学论坛总结).中国临床解剖学杂志,1997,15(l):l-3.
[6].马兆龙,杨月鲜,杨广夫,等.踝关节的断面影像解剖学研究[J].解剖学杂志,1996 ,19 (增刊):59.
[7].沙勇,张绍祥,刘正津,等.踝、距下关节外侧韧带断层与MRI图像的对照研究及临床意义[J].中国临床解剖学杂志,2000 ,18(4)289-293.
[8].BeltranJ. Ligament of the lateral aspect of the ankle and sinus tarsi: An MR imaging study[J]. Radiology,1990 ,177(2) :455 - 458.
[9].Adam Budny. Subtalar joint instability: current clinical concepts. Clin podiatr Med Surg,2004 Jul;21(3):449-460.
[10].BiteU,Jackson IT,Forbes GS,et al:Orbital volume measurement、in enophthalfnos using:three-dimensional CT imaging[J ].Plast Reeonstr Surg, 1985,75:502-507.
[11].Vannier MW,Marsh JL.Three-dimensional image,surgical planning and image-guided therapy[J ].Radiol CIin North Am,1996,34:545-552.
[12].Tomura N,MIYauehi T,Shindo M,et al:Three-dimensional computed tomogragh in the head and neck diseases with bony abnoemalities [J].Comput Med Imaging Graph,1993,17:411-420.
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[13].Hoekenbury RT,Sammarco GJ.Evaluation and treatment of ankle Sprains clinieal recommendations for a positive outeome[J].Phys Sports Med,2001,29(2):57-64.
[14]. Jarde O,Duboille G,Abi-Raad G,et al .Ankle instability with involvement of the subtalar joint demonstrated by MRI: results with the castaing Proeedure in 45 eases[J].Aeta orthop Beig,2002,68:517-528.
[15].王蕾,陈志刚,雷益. MRI扫描技术在踝关节损伤的应用价值[J].实用放射学杂志.2006,22(7):861-863.