informationization第137课结核（Tuberculosis）系统诊断之（三十）—腕关节结核的影像表现（一）
上期试题：确诊膝关节滑膜结核时，以下哪项最可靠e
A．低烧、盗汗、食欲差
B．膝关节肿胀、疼痛、功能受限
C．血沉增快
D．X线检查膝关节骨质疏松
E．滑膜病理检查
腕关节结核（tuberculosis of wrist joint）包括桡尺骨腕、掌腕和腕骨间结核。由于腕关节结构复杂及其特点，使得腕关节结核病变容易播散。在腕骨诸骨中，结核初感染时以头状骨结核发病率最高，次为钩状骨和大多角骨。头状骨结核病灶最容易蔓延至腕骨间小关节，累及掌骨和腕的伸肌腱鞘，造成广泛破坏，形成全关节结核；由于腕骨血供较差，极易形成骨质坏死，可在手背形成脓肿与窦道。
Wrist TB (tuberculosis of wrist to be) including the oar ulna wrist, palm and wrist between carpal bone tuberculosis. Due to the complexity of wrist joint structure and its characteristics, making it easier for the wrist joint tuberculosis get spread. At the beginning of the bone in carpal bone tuberculosis infection with the highest incidence of bone tuberculosis, heads for hooked bone and trapezium. Head shape bone tuberculosis lesions are most likely to spread to the small joints between carpal bone, involving the metacarpal and wrist extensor tendon sheath, caud widespread destruction, forms the joint tuberculosis; Due to poor carpal bone blood supply, easy to form bone necrosis, can be in the back of hand abscess and fistula.
depend临床上主要表现为局部软组织肿胀而相应的皮肤颜色并无改变；由于腕关节囊薄弱，病变易侵犯腱鞘而影响手指的功能，手背部的脓肿易想形成窦道。早期腕关节结核的疼痛和肿胀可从某一点或某一关节腔开始，进而向其他方向播散，晚期腕关节严重破坏后可发生腕下垂和尺偏畸形。
Clinical mainly for local soft tissue swelling and corresponding skin color is not changed;
Due to the weakness of wrist joint capsule, the lesion is violation of tendon sheath and affect the function of the fingers, hands back abscess is easy to form a fistula. Early tuberculosis wrist joint pain and swelling can start from a point or a articular cavity, and then spread to the other direction, late carpal tunnel rious damage can occur after prolap of wrist and foot deformity.
X线平片是腕关节结核诊断的重要影像学方法之一，有时为了显示早期和细微病变，多摄取双侧腕关节平片进行对照。早期单纯滑膜型结核表现为腕骨骨质疏松和软组织肿胀，进而骨小梁模糊，腕骨轮廓不完整，晚期由于骨皮质消失及皮质下侵蚀，腕骨可变小。骨性结核病灶首先开始于桡骨远端，其次为腕骨，很少继发于尺骨。病灶常为多发性，呈虫蚀样或类圆形骨质缺损区，很少有死骨形成。病变晚期，腕关节间隙明显变窄或消失，可见多个腕骨破坏、轮廓模糊、形态变小，严重者可侵及第2—5掌骨基底部，导致关节畸形及软组织明显肿胀，有时其内可见钙化影。腕骨结核常合并腱鞘结核，有时可见斑点状钙化。儿童的腕关节结核，患侧骨化核出现较早。
abstract什么意思
chouX-ray plain film is one of important imaging methods for the diagnosis of wrist joint tuberc
ulosis, sometimes in order to show early and small lesions, high in bilateral carpal tunnel plain radiographs were compared. Early type simple synovial tuberculosis of carpal bone and soft tissue swelling, osteoporosis and trabecular bone fuzzy, carpal bone contour incomplete, late disappear becau of the bony cortex and the subcortical erosion, carpal bone variable. Osous tuberculosis kitchen first started in the distal radius, followed by carpal bone, little condary to the ulna. Lesions are often multiple, inct damage in kind or class round bone defect area, there are few dead bone formation. Pathological changes late, wrist joint clearance significantly narrowed or disappear, visible multiple smaller carpal bone destruction, outline, shape, vere cas can invade and 2-5 metacarpal ba, lead to joint deformities and obvious swelling of soft tissue, sometimes with calcification shadow inside. Carpal bone tuberculosis merger which often, sometimes visible punctate calcification. The wrist joint tuberculosis of children, one side ossification nucleus appeared earlier.
houhold↑左腕关节骨性结核
左腕正侧位X线片可见桡骨远端、舟状骨、月骨、三角骨多发虫蚀样骨质缺损，尺骨结构完整，桡腕关节间隙略变窄
↑右腕关节骨性结核
arou右腕正侧位X线片可见尺桡骨远端与腕骨骨质破坏明显，关节间隙消失，第2—5掌骨基底部亦侵蚀破坏；周围软组织肿胀并见较高密度钙盐沉着影
CT可作为腕关节结核的重要辅助检查方法，可以更加清晰的显示腕关节结核时的整体骨质疏松和周围软组织肿胀；还可以客观显示各个腕骨及尺桡骨关节面不同程度的骨质破坏区、边缘情况以及关节间隙是否破坏。有时可见桡腕关节和腕掌关节不同程度的脱位与半脱位。
CT can be ud as the important auxiliary examination method, wrist joint tuberculosis can be more clearly shows that the wrist joint tuberculosis overall osteoporosis and surrounding soft tissue swelling; Can objectively display each wrist and foot radius articular surface varying degrees of bone destruction, edge cas, and whether the joint damage. Sometimes visible radiocarpal joint and wrist joint different degree of dislocation and subluxation.
tsl
↑腕关节骨性结核
CT横断面扫描（骨窗）可见腕骨普遍性骨质疏松，周围软组织明显肿胀积液
↑双侧腕关节骨性结核
双腕关节CT横断面扫描（骨窗）可见双侧腕骨普遍性骨质疏松，软组织肿胀，右侧桡骨远端及双侧腕骨多发虫蚀样骨质破坏区，边缘清楚
六一儿童节英文
MRI对腕关节结核的诊断缺乏特征性，但多方位成像和组织分辨力高等特点使得在显示腕关节积液、滑膜增厚和骨质破坏等你方面更为清晰，T1WI上表现为低信号，T2WI及脂肪抑制序列均呈高信号；增强扫描时增生的滑膜与肉芽组织可呈明显不均匀强化。
Characteristic of MRI in the diagnosis of wrist joint tuberculosis lack, but multiple high resolution imaging and organization makes the display wrist joint effusion, synovial thickening and bone destruction is more clear, wait for you to show the low signal on T1WI, T2WI and fat suppression quence has high signal; Enhancement scanning, hyperplasia of the synovial membrane and granulation tissue can show obvious uneven reinforcement.
↑右腕关节结核
右腕冠状面与横断面MRI扫描可见腕骨、尺桡骨关节面多发骨质破坏，T1WI呈低信号，部分关节间隙变窄，关节滑膜增厚及软组织肿胀，增强后滑膜明显不均匀强化
医学博士专栏
第二十五期：来自欧塔博士的建议之飞鼻塞时乘飞机或潜水
如果你的耳部感染，则最好不要乘飞机或潜水，因为可能导致气压伤。如果患有感冒、过敏或鼻炎，但是又想知道是否可以乘飞机或潜水而不会造成气压伤或不适，那么自己试试下面的这个测试：乘电梯到最高层建筑的顶层。在下落过程中你可以尝试在气压伤中讨论的方法来说衡量耳朵内外的压力。如果你做不到，那么就不要坐飞机或潜水。
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