基于MR成像的腕和手指精细解剖及损伤机制研究

The aim of this study is using MRI to investigate the normal cross-sectional anatomy and injury mechanism of the wrist and fingers. We will first study the normal cross-sectional MR images of the wrist and fingers in cadavers and correlates the MRI appearances with large histological section to demonstrate the flexor tendons, the extensor tendons, and theirs supporting structures including tendon sheath and pulleys, the intrinsic and extrinsic ligament of the wrist and the triangular fibrocartilage, the collateral ligament of fingers. The anatomic features of the wrist and fingers and their functional relationship will be demonstrated with MR images. Next, we will study the injury mechanism of the wrist and fingers and their MR imaging features by create the injury to the wrist and finger in cadaver, to provide the theoretical basis for evaluation and interpretation of the wrist and fingers injuries; to reveal the relationship between injury mechanism and the MRI features. Finally, will study the wrist and hand injury in clinical setting to study their MR imaging features. Our goal is using the MRI, a noninvasive technique to define the relation between the subtle anatomic changes and the injury mechanism, to monitor the development and the nature progression of the writs and hand injury, to lay the foundation for future basic research and clinical applications on wrist and finger injury at the molecular level.

前期研究证明，MR成像技术可清晰显示腕和手指精细解剖结构及损伤的影像学表现。 本项目拟采用MR成像技术，研究尸体标本腕和手指的正常断层解剖结构及影像学表现，主要研究伸肌腱、屈肌腱和支持结构包括腱鞘、滑车、内在韧带、外在韧带、三角纤维软骨和手指侧韧带等，阐明腕和手指的解剖特点、功能变化与影像表现的相关性，为影像诊断和外科治疗提供实用的断层解剖学依据；对大体标本进行模拟损伤实验，并行MR检测，研究腕和手指不同部位的损伤机制与影像学表现，阐明损伤机制和MR影像特点的相关性，为腕和手指损伤的诊断治疗提供科学的影像学依据；研究国人正常腕和手指的MR断层解剖结构和不同部位的损伤机制及其MR影像特点，旨在早期发现其细微解剖结构变化和明确损伤部位及类型，并从分子水平无创地监测损伤的发生发展过程，为腕和手指损伤的早期诊断、治疗及功能恢复提供科学准确的解剖学和影像学依据，为损伤的基础研究和临床应用奠定基础。

背景：腕和手指解剖结构复杂精细，人类生活中的捏、握、抓、夹、提等动作都要依赖于腕和手指灵活的运动和敏锐的感觉完成。腕和手指肌腱韧带损伤在临床上很常见，损伤后常导致不同程度的功能障碍或丧失。该项目利用磁共振成像技术，研究腕和手指的精细解剖结构和损伤的影像学表现，为损伤的诊断和治疗提供了科学的影像学依据，且具有重要的临床应用价值。.研究内容：采用MR成像技术研究尸体标本腕和手指的正常断层解剖结构及影像学表现，主要研究伸肌腱、屈肌腱和支持结构包括腱鞘、滑车、内在韧带、外在韧带、三角纤维软骨和手指侧韧带等。对大体标本进行模拟损伤实验，并行MR检测，研究腕和手指不同部位的损伤机制与影像学表现。研究国人正常腕和手指的MR断层解剖结构和不同部位的损伤机制及其MR影像特点。.结果：正常手指肌腱韧带MRI表现为T1WI和质子密度压脂（PD FS）序列均为细条带状均匀低信号。手指肌腱韧带损伤患者主要表现为损伤韧带T1WI序列信号不清、纤维连续性中断，PD FS序列信号不均匀增高，损伤周围可见软组织水肿。健康志愿者TFCC在MRI各序列上表现为以低信号为主。根据Palmer分型，中心穿孔主要表现为PD FS序列上线状信号增高影，垂直于关节盘呈矢状走行，远端尺腕关节间隙内积液；尺侧、远端及桡侧附着端损伤主要表现为损伤处形态欠规则，结构模糊，PD FS序列上损伤的结构内信号增高。退行性损伤主要表现为三角纤维软骨形态不规则，PD FS序列上信号不均匀，可见混杂中高信号，合并月骨、尺骨关节软骨改变，月三角韧带处高信号影以及尺腕关节或远端桡尺关节炎。.结论：该研究对腕和手指损伤的早期发现、早期诊断、精准治疗和康复具有重要的临床应用价值，对降低损伤的致残率、提高患者生存质量具有极其重要意义。