整形２２

【臨床症状】20代　スポーツ中に負傷

【問題】画像所見と診断名は？

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※ T2*、プロトン強調、脂肪抑制画像の順に表示

➡ 冠状断
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※ T2*、脂肪抑制画像の順に表示

    ▶答えはこちら
    • 冠状断の画像にて脛骨外側高原に骨片（剥離骨折）を認め、Segond骨折が疑われる
    • また、プロトン強調の矢状断にてACL（前十字靭帯）中央部に断裂所見がある
    • 脂肪抑制の矢状断にて大腿骨と脛骨に浮腫性変化を認めpivot shift injuryの状態
    • T2*冠状断で内側側副靭帯損傷の合併も認める
    • 他、関節水腫内に14mm大の浮遊構造物あり（Cyclops lesion疑い）
    ※ プロトン強調画像の冠状断は非提示

    【Segond骨折】

    ・屈曲した膝に対して、内旋および内半負荷が原因の脛骨外顆外側面の剥離骨折

    ・ACL（前十字靭帯）断裂を75～100％、半月板損傷を66～75％の割合で合併する事が知られている

    ・骨片が小さいと見逃される可能性がある

    【Cyclops lesion】

    ・Cyclops lesionはACL断裂後の合併症と言われているが、再建していないACL断裂にも起こる事があるという報告がある

    Runyan BR, et al. Cyclops lesions that occur in the absence of prior anterior ligament reconstruction. Radiographics. 2007 Nov-Dec;27(6):e26. Epub 2007 Aug 21.