- 期刊
利用屈曲姿勢幫助手指皮帶輪在MRI影像上的診斷－病例報告
Pulley System Injury Diagnosis by Flexed Finger on MRI: Case Report
摘要
手指頭的活動是靠兩條肌腱運作而成，而這兩條肌腱是靠皮帶輪（pulley system）固定在手指裡。皮帶輪不只幫助肌腱固定在正確的位置上，並且使肌腱和手指骨骼能互相配合做出屈曲的動作。一旦皮帶輪受傷、撕裂，就會影響到肌腱活動的正確位置，進而影響手指正常的靈活度。但由於皮帶輪的厚度小於0.3 mm，非常微小，不易在醫學影像上診斷，故我們藉由手指屈曲的姿勢，整體評估肌腱、皮帶輪和骨骼關節間的相對位置和關係，對於皮帶輪撕裂傷的診斷非常有幫助。本文案例為一44歲中年女性，因中指發炎、腫痛而到醫院求醫，超音波診斷有關節水腫和滑液膜變厚的狀況，為求手術前精確的診斷，臨床醫師安排了磁振造影掃瞄。磁振造影除了一般的檢查序列外，還外加了以屈曲姿勢完成的影像，從屈曲姿勢可以看到肌腱的位置不正確，且骨骼和肌腱之間的距離變大，這些都可成為皮帶輪斷裂的佐證。由此例我們可以了解，利用屈曲姿勢的磁振造影影像對於診斷細微的皮帶輪撕裂傷，有很大的幫助。
並列摘要
Normal finger flexion is a complex motor action that requires flexor digitorum profundustendon (FDP) and flexor digitorum superficialis (FDS). Pulley system is the most important organization to maintain the apposition of these tendons. If the flexor tendon pulley system loss its function in maintain the flexor tendon to its position, digital motor performance of finger will be limited. Because the pulley thickness was＜ 0.3 mm in nonruptured pulley in asymptomatic fingers, it's hard to diagnose on medical images. We use finger flexion posture on MRI imaging to help radiologists make accurate diagnosis. This posture could reveals the relationship between tendon, pulley and skeleton. This patient was a 44-year-old female, suffered from finger swelling and went to our hospital. Ultrasound shows synovial membrane thickening with moderate amount of effusion in the dorsum recess right 3^(rd) finger. magnetic resonance imaging(MRI) has prepared for the surgery. We include conventional sequences and finger flexion posture, and this flexor posture imaging helps the doctor to diagnose abnormal position of flexor tendon. According to this, we can prove the injury of pulley system. Pulley system injury diagnosis can be accurate diagnosed by flexed finger posture on MRI imaging.