I-Knee Pain & Acute Trauma I-diagnostic Imaging Part I | El Paso, TX

Tibial Plateau Fractures

• Uhlobo lwempembelelo lwamaqhekeza lubangele
• Isiphumo esivela kuV valgus okanye u-varus uxinzelelo kunye okanye w / o ukulayishwa kwe-axial
• Ukudibanisa neenxephezelo ezinokuthi zenzeke ngokukhawuleza
• Ukulimala koxinzelelo oluphezulu m / c ngenxa yokutsiba ukuwa kunye nokulayishwa kwe-axial, ngokuphindaphindiweyo kunye nokuqhekeka kwe-plateau ye-tibial. Amadoda>abafazi. Izigulane zikwiminyaka yama-30
• Impembelelo ephantsi okanye akukho ntlungu egulini ezinezifo ze-osteoporosis d / t ezingenakucala
• Ukulimala kwempembelelo kuqheleke ngakumbi ngoxinzelelo lwethafa le-tibial. Abafazi> amadoda. Izigulana zikwi-70 yazo

I-Lateral Tibial Plateau Fractures Common Common

• I-anatomy esebenzayo idlala indima ebalulekileyo
• I-60% yesisindo esithweleyo yi-plateau
• Ithafa eliphakathi licoleke ngakumbi
• Ithafa elisecaleni liphezulu kancinane kwaye liconvex ngakumbi. Uxinzelelo lweValgus luchaphazela ithafa elisecaleni.
• I-Tibial fracture fractures ithathwa njenge-intra-articular kwaye ifumaneka ukulibazisa ukuphulukiswa, ukungabambisani, ukulimala kwamadoda (m / c lateral) I-ACL izinyembezi, i-OA yesibini. Ezinye iingxaki: i-compartment syndrome, ukulimala kwamathambo.
• Ulawulo: ukusebenza kwiimeko ezininzi ngakumbi ukuba> 3-mm inyathela kwithafa
• Ukuba i-plateau okanye i-bicondylar Fxs ikhona, i-ORIF iya kufuneka.

Ukufanekisa Kudlala Indima Ebalulekileyo

• Uqala nge x-rayography. I-X-rayography ingabonakali ubunzima kunye nobukhulu balo bungozi.
• Ukuhlaziya i-CT w / o kuya kufana nokucacisa ukuphuka kwezinto eziyinkimbinkimbi kunye nokucwangciswa kwangaphambili
• IM imaging MR ingaqwalaselwa ukuvavanya ukungcola kwangaphakathi: i-meniscal, ukulimala kwe-ACL.
• Ukuhlelwa kweShatzke kunokunceda ukuvavanya ubunzima beli nzakala

Uphawu loLwazi oluPhambili

• I-AP kunye ne-lateral beam horizontal (itafile yesiphambano) esele ngamadolo radiograph. Qaphela ukudakumba okufihlakeleyo kwe-plateau esecaleni ebonakaliswe yi-plateau esecaleni ebonakala kwinqanaba elifanayo okanye elisezantsi njenge-medial. Uphawu olubalulekileyo lokuxilonga bubukho be-fat-blood-interphase okanye uphawu lwe-FBI kwindawo esecaleni yetafile enqamlezileyo (ngaphezulu kotolo) ebonisa ukwaphuka kwedolo kwe-intra-articular.

Lipohemarthorosis aka FBI Sign

• Unokufunyanwa ngu-radiographie, i-CT okanye i-MR imaging
• Uphawu lwe-FBI luphawu oluthembekileyo lwe-radiographic yesibini ye-intra-articular fractures yamadolo, nokuba incinci kangakanani na.
• Indlela: ukuphuka iziphumo kunye ne-hemthrosis ephawulekayo
• I-Hemarthrosis iya kwenzeka kwakhona w / o Fx. Nangona kunjalo, i-Fx iya kubangela ukuba umnkantsha ogqityiweyo ukhutshwe kwisigxina. I-fat is medium medium thickness (lighter) kwaye iya kubonakala phezulu kwinkunkuma xa isigulane sibanjwe kwindawo ephakamileyo ye-5-10-imizuzu ngaphambi kokuba i-radiograf
• Uphawu lweFBI luqinisekisa ubungqina beFx.
• I-ACL / i-PCL, iinyembezi ezingenasisigxina aziyi kubangela uphawu lweFBI

I-Lateral Tibial Plateau Fx

• I-trap lateral tibial Fx eyayilawulwa ngokusebenzayo
• Inkxalabo eqhelekileyo: i-OA yesibini yangaphambi kwexesha
• Ukulimala okungakumbi kunokubangela ukhathalelo oluthe xaxa

Ukuphambuka Kwangaphakathi Kwamadolo

• Ukulimala okuqhelekileyo okanye okungapheliyo kwe-meniscal fibrocartilages kunye nezithintelo zomlingo
• Iindlebe ze-ACL kunye nophondo oluphambili lwama-meniscus aphakathi kwezona zinto ziqhelekileyo
• Iinyembezi ze-ACL ezibuhlungu, nangona kunjalo, zihlala zibangelwa ukukrazula kwe-meniscus
• Iinyembezi ze-ACL ezibuhlungu zingenzeka njengokulimala okudibeneyo kwe-ACL, i-MCL, kunye ne-meniscus ephakathi.
• I-anatomy esebenzayo: I-ACL ivimbela ukufuduka kwangaphandle kwe-tibia kunye noxinzelelo lwe-varus yesibini
• Imisebenzi ye-MCL kunye kunye ne-ACL ekunqandeni ukujikelezwa kwangaphandle kwe-tibia ngakumbi xa unyawo lityalwe (isikhundla sekholi evalelwe)
• I-MCL inamathele ngokuqinileyo kumadoda ephakathi, ichaza i-classic triad ye-ACL, i-MCL kunye neendoda ezinqabileyo (i-O'Donahue i-triad eyoyikekayo)
• I-Cruciate ligaments (ACL / PCL) i-intra-articular kodwa i-extra-synovial. Akunakwenzeka ukuba ukrazulwe kwindawo evaliweyo yepakethi (ulwandiso olupheleleyo). Xa zonke iinkalo ze-tibia kunye ne-femur zidibene ngokupheleleyo, i-ACL / PCL incinci kwaye izinzileyo.
• Xa idolo liguquguquka i-20-30-degrees okanye ngaphezulu i-ACL i-taut kwaye ihlala ingazinzanga
• I-ACL yinto ebalulekileyo ye-mechanoreceptor esondla ulwazi kwi-CNS malunga nendawo edibeneyo. Ngaloo ndlela uninzi lweenyembezi ze-ACL zangaphambili ziya kukhokelela kwinqanaba elithile lokungazinzi kwamadolo

I-Anatomy esebenzayo ye-ACL

Ukuxilongwa kwe-ACL Tear

• Ukuxilongwa kwe-ACL izinyembezi kudinga u-MR imaging
• Iingxakini zikhona kungekhona nje ukulimala kwamagxalaba kodwa ukulimala kwi-articalular cartilage kunye ne-menisci.
• Uninzi lwabathengisi baya kwenza ubuncinane: i-T1 WI enye kwiinqwelomoya ze-coronal okanye i-sagittal. I-Sagittal kunye ne-coronal Proton-density slices ukuvavanya izakhiwo ze-cartilaginous. Imifanekiso ekhawulezayo ye-spin-echo sagittal, i-axial kunye ne-coronal ye-T2 egcwele i-fat-saturated okanye i-sagittal kunye ne-coronal STIR imifanekiso ibalulekile ukubonisa i-edema ngaphakathi kwi-substance of knee ligaments.
• Qaphela isambulo se-prog-protein-insensiti ye-MRI ebonisa i-ACL echanekileyo (ngasentla)
• I-ACL ihambelana nomgca weBlumensaat okanye umgca we-oblique ohambelana nophahla lwengxowankulu ye-condoral femyles. Ukungabikho kokulungelelaniswa okunjalo yi-ACL kubalulekile kwi-ACL izinyembezi

Ukucingwa kweDx yangaphakathi kweDangatement

• I-MRI ibonisa i-78-100% yobunene no78-100%
• Impawu zeprayimari ze-ACL izinyembezi: ukungabonakali kwe-ACL (ngentla ekhohlakeleyo eluhlaza), ukulahlekelwa kwe-axis yayo kumgca we-Blumensaat (ngaphezu kweentloko zantathu.), Ukubonakala kwe-wavy kunye neenkunkuma (ngaphezu komgca omhlophe) okanye i-edema kunye nokungafihli kwefu (ngasentla utolo oluphuzi)

Izibonakaliso ezithembekileyo zesekondari ze-ACL

• Ngangabonwa kwi-radiographs kunye neMRI
• Ukuhlukunyezwa kwe-Segond (80% inkcazo ye-ACL izinyembezi) (isilayidi esilandelayo)
• Ubonakaliso obunzulu be-femal mark notch ebonisa i-osteochondral fracture (ngasentla imifanekiso engezantsi) kunye
• I-pivot -shift yomnkantsha we-omelo kwi-posterolateral tibial condyle d / t ukujikeleza kwangaphandle kunye neempembelelo ze-valgus ngamaxesha angama-femal (eg.

I-Segond Fracture (Ukuvuswa kwe-ITB)

• Ukwaphuka kweSegond kwiTubercle kaGerdy. Uphawu olubalulekileyo lwe ACL ukulila kubonwa kwii-radiographs kunye neMRI

Ulawulo lwee-ACL Izinyembezi

• Kwiimeko ezinzima, ngokuqhelekileyo kusetyenziswa i-cadaveric okanye i-autograft (i-patella ligament okanye i-hamstring) ukulungiswa kwe-ACL
• Iingxaki: ukukrazula kwe-graft, ukungazinzi kunye ne-DJD yangaphambi kwexesha, ukuqina ngokubambisana d / t ukungabikho kwe-postoperative rehab okanye ukunciphisa i-gaft. Okunqabileyo ngakumbi, usulelo, ukubunjwa kwe-intri-aosseous synovial cysts, njl.

Khwae Trauma