I-Knee Pain & Acute Trauma I-Diagnosis Ukufanekisa Icandelo II | El Paso, TX

Iindlebe zeMeniscal

• Acute okanye ezingapheliyo. Imifanekiso ene-MRI (95% uvakalelo kunye ne-81% ekhethekileyo)
• I-Menisci yenziwe ngokubunjwa kwe-radial kunye ne-circumferential collagen fibers (i-97% yodidi lwe-1) exutywe ne-cartilage, i-proteoglycans, njl. 65-75% H2O.
• Ukuguga kungakhokelela ekutheni umntu angeneli
• Iinyembezi ezigqithiseleyo zi-d / t zokujikeleza kunye nokuxilisa, ama-knele azinzileyo amadolo abonisa amathuba amaninzi ezinyembezi
• Uphondo olungasemva lwemeniscus ephakathi lukrazulwe yi-m/c ngaphandle kokuba ku-A acuteCL iinyembezi xa i-meniscus esecaleni ikrazukile m/c
• I-meniscus ifakwe kakuhle kubantwana. Kubantu abadala, iindawo ezi-3 zikhona: ngaphakathi, phakathi nangaphandle (ngaphezulu komfanekiso ongezantsi)
• Ukulimala kwendawo engaphakathi akukho nathuba lokuphilisa
• Ukulimala kwendawo yangaphandle (i-25% ngokupheleleyo) inokuphilisa / ukulungiswa

Ukunikezelwa kwezonyango

• Ubuhlungu, ukuvala, ukuvuvukala
• Uphawu olubonakalayo olunobunzima: intlungu kwi-palpation kumgca odibeneyo
• Iimvavanyo: McMurry, Thessaly, Faka isicelo sokunyanzelisa
• Ulawulo: i-conservative vs. operative ixhomekeke kwindawo, uzinzo, ubudala besigulane, kunye ne-DJD kunye nohlobo lokukrazula
• I-meniscectomy engaphelelanga iyenziwa. I-80% yemisebenzi eyiyo ekulandeleni. Ithandeka kancinci ukuba> 40-yo kunye ne-DJD
• I-meniscectomy iyonke ayiyenziwa kwaye ibonwa nje ngokudlulileyo. I-70% OA i-3-iminyaka emva kokuhlinzwa 100% OA emva kwe-20 iminyaka utyando.

Mxial MR

• Ukubonakala kwimibala (eluhlaza okwesibhakabhaka) kunye ne-meniscus yangaphambili (obomvu)

Menisci Play Indima ebalulekileyo

• Enye yeendima ezibalulekileyo yinkqubo ye-“hoop-stress”.
• Iinyembezi ezinqabileyo zingaphazamisa kakhulu le ndlela.
• Ukufunda okuqhubekayo: www.ncbi.nlm.nih.gov/pmc/articles/PMC3435920/

Iindidi Indawo kunye nozinzo

• Iintlobo, indawo, kunye nokuzinza kweenyembezi zi-v. zibalulekile ngexesha le-MRI Dx
• Iinyembezi ezibonakalayo / ezide zenzeke ngokukodwa kwiinyembezi ze-ACL. Ezinye iinyembezi ezide ezithe zafunyanwa kummandla okanye "indawo ebomvu" ingaphilisa
• Umqheba webhakethi ukukrazuka: ukukrazuka okude kumphetho ongaphakathi onzulu kwaye uthe nkqo udlulela kwi-axis ende kwaye unokushenxiswa kwinotshi.
• I-Oblique / i-flap / i-parrot-beak iyinkxwaleko
• Ukulila ngexinesi kwi-90-degree to plateau

Axial T2

• I-Axial T2 I-fat ihleli kunye ne-STON tilisi ze-STIR uphondo oluphambili lwe-meniscus ephakathi.
• Qaphela i-radial tear yophondo lwangasemva lwe-meniscus ephakathi kufuphi nengcambu ye-meniscal. Esi sinokuba sisilonda esingazinzanga esifuna ukhathalelo loqhaqho
• I-meniscus, kule meko, ayikwazi ukunika "i-hoop-stress mechanism."

Iimpawu zeMRI zeCoronal kunye neSagittal

• I-faton ye-coronal kunye ne-sagittal proton yesisindo se-MRI slices reveal the horizontal (cleavage) ikhwebu echanekileyo kakhulu kwi-meniscus ekhulile
• Kwezinye iimeko, xa oku kukrazuka kungenayo i-radial component, kunokuphilisa ngokuyinxenye kuthintele imfuno yonyango.

I-T2 kwi-GRE Sagittal MRI Isiqendu

• Ingqungquthela yenkqonqqqqqutyana kunye neqanda eliqambileyo nelingu-radial.
• Olu hlobo lwezinyembezi aluqinisekanga kwaye kwiimeko ezininzi zingadinga ukunakekelwa kwabasebenzi

I-Bucket Handle Mfutshane

• Isibambo seBhakket isiliva m / c kwi-meniscus esp. kunye ne-ACL kunye ne-MCL
• Iimpawu zeMRI; uphawu lwe-PCL kabini kwiingcezu ze-sagittal
• Ukungabikho "uphawu lokuquba" kunye nabanye
• Iimeko ezininzi zifuna ukunakekelwa kwabasebenzi

DDx Ukusuka kwiMeniscal Degeneration

• Ngamanye amaxesha iinyembezi ze-meniscal zifuna ukuba yi-DDx ukusuka kwi-meniscal degeneration enokuthi ibonakale iqaqambile (uphawu oluphezulu) kwi-MRI ebuthathaka.
• Umgaqo olula kukuba ukuba kukho i-meniscal tear yangempela aka iBanga lesi-3 lesion, ihlala ifikelela / idlulela kwi-tibial plateau surface.

Indima ye-MSK Ultrasound (US) kwi-Knee Examination

• MSK US kwiedolo ivumela ukucwangciswa okuphezulu kunye neengcamango ezinamandla ngokukodwa ngokuyinqobo (anaton, bursae, capsular ligaments)
• I-MSK US ayikwazi ukuvavanya ngokwaneleyo imigqaliselo ebalulekileyo kunye ne-menisci ngokupheleleyo
• Ngaloo ndlela uMM imaging uhlala ekhethekileyo

Iingxaki zePathologies eziphumelele ngempumelelo nge-MSK US

• I-Patellar tendinosis / i-patellar tendon rupture
• I-quadriceps itheon isilizi
• Prepatellar bursitis
• I-infrapatellar bursitis
• Pes Anserine bursitis
• I-Popliteal cyst (Baker cyst)
• Ukudumba/ukudityaniswa okudityanisiweyo kunye nokuqina kwe-synovial kunye ne-hyperemia inokubonakaliswa ne-US (umzekelo, i-RA) ngakumbi ngokudityaniswa kombala wamandla we-Doppler

Isigulana esiveliswe nge-Atraumatic Knee Pain kunye nokudumba

• Iradiyografi ibonakalise ubungakanani bezicubu ezithambileyo ezixineneyo ngaphakathi kwendawo engaphezulu ye-patella kunye ne-OA ephakathi ukuya kwimodareyitha.
• I-MSK yase-US ibonise ingqokelela enkulu yolwelo olucandisiweyo olune-heterogeneous kunye nomsebenzi othambileyo we-Doppler kumda obonisa ukudumba kwe-d/t Dx ye-Superficial pre-patella bursitis

Iifoto ze-Axis zase-US ezinde

• Qaphela i-meniscus yecala eliqhelekileyo kunye nemicu ye-LCL (ngaphezulu komfanekiso ongezantsi) xa kuthelekiswa
• Ukuqhaqhaqhaqhaqhaqhaqhaqhoqhoqhoba kunye nokuqhathaniswa kwe-meniscus yesikhokelo kunye ne-LCL yokuqhawula (ngasentla umfanekiso ophezulu)
• Umlinganiselo omkhulu: akakwazi ukujonga ngeso lengqondo yonke i-meniscus kunye ne-ACL / PCL
• Kuphakanyiswa ukuhanjiswa kweMRI

Ukukhutshwa kweTendon Distal ye-Quadriceps

• Phawula ukugqithwa kwetendon ye-distal ye-Quadriceps muscle evezwe njenge-fiber separation kunye ne-fluid (hypo to anechoic) ukuqokelela kwamanzi kwi-toni
• Izinzuzo ze-MSK US malunga neMRI ukuvavanya izakhiwo ezingenanto:
• Ukucingela ngamandla
• ukufumaneka
• Isebenza kakuhle emalini
• Ukulungiselela umonde
• Ukungalungi: ubunzulu obunqamlekileyo bezakhiwo, ukungakwazi ukuvavanya ithambo kunye ne-cartilage, njl.

Ukulimala kwe-Osteochondral Knee (OI)

• Ukulimala kwamadolo e-osteochondral kunokwenzeka kubantwana abaneminyaka eyi-10-15 yovezwa njenge-Osteochondritis Dissecance (OCD) kunye nakwi-skeleton evuthiweyo m / c emva koxinzelelo lwe-hyperextension kunye ne-rotation trauma, ngokukodwa kwi-ACL tear.
• I-OCD-iqhubela phambili kwimikhosi ephindaphindiweyo kwisifo esilumkileyo kwaye ichaphazela i-m / c yecala-postal-partal of condoral femyle.
• I-OI kwithambo elivuthiweyo lenzeka i-m / c ngexesha le-ACL iinyembezi ezichaphazela kakhulu into ebizwa ngokuba yi-terminal sulcus ye-condyle ye-femoral esecaleni kwi-junction ye-weight-bearing section echasene ne-tibial plateau kunye nenxalenye ehambelana ne-patella.
• Ukulimala kwe-Osteochondral kunokusonakalisa i-articular cartilage ebangela i-OA yesibini. Ngaloo ndlela kufuneka uhlolwe ngophando
• Ukufanekisa kudlala indima ebalulekileyo kwaye kufuneka kuqalwe nge-radiography ngokuphindaphindiweyo ilandelwa nguM imaging kunye nokuthunyelwa kwamathambo.

OCD Knee

• I-95% edibene nexinzelelo. Ezinye i-etiology: ischemic bone necrosis ngakumbi kubantu abadala
• Ezinye indawo eziqhelekileyo zokulimala kwe-osteochondral: i-elbow (capitellum), i talus
• Isinyathelo se-1st: i-radiografi iyakwazi ukubona i-osteochondral fragment enokuqhotyoshelweyo okanye idibeneyo
• Indawo: inkalo ye-posterior-lateral ye-condyle ye-femal medial. Itonela (inotshi ye-intercondylar) ibalulekile
• I-MRI: imeko yokukhetha> i-90% ekhethekileyo kunye novakalelo. Kubalulekile ukuqhubekeka nolawulo. Umqondiso we-T1-low umda obeka umda kunye ne-T2 ephezulu yomda wokumisa umda obonisa ukungqinwa kunye nokunyanga okungenakulindeleka. Jonga ugqirha wamathambo
• Ulawulo: lesion ezinzile esp. kubantwana abancinci> ukuphilisa ubunzima bokuthwala ubunzima kwi-50-75%
• Isilonda esingazinzanga kunye nomntwana omdala okanye ukuvalwa kwe-physeal ezayo> ukulungiswa kokusebenza.

Khwae Trauma