膝关节伸膝装置:解剖与损伤模式
本文综述膝关节伸膝装置的放射学解剖与损伤模式,涵盖股四头肌及肌腱、髌骨、髌周脂肪垫、髌股关节及支持带、髌腱和胫骨结节。影像学在鉴别诊断和指导治疗中至关重要,X线、CT、超声和MRI各有优势,联合应用可实现准确、临床相关的评估。
要点
- X线是评估髌骨高度、骨折形态和骨骼变异的首选基础检查。
- 超声可动态高分辨率评估肌腱和支持带,区分部分与完全撕裂。
- MRI全面表征软组织、骨髓、软骨及关节内病变,用于复杂损伤术前规划。
关键影像表现/征象
- 伸膝装置包括股四头肌及肌腱、髌骨、髌周脂肪垫、髌股关节及支持带、髌腱和胫骨结节,任何组成部分断裂可导致疼痛、不稳或主动伸直丧失。
- 伸膝装置位置表浅且持续承受生物力学负荷,易发生急性创伤、重复性微创伤、慢性退变和儿童牵拉性骨骺炎。
临床应用与阅片要点
- X线用于评估髌骨高度、骨折形态和骨骼变异,是基础检查。
- CT是术前可靠工具,用于明确骨折构型、粉碎程度和关节面受累情况。
- 超声可动态评估肌腱和支持带,区分部分与完全撕裂,并评估术后完整性。
- MRI用于全面表征软组织、骨髓、软骨及关节内病变,是复杂损伤和髌股不稳术前规划的核心。
- 术后影像用于监测愈合、检测并发症(如结构延长、再撕裂、内固定刺激和复发不稳)并指导康复。
以上解读依据论文摘要(全文未开放获取或许可不允许翻译转载)。
英文原文(摘要)· 点击展开
The extensor mechanism of the knee is essential for maintaining normal daily function and for activities such as walking and athletic performance. It comprises the quadriceps muscles and tendon, patella and peripatellar fat pads, patellofemoral joint and retinacula, patellar tendon, and tibial tuberosity. Disruption of any component can result in pain, instability, or loss of active extension. Owing to its superficial location and continuous biomechanical loading, it is particularly vulnerable to acute trauma, repetitive microtrauma, chronic degeneration, and traction apophysitis in the pediatric population. Imaging is essential for accurately differentiating between diagnoses and guiding management. Radiographs remain indispensable for assessing patellar height, fracture morphology, and skeletal variants, while computed tomography (CT) is a reliable preoperative tool for defining fracture configuration, comminution, and articular involvement. Ultrasound (US) offers dynamic, high-resolution evaluation of tendons and retinacula, facilitating differentiation of partial from complete tears and assessment of postoperative integrity. Magnetic resonance imaging (MRI) provides comprehensive characterization of soft tissues, bone marrow, cartilage, and associated intra-articular pathology, and is central to preoperative planning in complex injuries and patellofemoral instability. In addition to diagnosis, imaging findings directly influence treatment decisions, including fracture fixation strategies, tendon repair or augmentation, and treatment selection. Postoperative imaging plays a vital role in monitoring healing, detecting complications such as construct elongation, re-tear, hardware irritation, and recurrent instability, and guiding rehabilitation. This review highlights the radiological anatomy and injury patterns of the knee extensor mechanism, emphasizing that integrated use of radiographs, ultrasound, and MRI enables accurate, clinically relevant assessment.
引用
- Flores D, Atinga A, Beaulieu C, et al. Extensor apparatus of the knee: anatomy and injury patterns. Skeletal Radiol. 2026. PMID: 42059955. doi:10.1007/s00256-026-05196-1
供执业医师工作参考,不替代临床判断;数值与分级以指南原文为准。