骶骨衰竭骨折影像学诊断课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,骶骨衰竭骨折影像学诊断,骨折分类,骨折,创伤性,病理性,疲劳性,衰竭,应力性,Medical School Hospital,Qingdao University,骨折概念,创伤性骨折：强外力作用于正常强度骨骼,病理性骨折：轻微外力作用于,内源性强度减弱的骨骼（不可逆）,疲劳骨折：反复性外力作用于正常强度骨骼,衰竭骨折：轻微外力作用于,内源性强度减弱的骨骼（可逆）,Medical School Hospital,Qingdao University,应力性骨折历史,历史,1855年：Breithaupt首次描述士兵足应力性骨折（疼痛、水肿）,1897年：命名“行军骨折”，X线示跖骨干骨折,一般概念,部位：承重骨与非承重骨,有关因素：大量活动、机械环境改变,应力性骨损伤：常见，占运动伤 10%,Medical School Hospital,Qingdao University,应力性骨折历史,名称,应力性骨折（stress fracture）,行军骨折（marching fracture）,裂缝骨折（crack fracture）,假骨折（pseudofracture）,自发性骨折（spontaneous fracture）,衰竭骨折（exhaustion fracture）,Medical School Hospital,Qingdao University,应力性骨折类型,疲劳骨折（=应力性骨折？！）,反复性外力作用于正常骨骼，单一外力不引起骨折,反复性外力引起骨骼机械性衰竭,衰竭骨折,正常外力作用于异常骨骼（可逆性）,潜在性病变削弱骨弹性抵抗力,Medical School Hospital,Qingdao University,骶骨衰竭骨折潜在因素,骨质疏松,放射治疗,激素治疗,类风湿性关节炎,骨质软化或佝偻病,糖尿病,骨纤维发育不良,Paget病,焦磷酸盐性关节病,胫骨骨折愈合后,成骨不全,石骨症,甲旁亢,坏血病,Medical School Hospital,Qingdao University,Sacral Insufficiency Fracture,假骨折（pseudofracture）,衰竭骨折（exhaustion fracture）,疲劳骨折：反复性外力作用于正常强度骨骼,Sacral Insufficiency Fracture,Medical School Hospital,Qingdao University,骶骨衰竭骨折影像学表现,疲劳骨折：反复性外力作用于正常强度骨骼,骶骨衰竭骨折MRI表现,Medical School Hospital,Qingdao University,骶骨衰竭骨折影像学表现,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,反复性外力引起骨骼机械性衰竭,Medical School Hospital,Qingdao University,骶骨衰竭骨折病理改变,松质骨微骨折,骨折周围骨髓水肿及出血,骨小梁塌陷、密集,内骨痂形成,应力持续 皮质断裂,完全性骨折或移位,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,线样或片状不均匀性密度增高,裂缝骨折（crack fracture）,线样或不规则片状硬化：30%,Medical School Hospital,Qingdao University,疲劳骨折：反复性外力作用于正常强度骨骼,骶骨衰竭骨折鉴别诊断,Medical School Hospital,Qingdao University,应力持续 皮质断裂,骶骨衰竭骨折影像学诊断,骨折周围骨髓水肿及出血,骶骨衰竭骨折MRI表现,Medical School Hospital,Qingdao University,反复性外力引起骨骼机械性衰竭,骶骨衰竭骨折CT表现,骶骨衰竭骨折临床表现,性别：女性男性,年龄：60岁,病程：18个月,表现,下背痛,骶髂关节疼痛及压痛,活动加重，休息减轻,既往,盆腔肿瘤放疗,放疗后至出现症状214月,无外伤史,全身性骨质疏松,Medical School Hospital,Qingdao University,骶骨衰竭骨折影像学表现,骨折侧别,双侧 76%,单侧24%,骨折部位,骶骨耳部 100%,骶,1-3,椎体：57%,椎体前半部84%,贯通16%,合并其他部位骨折,耻骨,坐骨,腰椎横突,髂骨,Medical School Hospital,Qingdao University,骶骨衰竭骨折X线表现,线样或片状不均匀性密度增高,骨折线,骨质疏松,阳性率：30%,Medical School Hospital,Qingdao University,骶骨衰竭骨折X线表现,Medical School Hospital,Qingdao University,骶骨衰竭骨折CT表现,松质骨折线：60%,线样或不规则片状硬化：30%,骶骨前缘骨皮质断裂：46%,后缘皮质断裂,骨质疏松,阳性率：90%,Medical School Hospital,Qingdao University,骶骨衰竭骨折影像学表现,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,骨折周围骨髓水肿及出血,线样或片状不均匀性密度增高,Medical School Hospital,Qingdao University,骶骨衰竭骨折鉴别诊断,假骨折（pseudofracture）,病理性骨折：轻微外力作用于 内源性强度减弱的骨骼（不可逆）,Medical School Hospital,Qingdao University,部位：单或双侧骶骨耳部,骶骨衰竭骨折X线表现,行军骨折（marching fracture）,Sacral Insufficiency Fracture,线样或片状不均匀性密度增高,骶骨衰竭骨折CT表现,Medical School Hospital,Qingdao University,骶骨衰竭骨折MRI表现,检查方位,横轴位,冠状位,检查序列,SE T,1,WI,Fat+FSE T,2,WI,STIR,增强扫描,Medical School Hospital,Qingdao University,骶骨衰竭骨折MRI表现,部位：单或双侧骶骨耳部,信号：弥漫性长T,1,长T,2,信号,形态：“垂直+前后”走向，双侧呈“H”形,骨折线,蛇形或匍匐形,平行于骶髂关节,累及骶骨中前份，少数前后贯通,T,1,WI和T,2,WI：低信号,Medical School Hospital,Qingdao University,增强扫描,骨髓水肿区不均匀强化,骨折线无强化,阳性率：100%,骶骨衰竭骨折MRI表现,Medical School Hospital,Qingdao University,骶骨衰竭骨折MRI表现,Medical School Hospital,Qingdao University,骶骨衰竭骨折MRI表现,Medical School Hospital,Qingdao University,骶骨衰竭骨折CT表现,Medical School Hospital,Qingdao University,骶骨衰竭骨折MRI表现,骶骨衰竭骨折影像学表现,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,Fat+FSE T2WI,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,有关因素：大量活动、机械环境改变,T1WI和T2WI：低信号,裂缝骨折（crack fracture）,部位：承重骨与非承重骨,病理性骨折：轻微外力作用于 内源性强度减弱的骨骼（不可逆）,病理性骨折：轻微外力作用于 内源性强度减弱的骨骼（不可逆）,骶骨衰竭骨折核素扫描,同位素浓聚,阳性率：100%,Medical School Hospital,Qingdao University,骶骨衰竭骨折核素扫描,Medical School Hospital,Qingdao University,骶骨衰竭骨折鉴别诊断,放疗后骨髓水肿,信号强度均匀,无骨折线,放射治疗停止，水肿逐渐减弱、消退,骨髓转移瘤,散在性发病,大小、形态及部位不定,骨质破坏及软组织肿块,Medical School Hospital,Qingdao University,骨髓瘤,红骨髓区,多发穿凿样骨质破坏,病理性骨折,Bence-Jones蛋白,salt pepper sign,骶骨衰竭骨折鉴别诊断,Medical School Hospital,Qingdao University,应力性骨折（stress fracture）,骶骨衰竭骨折X线表现,Medical School Hospital,Qingdao University,正常外力作用于异常骨骼（可逆性）,骶骨衰竭骨折影像学诊断,Fat+FSE T2WI,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,Sacral Insufficiency Fracture,T1WI和T2WI：低信号,反复性外力作用于正常骨骼，单一外力不引起骨折,骨折周围骨髓水肿及出血,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,Medical School Hospital,Qingdao University,Quiz,Sacral Insufficiency Fracture,Quiz,Medical School Hospital,Qingdao University,Myeloma,Quiz,Medical School Hospital,Qingdao University,Metastases,Medical School Hospital,Qingdao U