影像学园
资料库，助力影像专业学习
来源：双语学影像；本期病例选自AuntMinnie.com
Our appreciation is extended to Dr. Wei-Shin Wang,Indiana University ；Department of Radiology,for contributing this case.
History and radiographs
Woman with wrist pain. Additional history temporarily withheld.
患者女性，腕关节疼痛。其余病史暂不提供。
1.Which choice characterizes the abnormal structure(s)?
下列哪部位表现异常？
Entire proximal carpal row 腕骨近侧列诸骨
Radial-carpal joint 桡腕关节
Lunate bone 月骨
Capitate bone 头状骨
None of the above 以上都不是
Additional history and Images
Additional history: The patient fractured her scaphoid six weeks prior.
进一步提供病史：患者6周前舟状骨骨折。
2.Which of the following is the most likely diagnosis?
最有可能的诊断是什么？
Glomus tumor 血管球瘤
Calcium pyrophosphate dihydrate (CPPD) disease 二水焦磷酸钙盐沉着性疾病
Osteonecrosis 骨坏死
Osteomyelitis 骨髓炎
Gout 痛风
选择题答案：
None of the above
The abnormal structure is the scaphoid bone
Osteonecrosis
Fracture with osteonecrosis of scaphoid proximal pole.
Findings and Diagnosis
There is a fracture of the scaphoid. The proximal pole of the scaphoid appears slightly more corticated than the surrounding osseous structures.
该患者舟状骨骨折。舟状骨近端与邻近骨质相比略硬化。
Healing fracture of the scaphoid
舟状骨骨折愈合
Comminuted fracture of scaphoid without signs of avascular necrosis
舟状骨粉碎性骨折、未见明显缺血性坏死
Comminuted fracture of scaphoid with signs avascular necrosis
舟状骨粉碎性骨折伴缺血性坏死
Remote injury of the scaphoid
舟状骨陈旧性损伤
Avascular necrosis of the scaphoid (following fracture)
舟状骨骨折继发缺血性坏死
Discussion
Scaphoid fractures most commonly occur when falling on an outstretched hand. It represents 71% of all carpal bone fractures. The majority of the fractures involve the waist of the scaphoid and are mechanically stable if the fracture line is perpendicular to the long axis of the scaphoid. Stable fractures can heal with immobilization. For unstable fractures or those demonstrating delayed union, surgical fixation may be needed.
舟状骨骨折多发生于摔倒时腕部背屈。约占所有腕骨骨折的71%。如果骨折线垂直于舟状骨长轴，骨折一般为稳定性骨折，而稳定性骨折一般可以通过固定，逐渐愈合。如果为不稳定骨折或骨折愈合延迟，可采取手术治疗。
Fractures of the proximal pole of the scaphoid are at risk of developing avascular necrosis. The blood supply to the proximal pole comes from the dorsal branch of the radial artery, which enters the waist and branches proximally. Any fracture that disrupts this artery will increase the risk of avascular necrosis. Approximately 15% to 30% of scaphoid fractures will develop avascular necrosis, the majority of which involve the proximal pole of the scaphoid.
舟状骨近端骨折易合并舟状骨坏死。舟状骨的血，主要由桡动脉背侧支发出，进入腰部和近端。任何外伤损伤该动脉可增加缺血坏死的几率。约15%-30%的舟状骨骨折可发展为缺血性坏死，其中大多数发生于舟状骨近端。
Fractures of the scaphoid can be evaluated with multiple modalities. If avascular necrosis is a concern, MRI is the best imaging modality to evaluate the viability of any bony fragments. If there is decreased signal intensity on T1 and T2, there is no viable bone remaining. On CT, there will be increased density of bony fragments, which is indicative of ischemia.
舟状骨的骨折可通过多种方法评价。如果无法确定是否存在缺血坏死，MRI是最好的影像学检查方法，可以有效评估骨碎片的情况。如果T1WI、T2WI均为低信号，则提示该骨片失去活力，CT上表现为骨片密度增高，提示局部坏死。
In this case, there is a comminuted fracture of the proximal pole of the scaphoid. There is increased density of the fracture fragments with nonunion. The patient fractured her scaphoid six weeks prior and without significant interval healing, she is at high risk of developing avascular necrosis.
本例中，舟状骨近端粉碎性骨折,可见骨片游离、密度增加。该患者6周前舟状骨骨折，未经治疗，有很大几率发生缺血坏死。
Scaphoid fractures account for 70% of all carpal bone fractures.
舟状骨骨折约占全部腕骨骨折的70%。
Avascular necrosis of the scaphoid occurs when the dorsal branch of the radial artery is disrupted.
桡动脉背侧支断裂时可发生舟状骨缺血坏死。
Avascular necrosis occurs in 15% to 30% of all scaphoid fractures, with the proximal pole most commonly affected.
约15%-30%的舟状骨骨折可发生缺血坏死，其中大部分发生于舟状骨近端。
Avascular necrosis is seen as decreased signal intensity on T1- and T2-weighted images and increased bone density on CT.
缺血坏死一般表现为T1WI、T2WI信号减低，CT表现为骨质密度增加。
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