Abstract：
Scapholunate interosseous ligament injuries are a major cause of wrist instability and can be difficult to diagnose radiographically. To improve early diagnosis of scapholunate ligament injuries, we compared injury detection between bilateral routine clinical radiographs, static CT, and dynamic four-dimensional CT (4DCT) during wrist flexion-extension and radioulnar deviation. Participants with unilateral scapholunate ligament injuries were recruited to a prospective clinical trial investigating the diagnostic utility of 4DCT imaging for ligamentous wrist injury. Twenty-one participants underwent arthroscopic surgery to confirm scapholunate ligament injury. Arthrokinematics, defined as distributions of interosseous proximities across radioscaphoid and scapholunate articular surfaces at different positions within the motion cycle, were used as CT-derived biomarkers. Preoperative radiographs, static CT, and extrema of 4DCT were compared between uninjured and injured wrists using Wilcoxon signed rank or Kolmogorov-Smirnov tests. Median interosseous proximities at the scapholunate interval were significantly greater in the injured versus the uninjured wrists at static-neutral and maximum flexion, extension, radial deviation, and ulnar deviation. Mean cumulative distribution functions at the radioscaphoid joint were not significantly different between wrists but were significantly shifted at the scapholunate interval towards increased interosseous proximities in injured versus uninjured wrists in all positions. Median and cumulative distribution scapholunate proximities from static-neutral and 4DCT-derived extrema reflect injury status.
摘要：
肩胛骨间韧带损伤是腕关节不稳定的主要原因，可能难以通过影像学检查进行诊断。提高肩胛骨韧带损伤的早期诊断水平。我们比较了双侧常规临床X光片之间的损伤检测，静态CT,和动态四维CT（4DCT）在腕关节屈伸和尺尺偏时。单侧肩胛骨韧带损伤的参与者被招募到一项前瞻性临床试验中，研究4DCT成像对韧带腕关节损伤的诊断效用。21名参与者接受了关节镜手术以确认肩胛骨韧带损伤。关节运动学,定义为在运动周期内的不同位置处，跨放射骨和肩胛骨关节面的骨间近端分布。用作CT衍生的生物标志物。术前X光片,静态CT,使用Wilcoxon签名等级或Kolmogorov-Smirnov测试比较未受伤和受伤手腕之间的4DCT极值。在静态中性和最大屈曲时，受伤的腕关节与未受伤的腕关节之间的骨间近端中位数明显更大，扩展,径向偏差,和尺骨偏差。腕关节之间的平均累积分布功能没有显着差异，但在所有位置的受伤腕关节与未受伤腕关节的骨间近端均在肩cap骨间隔处显着转移。静态中性和4DCT导出的极值的中位数和累积分布的舟骨接近度反映了损伤状态。
