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Ukujonga kunye nokuchonga

IQela lokuBamba iKlinikhi eNgemva kunye neQela lokuxilonga. UDkt Alex Jimenez usebenza kunye neengcali zokuxilonga eziphezulu kunye neengcali zokucinga. Kubudlelwane bethu, iingcali zokujonga umfanekiso zibonelela ngokukhawuleza, ngembeko, kunye neziphumo ezikumgangatho ophezulu. Ngentsebenziswano nee-ofisi zethu, sibonelela ngomgangatho wenkonzo ngokwegunya lezigulana zethu nezilufaneleyo. I-Diagnostic Outpatient Imaging (i-DOI) liziko le-Radiology ye-state-of-art e-El Paso, TX. Yeyona ndawo yodwa yohlobo lwayo e-El Paso, ephethwe kwaye iqhutywa yiRadiologist.

Oku kuthetha ukuba xa ufika kwi-DOI kuvavanyo lwe-radiologic, zonke iinkcukacha, ukusuka kuyilo lwamagumbi, ukhetho lwezixhobo, itekhnoloji ekhethwe ngesandla, kunye nesoftware eqhuba iofisi, ikhethwe ngononophelo okanye iyilwe yiRadiologist. kwaye hayi ngomgcini-mali. I-niche yethu yemarike yindawo enye yokugqwesa. Imilinganiselo yethu enxulumene nokhathalelo lwezigulane zezi: Sikholelwa ekuphatheni izigulana ngendlela esiya kuphatha ngayo intsapho yethu kwaye siya kwenza konke okusemandleni ethu ukuqinisekisa ukuba unamava amnandi kwikliniki yethu.

I-Ankle & Iinyawo Ukuchonga Ukujonga Ukuphefumula I-Arthritis & I-Trauma I | El Paso, TX.

I-Ankle & Iinyawo Ukuchonga Ukujonga Ukuphefumula I-Arthritis & I-Trauma I | El Paso, TX.

by | Ukujonga kunye nokuchonga

IAnkle Fractures

  • I-10% yazo zonke iifractures. I-2nd m / c ilandela intamo ye-femoral Fx. Ubalo lwabantu: amadoda aselula asebenzayo kunye nabasetyhini abadala be-osteoporotic
  • I-Stable Fx: Ukugqitywa ngokubanzi kulungile
  • I-Fx engaqinisekanga: ifuna i-ORIF. 15% -20% amathuba we-2nd OA.
  • Indima yomfanekiso kukuqinisekisa ukuntsonkotha, uzinzo kunye nesicwangciso sokhathalelo (okt, ukusebenza ngokuchasene nolondolozo)
  • Uhlobo lwe-Weber lubona ukugqithwa kwe-distal tibial-fibular syndesmosis kunye nokungazinzi
  • I-Weber A - ngaphantsi kwe-syndesmosis. Izinzile, ngokuqhelekileyo ukuvuswa kwe-distal fibular malleolus
  • I-B B - kwinqanaba le-syndesmosis: ingaba ngaphandle kwe-syndesmosis kunye ne-stndesmosis eqinile okanye yokuqhawula kwaye ingaqiniseki
  • I-Weber C - ngaphezulu kwe-syndesmosis. Ngalo lonke ixesha ingazinzanga d/t ukukrazuka kwe-syndesmosis
  • Ukwahluka kweefractures kunokubandakanya isikhundla / indima yethambo le-talus ngexesha le-Fx (umzekelo, ukuthunjwa, ukunyuswa, ukujikeleza, njl.) Oku kwaziwa ngokuba yi-Lauge-Hanson classification

I-Tibiofibular Syndesmosis kunye nozinzo lwe-Ankle

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.

I-Clinical Dx Ukuchaneka

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.

UkuBona nokuBonwa kwe-AP

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.

I-AP, iMedical Oblique kunye neMibono yeLateral

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • Ukutyhila i-infrasyndesmotic Fx ye-fibular malleolus (Weber A)
  • Ukulimala okuzinzileyo
  • Ukunyamekelwa kwe-Conservative ngendlela ye-short-leg walk cast / boot ingasetyenziswa. Ukuchacha kakuhle. Ukuba akukho bungqina bokulimala kwe-osteochondral, amathuba aphantsi kakhulu e-OA yasemva kokwenzakala
  • Akukho mfanekiso wokucinga ofunekayo. I-MRI inokukunceda ukutyhila i-bone disusion kunye nokulimala kwe-osteochondral

Weber B kwiNqanaba leSyndesmosis

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • Unokuzinza okanye ungazinzi. Ngezinye izihlandlo, isigqibo senziwa ngexesha lokuhlola.
  • Ukutshekisha kwe-CT kunokuncedisa ukuphonononga kwakhona
  • Ulawulo: kuxhomekeke ekuzinzileyo. Uzinzo olongezelelweyo olufunekayo ukuba i-syndesmosis yaphuka

Weber C

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • I-AP, i-oblique ye-medial kunye neembono zecala zityhila i-Weber C - ukulimala kwe-suprasyndesmotic kunye nokwandisa okungaqhelekanga kwe-d / t ukuphazamiseka kwe-tib-fib syndesmosis. Ukwenzakala okungazinzanga kakhulu.
  • Ngamanye amaxesha, xa i-Weber C Fx ibeka i-6-cm ukusuka kwincam ye-malleolus esecaleni, inokubizwa ngokuba yi-Pott's ankle Fx (igama emva kwePercival Pott's oye wacebisa ulwahlulo lwangaphambili lwe-ankle fractures ngokusekelwe kuzinzo kunye neqondo lokujikeleza). Eli gama liphelelwe lixesha.
  • Ulawulo: ukusebenza kunye nokuzinza okongezelelweyo kwe-syndesmosis

I-Maisonneuve Fracture

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • Ngokuphindaphindiweyo ukuqhuma okuvuthayo kwe-fibula ehamba phambili idibene nokulimala kwe-ankle
  • Akukho fracture yangasese ephawulwayo ephawulwa ngamazwe, ngoko ke unokuphosakelwa kwiimbono ze-ankle kwaye ufune i-tibia kunye ne-fibula
  • Izixhobo zeRad: Ukwandisa kwe-ankle d / t syndesmosis zigqabhule kwaye ngamanye amaxesha i-deltoid ligament ukuphazamiseka. I-membrane ye-interosseous ichithwe ngeFx-Fx-proximal Fx ebangelwa ukubethelwa kwamandla ngokujikeleza kwangaphandle
  • Ulawulo: ukusebenza

IBimalleolar kunye neTrimalleolar Fx

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • Ngaphezulu kwemifanekiso ephezulu Bimalleolar Fx v. engazinzanga, isiphumo sokubiza kunye nokuphanga / ukujikeleza kwangaphandle. Rx: ORIF.
  • I-Trimalleolar Fx: I-3-inxalenye ye-ankle Fx. I-malleolus ephakathi kunye ne-lateral kunye ne-avulsion ye-posterior aspect of tibial plafond. Okungazinzanga ngakumbi. Rx: usebenza

Tillaux Fx

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • I-Pediatric Fx echaphazela umntwana omdala xa i-medial side ye-physis ivaliwe okanye malunga nokuvala ngecala elisecaleni lize livule. Ukuvuswa yi-tibi-fibular ligament yangaphambili. Iingxaki: I-2nd dry / OA yangaphambi kwexesha. Rx: inokugcinwa ukuba izinzile ngokukhutshwa kwe-boot.

Ukulimala kweZiko lokuKhula

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • Udidi lweSalter-Harris lunceda ukuxilonga nokuxela ukulimala kwamagciwane.
  • Inomemonic encedisayo: SALTR
  • S: uhlobo 1-ukutyibilika kwipleyiti yokukhula
  • A: uhlobo lwe-2-ngasentla, i-Fx idlulela kwi-metaphysis
  • L: Uhlobo lwe-3-oluphantsi, i-intra-articular Fx ludlulela kwi-epiphysis
  • T: type4, "nge" Fx idlulela kuzo zonke: i-physis, i-metaphysis, kunye ne-epiphysis.
  • R: uhlobo 5, “yonakele.” Ukutyumza ukwenzakala kwiphysis ekhokelela ekufeni okupheleleyo kwepleyiti yokukhula
  • Uhlobo lwe-1 kunye ne-5: lukhoyo ngaphandle kokuphulwa
  • Uhlobo lwe-2: lunesisombululo esilungileyo kwaye saqwalaselwa ngokuqhelekileyo.
  • Ulawulo: ukuthunyelwa kugqirha wamathambo wabantwana
  • Iingxaki: ukuvala kwangaphambili kwe-physis, ukunciphisa umlenze, i-OA ngaphambi kwexesha kunye nabanye.

Ukuqhekeka kwamabala

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • Uninzi lweTarsal Fx. 17% evulekile iFx
  • Iinkqubo: ukulayishwa kwe-axial (i-intra-articular Fx kwi-sub-talar kunye ne-calcaneal-cuboid joints) kwiimeko ze-75%). Ukuvuswa kwethambo le-Achilles (m / c kwithambo le-osteoporotic). Ukuxinezeleka (ukukhathala) Fx.
  • I-intra-articular Fx ithatha i-prognosis. Ngokuqhelekileyo zatshintshiwe. Rx: ukusebenza.
  • B / I-fx intra-articular fx kunye ne-vertebra compression Fx kunye noxinzelelo lwe-vertebral Fx (T10-L2) idla ngokuba nguCasanova aka Don Juan (Lover's) fx.
  • Ukufanekisa: x-radiografi ngokufakela "umbono wesithende" I-1st inyathelo. Ukutshekisha kwe-CT kukulungele iDx kunye nokucwangcisa kwangaphambili.
  • Radiography: I-angle ye-Bohler (<20-degrees) i-angle yeGissane> i-130-degrees. Chaza iCalcan, Fx.

Amathambo eTarsal

iinyawo ezinyaweni zesifo se-arthritis kunye ne-traum el paso tx.
  • I-M / C i-tarsal bone iTarsal. Ummandla we-M / C: intamo ye-talar (30-50%). Indlela: Ukulayishwa kweexial kwi-dorsiflexion. Iingxaki: Ischemic osteonecrosis (AVN) yeetalus. Ukuqala (2nd OA). Ukufanekisa: I-1st inyathelo: ii-radiographs, i-CT inokukunceda xa kuqhubeka ukucaciswa
  • Ukuhlelwa kwe-Hawkins kunceda nge-Dx, i-prognosis & nonyango. "Umqondiso we-Hawkins' kwifilimu ecacileyo / i-CT scan inokunceda nge-AVN Dx. (ngaphezu kweentolo eziluhlaza zibonisa i-prognosis elungileyo d/t umgca we-radiolucent obonisa ukuba akukho AVN kuba ithambo li-vascularized kwaye ngenxa yoko lifakwe kwi-resorbed)
  • Rx: Thayipha i-1: ulungelelaniso ngomlenze omfutshane okanye umlenze (ingozi ye-AVN-0-15%), Thayipha i-2-4-ORIF (ingozi ye-AVN 50% -100%)

Ukujonga i-Ankle kunye neenyawo

 

I-Arthritis ye-Knee: Ukujonga ukujonga ukujonga ii-II El Paso, TX.

I-Arthritis ye-Knee: Ukujonga ukujonga ukujonga ii-II El Paso, TX.

by | Arthritis, Ukujonga kunye nokuchonga

Sagittal Fluid Sensitivity

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.
  • I-Sagittal Fluid Sensitive Sensitive MR slice ebonisa iNetovial popliteal popliteal (i-Baker's) cyst (ngentla yemifanekiso ephezulu) kunye nesiphumo esivumelanayo sesinxibelelaniso esingaphezulu (umfanekiso ongezantsi)
  • Qaphela iindawo ezininzi ezimnyama ezibonisa ubumnyama kwimifanekiso yomibini, emele ukubekwa kwemibhobho yokufakelwa kwi-fibrinoid aka aka "imizimba yerayisi" uphawu lwe-MRI ebonakalisa uphawu lweRA

Ukuhanjiswa kweRheumatological Referral kunye ne-DRM

  • Ulawulo lokugcinwa kwemilondolozo olulandelwa lulondolozo lwentsebenziswano kwiimeko zamathambo ezihlukumezayo kunye namaqela ahlukeneyo
  • Ukufunda okunye:
  • Ukuxilongwa nokuLawula iRumatoid Arthritis -AAFP
  • www.aafp.org/afp/2011/1201/p1245.html

ISeptic Arthritis (SA)

  • Isifo samathambo - d / t ibhaktiriya okanye ukungqubana kokungunda kokudibeneyo. I-SA inokubangela ukutshatyalaliswa okuhlanganyelweyo okukhawulezayo kwaye ifuna ukuba i-Dx kunye nolawulo lwe-antibiotic ngokukhawuleza
  • Amalungu achaphazelekayo: amalunga amakhulu anegazi elityebileyo (idolo i-50%> iinyonga> amagxa).
  • Iirhuts of Infection:
  • I-1) I-memo yodwa i-m / c
  • 2) Sasaza kwiziko elikufutshane
  • I-3) Ukufakwa ngokuthe ngqo (umz., Ukwenzakala, iatrogen)
  • Izigulana ezisemngciphekweni: abantwana, isifo seswekile, ukugonywa, umonakalo odibeneyo / usulelo, umzekelo, RA, njl.
  • Abasebenzisi beziyobisi ze-IV basengozini enkulu kwaye banokuthi bangcolise ukudibanisa ii-atypical joints "SI joints" SIJ, SCJ, Symphysis pubis, ACJ, njl.

 

  • Klinikhi: ziyahluka kwaye kuxhomekeke kwimpendulo ye-immune response kunye ne-bacterial virulence. Inokuthi ivele ngokukhawuleza kokuqala okanye ukunyanzeliswa kweentlungu ezidibeneyo zangaphambili, ukuvuvukala, ukunciphisa iROM. Imiqondiso jikelele ye-malaise, umkhuhlane, ukukhathala nokuphakama kwe-ESR, i-CRP, i-Leucocytosis inokuba khona.
  • Isifo seswekile se-NB kunye ne-immunocompromised sinokuthi sivelise ukubonakaliswa okumbalwa kunye nokungabikho komkhuhlane
  • I-Dx: ikliniki, i-radiological kunye nebhubhoratri. I-Arthrocentesis ingafuneka ukuba inkcubeko, isibalo seeseli kunye nokuhlolwa kwe-synovial
  • Ulawulo: IV antibiotics
  • Ukujonga iDx: iqala nge-radiogra kodwa kwinqanaba lokuqala uninzi olunokubakho alunakuba lolwazelelekileyo. I-MRI inokuba nolwazelelelo kwaye incede ekuchongeni kwangoko kokudityaniswa kwamadlala, i-edema yamathambo, njl. I-US kunokuba luncedo kumalungu adibeneyo nabantwana. I-US inceda ngokukhokela ngenaliti. I-scintigraphy yethambo inokusetyenziswa ngokwasemoyeni ukuba i-MRI ichasene

Imizila yeContactination Joint

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • 1. Uhlobo (M / C)
  • 2. Ukusasaza kwisiza esiseduze
  • 3. Inoculation ngqo
  • I-M / C yendalo-iStaph aureus
  • I-NB Intsholongwane ye-Gonococcal ingaba yintlukwano ephezulu kwezinye iimeko
  • Abasebenzisi beziyobisi ze-IV: I-Pseudomonas, i-candida
  • Isilya seSickle: i-Salmonella
  • Izilwanyana (iikati / izinja) ziluma: Pasteurella
  • Ngamaxesha athile ungcoliseko lokungunda lunokwenzeka
ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

Yezigulanaa

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Ekuqaleni ayingacaciswanga nge-ST / ukufakwa ngokudibeneyo, ukubonwa / ukugqobhoza kweenqwelomoya. Kuba kuthatha i-30% ye-compact kunye ne-50-75% ithambo le-trabecular ukuba litshatyalaliswe ngaphambi kokuba kubonwe kwi-x-ray, i-radiography ayikhathaleli kwezinye zeenguqu zokuqala. Ukucingela i-MR yeyona ndlela ikhethiweyo
  • Ukuba i-IRM ayifumaneki okanye iyaphikiswa. I-Bone scintigraphy kunye ne-Tc-99 MDT inokunceda
  • Kubantwana, e-US bakhetha ukuphepha i-ionizing radiation. Kubantwana, i-US inokuba nobuthathaka ngakumbi kunabantu abadala ngenxa yokunqongophala kwamathambo

Radiographic Dx

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Iziphumo zakuqala azinamvuzo. Iimpawu zakuqala zingabandakanya ukwandiswa okuhlanganisiweyo kwe d / t. Ukudumba kwezicubu ezithambileyo kunye nokuchaphaza / ukungcungcuthekiswa kweenqwelomoya
  • Iiveki ze-1-2: i-periarticular and adjacent osseous changes zibonakalisa njengokutsalwa kwesinambuzane, ukudliwa kwenundu, ukuvumela ukutshutshiswa kwamathambo, ukulahleka, kunye nokungaqondakali kwe-epiphyseal "cortical line" ekhulayo kunye nokunyuka kokuvuvukala kwezicubu. I-MRI inokuba luncedo ekuqaleni kuka-Dx.
  • Iimpawu ezisezantsi: ukuzaliswa kokuhlanganiswa kunye kunye ne-anloloses
  • I-NB ye-arthritis ye-Septic ingaphuthuka ngokukhawuleza ngaphakathi kweentsuku kwaye idinga i-antibiotic yakudala ye-IV ukukhusela ukutshabalalisa okukhulu

I-T1 kunye ne-T2 Knee MRI

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • I-T1 (ngasentla ngasekhohlo) kunye ne-T2 i-sagittal knee ii-MRI izilayi zibonisa ukulahleka kwesiginali eqhelekileyo yomqondiso kwi-T1 kunye nokunyuka kwi-T2 ngenxa yeedema ye-septic. Ithambo le-sequestrum d / t osteomyelitis eqhubela phambili kwi-septic arthritis iyaphawulwa. Ukumakishwa kokudityaniswa okudibeneyo kunye needema ezikufuphi nezicubu ziyabonakala. I-Dx: i-OSM kunye ne-septic arthritis
  • Ukuxeliswa kunganceda i-Dx ye-septic yokudibanisa. Nangona kunjalo, i-Dx yokugqibela isekwe kwi-Hx, uvavanyo lomzimba, uvavanyo lwegazi kwaye okubaluleke kakhulu kukunqweneleka ngokufana (arthrocentesis)
  • I-Synovial umthambo kufuneka ithunyelwe kwi-Gram staining, inkcubeko, ukuhlolwa kwe-glucose, isibalo se-leukocyte, kunye nokuzimisela
  • ISR / CRP inokuphakanyiswa
  • I-Synovial fluid: I-WBC ingaba yi-50,000-60,000 / ul, ne-80% ye-neutrophils enezinga le-glucose echanekileyo I-Gram stain: kwi-75% ye-co-accin cocci. Ukuguqulwa kwegram kuncinci kwiintsholongwane ze-gonococcal nge-25% yeenkcubeko kuphela
  • Kwi-9% yamatyala, iikholeji zegazi ziphela zivela kumthombo we-pathogen kwaye kufuneka zifunyenwe ngaphambi kokuba unyango lwe-antibiotic
  • Amanqaku: www.aafp.org/afp/2011/0915/p653.html
  • www.aafp.org/afp/2016/1115/p810.html

I-Crystal-Induced Knee Arthritis

  • I-crystalline arthritis: iqela lezinto ezibangelwa yi-crystal deposition kunye neenxa zonke.
  • 2-m/c: Iikristale zeMonosodium urate (MSU)� kunye neCalcium Pyrophosphate Dehydrate crystals (CPPD) arthropathy
  • Igawuthi: Ukubekwa kwe-MSU kumalungu ajikeleze kunye nezicubu ezithambileyo. Amanqanaba aphakamileyo e-serum uric acid (UA) (> 7mg / dL) ebangelwa kukuveliswa ngokugqithisileyo okanye ukukhutshwa okungaphantsi kwe-uric acid
  • Nje ukuba i-UAU ifikelele / idlule kwi-7mg / dL, iya kufaka kwizicubu zomzimba. I-gout eyintloko: ukuphazamiseka kwe-metabolism ye-nucleic acids kunye ne-purines iyaphule. Ukuphuma kwesibini: Ukunyuka kweseli okunyukayo: I-Psoriasis, i-leukemia, i-myeloma emininzi, i-hemolysis, ichemotherapy, njl.
  • I-Gout ibonisa ngezigaba ze-5:
  • 1) i-hyperuricemia (iminyaka / iminyaka emininzi)
  • Ukuhlaselwa ngokukrakra kwe-arthritis ye-gouty (i-wax kunye neyadala kwaye idlulela iminyaka emininzi)
  • Isigaba sesithuba phakathi kokuhlaselwa
  • Isifo se-tophaceous esingapheliyo
  • Gouty nephropathy
ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

Ukunikezelwa kwezonyango

  • Kuxhomekeke kumanqanaba
  • Uhlaselo olusebenzayo: iintlungu ezidityanisiweyo ezinobukrakra "zokuqala kunye ezimbi" kude kube buhlungu ukubamba ukukhanya
  • I-DDx: ukuhlanganiswa kwe-septic (zombini inokuthi ikhona) i-bursitis njl
  • I-gouty arthritis ibonisa nje nge-monoarthropathy
  • Inqanaba lokunyanga okungapheliyo: idiphozithi kumalungu, i-pinna yendlebe, iioyile, kunye neminye imimandla. I-Nephrolithiasis njl. Amadoda> abafazi. Ukutyeba kakhulu, ukutya kunye nobudala> 50-60.
  • Iimpawu zengxowankulu: Ukuhlaselwa kwangethuba kungekhona kwaye kungabonakalisa ukuxhatshazwa okuthe ngqo
  • I-radiography ye-ging tophaceous engapheliyo: ihlikiwe ngaphandle kwe-peri-articular, para-articular kunye ne-intraosseous yukhukuliseko olunemiphetho engaphezulu. Umphetho obonakalayo wes sclerosis kunye nokubalwa kwangaphakathi, itouti ethambileyo yecuthi. Indawo ekujoliso kuzo: isiphelo esisezantsi m / c
  • I-Rx: allopurinol, colchicine (esp ukuthintela iziqalo ezikhulu kunye nolondolozo)

Synovial Aspiration

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • I-Synovial aspiration kunye ne-microscopy ephazamisayo ibonakalisa i-MSU enokungahambi kakuhle kweenaliti ezinobungqina obukhulu be-PMN. I-DDx: ama-crystals (CPFD) angaphantsi kwe-CPPD (ngenhla ngasekunene) abonwa kwi-Pseudogout ne-CPPD
ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

Enkulu ST

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Ubungqingqwa kunye nokudityaniswa okuhlanganyelweyo kukhuphe ukhukuliseko lomhlaba ngokuguguma, ukugcinwa okugcwele koxinano lwethambo, ukubalwa kwangaphakathi Dx: isifo esingapheliyo esifumbileyo

Iimpawu zeMRI Gout

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Ukhukuliseko olunemida engaphezulu, umqondiso ophantsi kwi-T1 kwaye uphezulu kwi-T2 kunye nemifanekiso egxinwa ngamafutha. Ukuphucuka kokungafani kokuphuculwa kwe-tophaceous deposits d / t izicubu zokugcoba
  • Dx: yokugqibela Dx; i-synovial aspiration kunye ne-microscopy ephazamisayo

Amanqaku angaphezulu

Knee Arthritis

 

Ukuvavanywa kwabagulana ukuhambisa nge-Knee Pain: Icandelo II. Ukuxilongwa ngokungafani

Ukuvavanywa kwabagulana ukuhambisa nge-Knee Pain: Icandelo II. Ukuxilongwa ngokungafani

by | Arthritis, I-Arthropathies, Chiropractic, Uvavanyo lweChiropractic, Ubuhlungu obungapheliyo, impilo, Ukujonga kunye nokuchonga, Ukunyamekela, Izifundo zoPhando, Uvavanyo lweSkrini, Ukulimala kwezemidlalo, Unyango, Ukuphila

Amadolo awona manqaku amakhulu emzimbeni womntu, apho izakhiwo eziyinkimbinkimbi zemilenze engaphantsi nephezulu zihlangene. Ukuxhomekeka kwamathambo amathathu, i-femur, i-tibia, kunye ne-patella ejikelezwe ziintlobo ezinamaqhina adibeneyo, kuquka i-cartilage, i-tendon kunye nemigqa, i-knee isebenza njenge-hinge, ikuvumela ukuba uhambe, ugxume, u-squat okanye uhlale. Ngenxa yoko, nangona kunjalo, idolo libhekwa njengelinye lamalungu amaninzi afanelekile ukuhlaselwa. Ukulimala kwamadolo yisona sizathu esibalulekileyo buhlungu.

Ukulimala kwamadolo kungenzeka ngenxa yempembelelo ngqo kwi-accident ye-slip-falling-accident okanye imoto yengozi, ukulimala ngokugqithiseleyo kwingozi yemidlalo, okanye ngenxa yeemeko ezinjenge-arthritis. Intlungu yesisu ngumqondiso oqhelekileyo ochaphazela abantu babo bonke ubudala. Ikwaqala kwakhona ngokukhawuleza okanye ithuthuke ngokuthe ngcembe kwexesha, ukuqala njengentlungu emncinci okanye ngokuthe ngcipheko ngokunyuka ngokukhawuleza njengoko ixesha liqhubeka. Ngaphezu koko, ukunyamezela kunokwandisa ingozi yamadolo. Injongo yale nqaku ilandelayo kukuxubusha ukuvavanywa kwezigulane ezenza ubuhlungu beentolo kwaye zibonise ukuxilongwa kwazo ngokwahlukileyo.

Abstract

Intlungu yamadolo sisikhalazo esiqhelekileyo sokubonisa ngezizathu ezininzi ezinokubangela. Ukwaziswa kweepateni ezithile kunokunceda ugqirha wosapho ukuba abone oyena nobangela ngokufanelekileyo. Amantombazana akwishumi elivisayo kunye nabasetyhini abasebancinci kunokwenzeka ukuba babe neengxaki zokulandela umkhondo njenge patellar subluxation kunye ne patellofemoral syndrome, ngelixa amakhwenkwe akwishumi elivisayo kunye nabafana abancinci banamathuba okuba neengxaki zedolo ezifana ne-tibial apophysitis (i-Osgood-Schlatter lesion) kunye ne-patellar tendonitis . Iintlungu ezichaziweyo ezibangelwa kukudumba okuhlangeneyo, njengokutsalwa kwemali eyinkunzi epiphysis, nayo inokubangela iintlungu emadolweni. Izigulana ezisebenzayo kunokwenzeka ukuba zibe ne-ligamentous sprains kunye nokulimala kakhulu okufana ne-pes anserine bursitis kunye ne-medial plica syndrome. Umothuko unokubangela ukophuka okuqatha okanye ukuqhekeka, okukhokelela kukudumba ngokudibeneyo kunye ne-hemarthrosis. I-Septic arthritis inokukhula kwizigulana zanoma yiphina iminyaka, kodwa i-arthropathy yokunyanzeliswa kwe-crystal inokwenzeka kubantu abadala. I-Osteoarthritis yedolo elihlangeneyo liqhelekile kubantu abadala. (NdinguGqirha weNdawo u-2003; 68: 917-22. Ilungelo lokushicilela ngo-2003 iAmerican Academy yoGqirha boSapho.)

intshayelelo

Ukugqiba isizathu esisisiseko sentlungu yamadolo kunokuba nzima, inxalenye ngenxa yokuxilongwa okubanzi kokuhlukana. Njengoko kuxutyushwa kwinxalenye I yale nqaku yamacandelo amabini, i-1 ugqirha wentsapho kufuneka aqhelane ne-knee anatomy kunye neendlela eziqhelekileyo zokulimala, kunye nembali ecacileyo kunye nokuhlolwa okugxilwe ngokomzimba kunokunciphisa izizathu ezinokwenzeka. Ubudala besigulane kunye nendawo ye-anatomic yentlungu zizinto ezimbini ezinokubaluleka ekufezekiseni ukuxilongwa ngokuchanekileyo (Iitheyibhile 1 kunye ne-2). �

Itheyibhile 1 Izizathu eziqhelekileyo zokuBamba Knee

Abantwana kunye nentsha

Abantwana kunye nabaselula abasondela ngeentlungu zedolo banokuba neemeko ezintathu eziqhelekileyo: i-patellar subluxation, tibial apophysitis, okanye i-patellar tendonitis. Ukuxilongwa okongeziweyo kokuqwalasela kubantwana kubandakanya ukunyusa i-epiphysis ye-femoral kunye ne-septic arthritis.

I-Patellar Subluxation

I-Patellar subluxation yinkcazo ebonakalayo kwintombazana ekhulayo eyenza ngeendlela zokunika i-knee .2 Oku kwenzakala kubangelwa kaninzi kumantombazana kunye nabasetyhini abancinci ngenxa yokwanda kwe-quadriceps (i-angle engama-Q), ngokuqhelekileyo kunamadrikhi e-15.

Ukukhathazeka kwe-Patellar kuyanqunyulwa ngokuxhomekeka kwe-patella kamva, kwaye kudla ngokukhawuleza. Ukuqhaqha kwamadolo okuxinayo kungabonakalisa i-hemarthrosis, ebonisa ukuba i-patellar ichithwa kunye ne-osteochondral fracture kunye negazi.

Tibial Apophysitis

Umfana osemncinci oveza ubuhlungu bendoda engama-knee kwi-tibial tuberosity kungenzeka ukuba abe ne-tibial apophysitis okanye i-Osgood -Sillatter lesion3,4 (umfanekiso we1) .5 Umguli oqhelekileyo ungumfana we-13 okanye we-14 ubudala (okanye i-10- okanye intombazana eneminyaka eyi-11) esandula ukuhamba ngokukhula.

Isigulane esine-tibial apophysitis sichaza ngokubanzi ukuxutywa kunye nokuncipha kweentlungu zedolo ixesha leenyanga. Iintlungu ziba mandundu xa u-squatting, ukunyuka okanye ukuhla izinyuko, okanye ukufinyaniswa okunamandla kwezihlunu ze-quadriceps. Le apophysitis yokusetyenziswa ngokugqithiseleyo igqithiswa ngokuxhuma kunye nokuphosa ngenxa yokuba ukuhlalisa okuphindaphindiweyo kubeka uxinzelelo olugqithisileyo ekufakweni kwe-tendon patellar.

Ekuhlolweni komzimba, i-tuberosity ye-tibial ithenda kwaye idumbile kwaye inokufudumala. Iintlungu zedolo ziveliswa kwakhona kunye nokwandiswa okusebenzayo okuchasayo okanye i-hyperflexion ye-passive yamadolo. Akukho nto ikhoyo. Iiradiographs zidla ngokuba zi-negative; ngokungaqhelekanga, babonisa ukuvuswa kwe-apophysis kwi-tuberosity ye-tibial. Nangona kunjalo, ugqirha akafanele enze iphutha ukubonakala okuqhelekileyo kwe-tibial apophysis yokuphuka kwe-avulsion. �

Uluhlu lwe-2 Ukuchongwa okuhlukeneyo kwe-Knee Pain

Umzobo we-1 Umbono wangaphambili weZakhiwo ze-Knee

Patellar Tendonitis

Idolo leJumper (ukucaphuka kunye nokudumba kwetellar tendon) kuxhaphake kakhulu kubafana abakwishumi elivisayo, ngakumbi ngexesha lokukhula2 (Umzobo 1) .5 Isigulana sinika ingxelo engacacanga yentlungu engaphandle yedolo eqhubekeke iinyanga kwaye iba mandundu emva kwemisebenzi efana nokuhamba phantsi izitepsi okanye ukubaleka.

Kuhlolisiso lomzimba, ithenda ye-patellar ithenda, kwaye intlungu iveliswa ngokunyuswa kwamadolo. Ngokuqhelekileyo akukho nkunkuma. Iidrafrafikhi azibonakalwanga.

I-Slipped Capital Femoral Epiphysis

Iimeko ezininzi zezilwanyana zibangelwa ukuthunyelwa kwentlungu emadolweni. Ngokomzekelo, ukutsalwa kwe-epiphysis ye-capital femel kufuneka iqwalaselwe kubantwana nakwishumi elivisayo elinobuhlungu bexolo.6 Isigulane esinalo meko sihlala sichaza ubuhlungu bendoda engendawo kwaye akukho mlando wexinzelelo.

Isigulane esifana nesigxina esiphezulu se-epiphysis ye-femor isaphezu komzimba kwaye ihleli kwitafile yeemviwo kunye ne-hip echaphazelekayo iguquguquke kwaye ijikeleze ngaphandle. Ukuhlolwa kweedolo kuyinto eqhelekileyo, kodwa intlungu ye-hip isenziwa ngokujikeleza kwangaphakathi okanye ukongezwa kwe-hip echaphazelekayo.

Ii-radiographs zibonisa ukufuduka kwe-Epiphysis ye-head head. Nangona kunjalo, i-radiographs engakhiyo ilawule ukuxilongwa kwezigulane ezinokufumana iziphumo zonyango. Ukukhangela kwe-tomuted (CT) ekhompyutheni kuboniswa kwezi zi gulane.

Osteochondritis Dissecans

I-Osteochondritis dissecans yinto e-articular osteochondrosis ye-etiology engaziwayo ebonakala ngokutshabalalisa nokuhlaziywa kwe-articalular cartilage kunye namathambo angaphantsi. Kwidolo, i-condyle ye-femoral ixhaphake kakhulu.7

Isigulane sibika iingcamango ezingaqhelekanga, ubuhlungu bendoda engendawo, kunye nokuqina kokusa okanye ukuchithwa okuphindaphindiweyo. Ukuba umzimba ovulekileyo ukhona, iimpawu zokungena okanye ukubamba ixolo kunye nazo zingabikwa. Ekuhloleni ngokomzimba, isigulane sinokubonisa i-quadriceps i-atrophy okanye isisa kunye ne-chondral ebandakanyekayo. Umonakalo odibeneyo onokubakho ungaba khona.7

I-radiographs ye-Plain-film ingabonisa isilonda se-osteochondral okanye umzimba okhululekile kwi-joint joint. Ukuba i-osteochondritis dissecans iyakrokrelwa, ii-radiographs ezicetyiswayo ziquka i-anteroposterior, itonela ye-posteroanterior, i-lateral, kunye neembono zoMrhwebi. Izilonda ze-Osteochondral kwi-lateral ye-condyle ye-femoral ephakathi zinokubonakala kuphela kwi-postteroanterior tunnel view. I-Magnetic resonance imaging (MRI) inovakalelo oluphezulu ekuboneni ezi zinto zingaqhelekanga kwaye iboniswa kwizigulane ezine-lesion osteochondral ekrokrelekayo.7 �

UDkt Jimenez White Coat

Ukulimala kwamadolo okubangelwa ukulimala kwezemidlalo, izingozi zeemoto, okanye imeko ephantsi, phakathi kwezinye izizathu, kunokuchaphazela i-cartilage, i-tendon kunye nemigqa edibanisa idolo. Indawo yokudabuka kwamadolo ahluke ngohlobo lwesakhiwo esithintekayo, kwakhona, iimpawu ziyahluka. Amadolo onke angaba buhlungu kwaye avuvuke ngenxa yokuvuvukala okanye usulelo, kanti i-meniscus okanye i-fracture eqhekekileyo ingabangela iimpawu kwiindawo ezichaphazelekayo. UDkt Alex Jimenez DC, i-CCST Insight

abadala

Ukusetyenziswa kweSyncromes

Interior Knee Pain. Izigulana ezine-patellofemoral pain syndrome (i-chondromalacia patellae) zihlala zinembali engacacanga yokuqaqanjelwa ngamadolo okuqala ukuya kumodareyitha okuhlala kwenzeka emva kwexesha elide lokuhlala (oko kubizwa ngokuba yi- theater sign ) .8 Patellofemoral pain syndrome sisizathu esiqhelekileyo iintlungu zangaphambili zamadolo kubafazi.

Kuvavanyo lomzimba, ukunganyanzeliswa okuncinci kunokuba khona, kunye ne-patellar crepitus kuluhlu lokuhamba. Intlungu yesigulana inokuphinda iveliswe ngokufaka uxinzelelo ngokuthe ngqo kumbonakalo wangaphandle wepatella. I-Patellar tenderness inokuphakanyiswa ngokufaka i-patella ngaphakathi okanye emva kwexesha kwaye iphakamise amanqaku aphezulu kunye nephantsi kwepatella. Radiographs zihlala zingaboniswanga.

Ubuhlungu Bomzimba Ophakathi. Enye into ehlala igujulwa ngayo i-plica syndrome. I-plica, i-redundancy ye-synovium edibeneyo, iyakwazi ukutshatyalaliswa ngokuphindaphindiweyo.4,9 Isigulane sibonisa ukuqala kabuhlungu kwintlungu yokuguqula idolo emva kokunyuka okuphawulekayo kwimisebenzi eqhelekileyo. Kuhlolisiso lomzimba, ithenda, ukuxhaswa kweselula kufumaneke kwimiba emxhatshazo emadolweni, nje kumgca kumgca odibeneyo. Akukho mveliso ehlangeneyo, kwaye isisele se-knee uvavanyo luqhelekile. Iidrafrafikhi azibonakalwanga.

I-Pes anserine bursitis ngomnye unobangela onokubakho wentlungu yedolo eliphakathi. Ukufakwa kwe-tendinous ye-sartorius, i-gracilis, kunye nemisipha ye-semitendinosus kwinqanaba le-anteromedial ye-proximal tibia yenza i-pes anserine bursa.9 I-bursa inokutsha ngenxa yokusetyenziswa ngokugqithiseleyo okanye ukuxhatshazwa ngokuthe ngqo. I-Pesânserine bursitis inokubhidaniswa ngokulula kunye ne-medial collateral ligament sprain okanye, ngokungaqhelekanga, i-osteoarthritis yecandelo eliphakathi kwedolo. �

Isigulane nge pes pes anserine bursitis sigxeka intlungu kwizinto eziphambene namadolo. Le ntlungu ingaba nzima ngakumbi ngokuphindaphindiweyo kunye nokwandiswa. Kuhlolisiso lomzimba, ububele bukhona kwimiba emxolweni yexolo, nje emva komda kwaye uphazamise kumgca odibeneyo ophakathi. Akukho ukuxubana kwamadolo okuhlangeneyo okukhoyo, kodwa kunokubakho ukuqhubela okuncane ekufakeni ukuxhamla kwemizimba. Ukuhlolwa koxinzelelo lwe-Valgus kwindawo ephakamileyo okanye ukuxhathisa ukuguqa kwamadolo kwisimo esifanelekileyo kunokuvelisa intlungu. Iidrafiografi ayidlalwa.

I-Lateral Pain Pain. Ukuqhaqhaqhaqhaqha phakathi kwebhodi yeliyobial kunye ne-condyle ye-femal yesikhokelo kungabangela i-tendonitis ye-band i-liyobial. I-9 Le syndrome engaphezulu kakhulu ivela kubagijimi nabaqhubi, nangona ingahlakulela kunoma yimuphi umntu emva komsebenzi obandakanya ukuphindaphinda kwamadolo. Ubunzima bebhanti ye-aliotibial, ukunyanyiswa kweenyawo ezininzi, i-genu varum, kunye ne-tibial torsion ziyizinto eziphambili.

Isigulane nge-tendonitis yebhanti ye-aliotibial ibika iingxwaba kwiindawo ezixhamlayo zexolo. Intlungu iqhutywe ngumsebenzi, ngokukodwa ukuhla kwehla kunye nokunyuka kwezitepsi. Kuhlolisiso lomzimba, ububele bukhona kwi-epicondyle ye-lateral ye-femur, malunga ne-3 cm ecaleni komgca odibeneyo. Ukuvuvukala kwamathambo kunye ne-crepitus kungabikho, kodwa akukho mveliso ehlangeneyo. Iidrafrafikhi azibonakalwanga.

Uvavanyo lweNoble lusetyenziselwa ukuvelisa kwakhona iintlungu kwi-iliotibial band tendonitis. Xa isigulana sikwindawo ethe tyaba, ugqirha ubeka ubhontsi phezu kwe-femoral epicondyle esecaleni njengoko isigulana siguquguquka ngokuphindaphindiweyo kwaye sandise idolo. Iimpawu zentlungu zihlala zibalaseleyo ngamadolo kwi-30 degrees of flexion.

I-popliteus tendonitis yinto ebangela ukuba ubuhlungu bendoda buxakeke. Nangona kunjalo, le meko ayinqabile.10

I ngxaki

I-Ligament yesiGaba esiPhakathi. Ukwenzakala kwimbumbulu yomphambili wangaphakathi kuhlala kwenzeka ngenxa yokungabikho koqhakamshelwano lokuncipha, njengaxa imbaleki ityala inyawo elinye kwaye ijikele kwelinye icala. Iziphumo zoxinzelelo lwevalgus emadolweni zikhokelela ekufudukeni kwangaphandle kwe-tibia kunye nokutsala okanye ukuqhekeka kwe-ligament.11 Isigulana sihlala sinika ingxelo yokuva okanye yokuziva i- pop ngexesha lokwenzakala kwaye kufuneka ayeke umsebenzi okanye ukhuphiswano kwangoko. Ukuvuvukala kwamadolo ngaphakathi kweeyure ezimbini emva kokulimala kubonisa ukuphuka kwe-ligament kunye ne-hemarthrosis elandelayo.

Ekuhloliseni ngokomzimba, isigulane sinomlinganiselo ochanekileyo wokuxuba ohlangeneyo owenza umda wokuhamba. Uvavanyo lwe-drawer yangaphakathi lunokuba luhle, kodwa lunokuba lubi ngenxa ye-hemarthrosis kunye nokulinda ngentshontsho. Uvavanyo lweLachman lufanele lube lukhuthaze kwaye lunokwethenjelwa kunokuba luvavanyo lwe-drawer yangaphambili (bona itekisi kunye nomfanekiso 3 inxalenye yendiqendu1).

Iidrafiographs ziboniswa ukuba zibone ukuphulwa komkhuhlane we-tibial. I-MRI yamadolo iboniswe njengenxalenye yolu vavanyo lwezonyango.

IsiLigamental Collateral Ligament. Ukulimala kwi-ligament ye-collateral ligament ngokuqhelekileyo kwaye ngokuqhelekileyo kubangelwa yintlungu. Isigulane sichaza ukugqithisa okanye ukudibanisa okubeka uxinzelelo lwe-valgus emadolweni, olulandelwa kukuqala kwentlungu kunye nokuvuvukala kwimpembelelo yexolo.11

Ekuhlolweni komzimba, isigulane esine-medial collateral ligament ukulimala sinophawu lwethenda kumgca we-medial joint. Uvavanyo loxinzelelo lwe-Valgus lwamadolo oluguquguqukayo ukuya kwii-degrees ze-30 luvelisa intlungu (jonga isicatshulwa kunye nomfanekiso we-4 inxalenye yeli nqaku1). Isiphelo esicacileyo esicacileyo sovavanyo loxinzelelo lwe-valgus lubonisa ibakala 1� okanye i-2 sprain, ngelixa ukungazinzi okupheleleyo kwe-medial kubonisa ukuphuka okupheleleyo kwe-ligament (i-grade 3 sprain).

I-Ligament Ligamental Collateral. Ukulimala kwe-ligal colalateral ligament ayifani ngokuqhelekileyo kunobungozi be-collateral ligament. I-latalal collateral ligament ixhomekeke kwimpembelelo ye-varus ukuya emadolweni, njengokuba kwenzeka xa umgijimi enyantya enye inyawo aze aphendukele kwi-knee ehambayo .2 Isigulane sichaza ngokuqaqambile kwintlungu yomzimba efuna ukuphelelwa komsebenzi ngokukhawuleza.

Ekuhloliseni ngokomzimba, ixabiso lentetho likhoyo kumgca wokudibanisa. Ukukhubazeka okanye intlungu kuqhutyelwa uvavanyo lwe-varus lokuxilongwa kwegolo oluguquguqukayo kwii-30 degrees (bona itekisi kunye ne-4 kwiNgxenye yeli nqaku1). Ii-radiographs aziqhelekanga kubonisiwe.

I-Meniscal Tear. I-meniscus inokutshatyalaliswa ngokukhawuleza kokulimala kwamadolo, njengokuba kunokuthi kwenzeke xa umgijimi eguquka ngokukhawuleza. I-11,12 Meniscal iinyembezi nazo zinokuthi zenzeke ngokubambisana nenkqubo yokuchitha ixesha elide, ngokukodwa kwisigulane esinomdla ongaphaya kwegciwane. idolo. Isigulane sivame ukubika ubuhlungu bentolo ephindaphindiweyo kunye neengqungquthela zokubamba okanye ukuvalela emadolweni, ngokukodwa ngokukrazula okanye ukuguqulwa kwamadolo.

Kuhlolisiso lomzimba, ukuxhatshaza okucothayo kubakho, kwaye kukho ububele kumgca odibeneyo okanye ohlangeneyo. I-Atrophy ye-vastus medialis obliquus isahlulo se-quadriceps muscle nayo inokubonakala. Uvavanyo lukaMcMurray lunokuba luhle (jonga umfanekiso we-5 kwinxalenye yendi nqaku1), kodwa ukuvavanywa kakubi akupheli ithuba lokulila.

I-radiographs ye-Plain-radiographs ngokuvamile ayibi kwaye ayifumaneki ngokucacileyo. I-MRI yiyo vavanyo lwe-radiologic olukhethiweyo kuba lubonisa iintlungu ezininzi ezibonakalayo.

Sulelo

Usulelo lwedolo lunokuthi lwenzeke kwizigulana nabuphi na ubudala kodwa luxhaphake ngakumbi kwabo amajoni omzimba abuthathaka ngenxa yomhlaza, isifo seswekile, ukunxila, “i-acquired immunodeficiency syndrome, okanye unyango lwe-corticosteroid. Isigulana esine-septic arthritis sibika ngokukhawuleza iintlungu kunye nokuvuvukala kwedolo ngaphandle kwe-antecedent trauma.13

Ekuhloleni ngokomzimba, idolo lifudumala, liyathukuthela, kwaye lithemba kakhulu. Nokuba ukunyuswa okufutshane kwendoda kubangele ubuhlungu obukhulu.

IArthrocentesis ityhila i-turbid synovial fluid. Uhlalutyo lolwelo luvelisa inani leeseli ezimhlophe zegazi (i-WBC) ngaphezulu kwama-50,000 nge-mm3 (50? 109 nge-L), ngaphezulu kwe-75 yeepesenti (0.75) iiseli zepolymorphonuclear, umxholo weprotheni ophakamileyo (ngaphezulu kwe-3 g nge-dL [30 g nge-L]), kunye noxinaniso lweswekile esezantsi (ngaphezulu kweepesenti ezingama-50 ezantsi kune-serum glucose concentration). Izifo eziqhelekileyo zibandakanya i-Staphylococcus aureus, iintlobo ze-Streptococcus, i-Haemophilus influenza kunye ne-Neisseria gonorrhoeae.

Ucwaningo lwe-Hematologic lubonisa i-WBC ephakamileyo, inani elinyukayo lamaseli e-polymoronekliya angaphantsi (okt, ukutshintshwa kwesobunxele), kunye ne-elethrocyte ye-sedimentation yezinga eliphezulu (ngokuqhelekileyo likhulu kune-50 mm ngeyure).

Abadala abadala

Osteoarthritis

I-osteoarthritis yexolo elidityanisiweyo yingxaki efanayo emva kweminyaka eyi-60. Isigulane sibonisa ubuhlungu besidolo esixhaswa yimisebenzi yokuthwala ubunzima kunye nokukhululeka ngokuphumla.15 Isigulane asikho iimpawu zenkqubo kodwa sivame ukuvusa ubunzima obusasaza obunokwenza umsebenzi othile. Ukongezelela kokuqina okungapheliyo kunye nentlungu, isigulane singabika iziqendu ze synovitis.

Iziphumo ekuhloliseni ngokomzimba ziquka ukuhla kweendonga zokunyakaza, i-crepitus, ukuchithwa okubambileyo kunye neenguqu ze-osteophytic ezitshintshiweyo emadolweni.

Xa i-osteoarthritis irhanelwa, ii-radiographs ezicetyiswayo ziquka i-anteroposterior kunye neembono ze-tunnel ze-posteroanterior, kunye nabathengisi abangenabunzima kunye neembono zecala. Iiradiographs zibonisa ukuncipha kwendawo edibeneyo, i-subchondral bony sclerosis, utshintsho lwe-cystic, kunye nokwakheka kwe-hypertrophic osteophyte.

I-Crystal-Impuced Inflammatory Arthropathy

Ukuqhaqhazela, intlungu kunye nokuvuvukala ekungabikho kwexinzelelo kubonisa ukuba kungenzeka ukunyuka kwe-crystal -ducedduced inflammatory arthropathy efana ne-gout okanye i-pseudogout.16,17 Gout ixhaphaza kakhulu idolo. Kule ngqungquthela, i-sodium urate crystals iyancipha kwi-knee kunye kwaye ibangela impendulo evuzayo. Kwi-pseudogout, i-calcium pyrophosphate crystals yi-agent engumzekelo.

Ekuhloliseni ngokomzimba, idolo elihlangeneyo lithengeleka, lifudumala, lithenda, kwaye livuvuka. Nangona uluhlu oluncinane lokunyakaza lubuhlungu kakhulu.

I-Arthrocentesis ityhila ulwelo olucacileyo okanye olunamafu kancinci. Uhlalutyo lolwelo luvelisa inani le-WBC lama-2,000 75,000 ukuya kuma-3 nge-mm2 (75 ukuya kwi-109? 32 nge-L), umxholo ophezulu weprotheni (ngaphezulu kwama-320 g nge-dL nganye (i-75 g nge-L]), kunye ne-glucose concentration Iipesenti ezingama-14 ze-serum glucose kugxininiso.XNUMX I-microscopy ekhanyayo ye-synovial fluid ibonisa iintonga ezinobungozi ezimbi kwisigulana esine-gout kunye ne-rhomboids eyi-birefringent ngokuqinisekileyo kwisigulana esine-pseudogout.

Popliteal Cyst

I-cyst popliteal cyst (Baker's cyst) yeyona cynovial cyst ixhaphakileyo edolweni. Ivela kwinqanaba lokudibana kwamadolo kwinqanaba le-gastrocnemio-semimembranous bursa. Isigulana sichaza ukuqala okunganyamezelekiyo kwintlungu ethambileyo ukuya kumodareyitha kwindawo epliteal yasedolweni.

Kuhlolisiso lomzimba, ukuzaliseka okubonakalayo kubakho kwimimandla ephakathi kwendawo ye-popliteal, okanye kufuphi nemvelaphi yintloko yentloko ye-gastrocnemius muscle. Uvavanyo lukaMcMurray lunokuthi lube lukhuthaze ukuba i-meniscus yenzelwa ingozi. Ukuxilongwa okucacileyo kwe-cyst popititis kungenziwa nge-arthrography, i-ultrasonography, i-CT, okanye i-MRI.

Ababhali babonisa ukuba abanalo iimbambano zomdla. Imithombo yenkxaso: ayikho ingxelo.

Ekugqibeleni, nangona idolo lihlangene kakhulu emzimbeni womntu apho kuhlanganiswe khona izakhiwo zamagqabi angaphantsi, kuquka i-femur, i-tibia, i-patella kunye nezinye izicubu ezincinci, idolo lingakwazi ukulimala okanye ukulimala kwaye buhlungu. Intlungu yesisu yenye yezona zikhalazo eziqhelekileyo phakathi koluntu jikelele, nangona kunjalo, ngokuqhelekileyo kubonakala kubadlali. Ukulimala kwezemidlalo, izingozi ze-slip-and-falling, kunye neengozi zezimoto, phakathi kwezinye izizathu, kunokukhokelela ekubuhlungu kweendolo.

Njengoko kuchazwe kwinqaku elingentla, ukuxilongwa kubalulekile ekunqumeni indlela yonyango engcono kakhulu yokulimala kwamadolo, ngokwezizathu zabo. Nangona indawo kunye nobukhulu bokulimala kwamadolo kunokuhluka ngokuxhomekeka kwisizathu somcimbi wezempilo, iintlungu zedolo ziyimpawu eziqhelekileyo. Izinketho zonyango, ezifana nokunyamekela kwe-chiropractic kunye nonyango lomzimba, lunokunceda ukunyanga iintlungu zamadolo. Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nemiba yempilo yomgogodla. Ukuxoxa ngalo mbandela, nceda uzive ukhululekile ukubuza uGqr. Jimenez okanye uqhagamshelane nathi apha915-850-0900 .

Ikhethwe nguGqirha Alex Jimenez

Ikholi ye-Green Call Now Button H .png

Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa

Intlungu yedolo luphawu olwaziwayo olunokuthi lwenzeke ngenxa yeengozi zamadolo kunye / okanye iimeko, kubandakanya ukulimala kwezemidlalo. Amadolo ngenye yezona zinto ezinzima kakhulu emzimbeni womntu njengoko zenziwe yintlupheko yamathambo amane, iigamente ezine, iintlobo ezihlukahlukeneyo, i-menisci emibini, kunye ne-cartilage. Ngokwe-American Academy ye-Family Physicians, izizathu eziqhelekileyo zokubandezeleka kwamadolo zibandakanya i-patellar subluxation, i-patellar tendinitis okanye i-jumper, kunye ne-Osgood-Schlatter. Nangona ubuhlungu beentolo buya kwenzeka kubantu abantu abangaphezu kwe-60 ubudala, ubuhlungu beendolo buya kwenzeka kubantwana nakwishumi elivisayo. Iintlungu zesisu zingaphathwa ekhaya emva kweendlela ze-RICE, nangona kunjalo, ukulimala kwamadolo amakhulu kunokufuna ukunyangwa kwangoko kunyango, kubandakanya ukunakekelwa kwe-chiropractic.

umfanekiso weblogi wekratshi yephepha

I-EXTRA EXTRA | INGXELO EBALULEKILEYO: El Paso, TX I-Chiropractor Kunconywe

Ngenanto
Ucaphulo
1. I-Calmbach WL, i-Hutchens M. Ukuvavanywa kwezigulane ezibonisa ubuhlungu beendolo: inxalenye I. Imbali, uvavanyo lweemvelo, i-radiographs, kunye neemvavanyo zelabhoratri. U-Fam Famician 2003; 68: 907-12.
2. UWalsh WM. Ukulimala kwamadolo. Ku: Imvukelo MB, iWalsh WM, uShelton GL, ii-eds. Incwadi yesandla yegqirha. 2 ed. I-St. Louis: Mosby, 1990: 554-78.
3. Dunn JF. Isifo se-Osgood-Schlatter. I-Fam Fam I-1990; 41: 173-6.
4. Stanitski CL. Iimpawu zokuguquka kwamadolo ezidlulileyo kumntwana. I-Instr Course I-1994; 43: 211-20.
5. I-Tandeter HB, uShvartzman P, uStevens MA. Ukuxhatshazwa kwamadolo ngokuchanekileyo: ukusebenzisa izigqibo zomthetho wokwenza i-radiograph ekhethiweyo. U-Fam Famician 1999; 60: 2599-608.
6. Amanzi PM, iMillis MB. Ukulimala kwe-Hip kunye ne-pelvic kumdlali omncinci. Ku: DeLee J, Drez D, Stanitski CL, eds. Amachiza ezemidlalo yama-Orthopedic: imigaqo kunye nokusebenza. Vol. III. Iyeza zonyango kunye nemidlalo yaselula. Philadelphia: Saunders, 1994: 279-93.
7. Schenck RC Jr, Goodnight JM. I-Osteochondritis. I-Bone Joint Surg [Am] 1996; 78: 439-56.
8. I-Ruffin MT 5th, iKiningham RB. Ubuhlungu beendolo zangaphambili: umngeni we-patellofemoral syndrome. U-Fam Famician 1993; 47: 185-94.
9. Cox JS, iBolanda JB. Iiperipatellar pathologies. Ku: DeLee J, Drez D, Stanitski CL, eds. Amachiza ezemidlalo yama-Orthopedic: imigaqo kunye nokusebenza. Vol. III. Iyeza zonyango kunye nemidlalo yaselula. Philadelphia: Saunders, 1994: 1249-60.
10. I-Petsche TS, uSelesnick FH. I-popliteus tendinitis: iingcebiso zokuxilonga nokuphathwa. I-Phys Sportsmed 2002; 30 (8): 27-31.
11. Micheli LJ, Foster TE. Ukulimala kwamadolo asemacaleni kumdlali okhulayo. I-Instr Course I-1993; 42: 473- 80.
12. Smith BW, iGreen GA. Ukulimala kwamadolo: Iqendu II. Ukuxilongwa nokuphathwa. U-Fam Famician 1995; 51: 799-806.
13. UMcCune WJ, i-Golbus J. I-arthritis. Ku: Kelley WN, ed. Umbhalo we-rheumatology. 5th ed. Philadelphia: Saunders, 1997: 371-80.
14. I-Franks AG Jr. Iinkalo zeRheumatologic zamadolo ezilahlayo. Ku: Scott WN, ed. Idolo. St. Louis: Mosby, 1994: 315-29.
15. Brandt KD. Ulawulo lwe-osteoarthritis. Ku: UKelen WN, ed. Umbhalo we-rheumatology. 5th ed. Philadelphia: Saunders, 1997: 1394-403.
16. UKelley WN, uWortmann RL. I-syn-ovitis ehlobene neCriststal. Ku: Kelley WN, ed. Iincwadi zeRheumatolism. 5th ed. Philadelphia: Saunders, 1997: 1313- 51. 1
7. Reginato AJ, Reginato AM. Izifo ezinxulumene nokuthunyelwa kwe-calcium pyrophosphate okanye i-hy- droxyapatite. Ku: Kelley WN, ed. Umbhalo we-rheumatology. 5th ed. Philadelphia: Saunders, 1997: 1352-67.
Vala i-Accordion
I-Arthritis ye-Knee: Ukujonga ukujonga ukujonga I-I El Paso, TX.

I-Arthritis ye-Knee: Ukujonga ukujonga ukujonga I-I El Paso, TX.

by | Arthritis, Ukujonga kunye nokuchonga

I-Degenerative Knee Arthritis

  • Knee Arthritis
  • I-Knee OA (arthrosis) yi-m / c yempawu ye-OA enamatyala angama-240 nge-100,000, i-12.5% ​​yabantu> 45 yo
  • Izinto ezinobungozi ezinokuguqulwa: ukuxhwaleka, ukukhuluphala, ukungabikho komzimba, ubuthathaka obuthathaka
  • Ukungaguquguquki: abasetyhini> amadoda, ukwaluphala, ufuzo, ubuhlanga / ubuhlanga
  • I-Pathology: sisifo se-articular cartilage. Ukuqhubela phambili ukuvuselela oomatshini kulandela ukwanda kokuqala kwamanzi kunye nobukhulu be-cartilage. Ukulahleka ngokuthe ngcembe kweeproteoglycans kunye nezinto zomhlaba. Ukuqhawula/ukwahlula. I-Chondrocytes yonakaliswe kwaye ikhulule i-enzymes kwi-joint. Ukuqhubela phambili kwe-Cystic kunye nokulahleka kwe-cartilage ngakumbi. Ithambo le-subchondral likhutshiwe kwaye libonakaliswe kuxinzelelo lomatshini. Iba yi-hypervascular forming osteophytes. I-Subchondral cysts kunye nokuqina kwethambo / i-sclerosis ikhula.
  • Ukucinga kudlala indima ebalulekileyo kwiDx / ukulinganisa kunye nokulawula
  • Klinikhi: intlungu ekuhambeni / ukuphumla, i-crepitus, ukuvuvukala d / t synovitis, ukutshixa / ukubamba i-d / t i-osseocartilaginous fragments kunye nokulahleka komsebenzi ngokuthe ngcembe. I-Knee OA ibonakala njenge-mono kunye ne-oligoarthritis. I-DDx: intlungu yasekuseni / ukuqina ngu> 30-min DDx kwi-arthritis evuthayo
  • Unyango: kwiimeko ezincinci ukuya kweziphakathi-ukhathalelo lolondolozo. I-OA enzima ye-knee arthroplasty

I-OA: I-LOSS Radiologic Presentation

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Unikezelo lweradiyologic-pathologic ye-OA: Ilahleko
  • Ukulahlekelwa kwendawo edibeneyo (engeyiyo ifom
  • Osteophytes
  • Subchondral sclerosis
  • Iigqithana zee-subchondral
  • Ukukhubazeka kweThambo: I-Genu Varum- yi-m / c deformity d /
  • Ukongeza: ukuncipha kwezicubu ezithambileyo ze-periarticular, ukungazinzi kunye nolunye utshintsho

Ukucinga

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Imifanekiso yezobugcisa yindlela yokukhetha
  • Imibono kufuneka ifake ib / l lithwala ubunzima
  • Ukuvavanywa kwendawo edibeneyo kubalulekile. Indawo edibeneyo -3-mm
  • Ukulinganisa kusekelwe kwinqanaba le-joint joint (JSN), i-osteophytes, i-deformation de bone, njl.
  • Bakala 1: i-JSN encinci, i-osteophyte
  • Bakala 2: i-osteophyte kunye ne-JSN kwi-AP yokujonga ubunzima
  • Bakala 3: ii-osteophyte ezininzi, i-JSN ecacileyo, i-subchondral sclerosis
  • Bakala 4: I-JSN enamandla, i-osteophyte ephezulu, ibhalwe i-subchondral sclerosis kunye ne-bony deformity
  • Ulwimi lwengxelo oluqhelekileyo luya kuthi:
  • Umncinci, onobubele, onomodareyitha okanye onamandla ongu-arthrosis

ubuchule

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Imifanekiso-mboleko: Amadolo okuthwala i-AP: inqaku elincinci leJSN yecala lokudibanisa elingakumbi kunye negumbi lokuxotshwa kwamadolo. I-osteophytes kwaye ibonakaliswe i-genu varum deformity ne-deformation de bone
  • Ngokwesiqhelo i-medial femorotibial compartment ichaphazeleka kwangethuba kwaye ngokuqatha
  • I-patellofemoral compartment iphinda ichaphazeleke kwaye ibonakaliswe kakuhle kwimibono ye-lateral kunye ne-Sunrise
  • Impressions: i-tri-compartmental knee arthrosis
  • Iingcebiso: ukuhanjiswa kumgqirha wamazinyo

JSN efanelekileyo

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • I-B/L ye-AP yokujonga ubunzima (phezulu komfanekiso ophezulu): I-Moderate ye-JSN ngokuyinhloko ye-medial femorotibial compartment. I-Osteophytosis, i-subchondral sclerosis kunye ne-mild bone deformation (i-genu varum)
  • Iimpawu ezongezelelweyo: I-PF OA, i-osteophytes ye-intra-articular, imizimba ye-osteocartilaginous ekhululekileyo yesibini kunye ne-subchondral cysts (ngaphezulu kweentolo)

Osteochondromatosis yesibini

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • I-Intra-articular osteocartilaginous imizimba ekhululekileyo eyaziwa ngokuba yi-osteochondromatosis yesibini
  • Okuqhelekileyo kwi-DJD ngokukodwa ngamalungu amaninzi
  • Inokukhawulezisa ukutshabalalisa i-cartilage kunye nokuqhubela phambili kwe-OA
  • Iimpawu ezinokuba zibi kakhulu ze synovitis
  • Ukuvalela kwe-intra-articular, ukubamba

Ulawulo lwe-Knee OA enamandla

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Unonophelo lokugcinwa kwe-Conservative: i-NSAID, umzimba, ukulahleka kwesisindo njl
  • Ukunyamekela komsebenzi kufuneka kusetyenziswe ukuba unonophelo olungapheliyo aluphumelelanga okanye iimpawu ziyaqhubeka nangona imizamo ekhuselekileyo kwiimeko ze-OA ezinzima
  • Ukuphononongwa kwinqaku
  • www.aafp.org/afp/2018/0415/p523.html

I-Calcium Pyrophosphate I-Dehydrate Deposition Disease

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • I-CPPD i-arthropathy eqhelekileyo emadolweni
  • Inokubonisa njenge-asymptomatic chondrocalcinosis, i-CPPD arthropathy efana ne-DJD kunye ne-pan predominance yama-cysts amakhulu angaphantsi. Ihlala ifunyanwa njenge-PFJ DJD ekwanti
  • I-pseudogout enohlaselo oluqatha lweentlungu zedolo ezifana ne-gouty arthritis
  • Izahlulo-mfanekiso yinyathelo le-1st kwaye ihlala iveza iDx
  • I-Arthrocentesis ene-polarized microscopy inokuba luncedo kwi-DDx phakathi kwe-CPPD kunye ne-Gouty arthritis

Irheumatoid arthritis

  • I-RA: isifo sokuvuvukala kwenkqubo ye-autoimmune esijolise kwizicubu ezithambileyo zamalungu e-synovium, i-tendon / ligaments, i-bursae kunye neendawo ezingaphezulu kwe-articular (umzekelo, amehlo, imiphunga, inkqubo ye-cardiovascular system)
  • I-RA yi-m / c i-arthritis evuthayo, i-3% yabasetyhini kunye ne-1% yamadoda. Ubudala: 30-50 F> M 3: 1, kodwa inokukhula nangaliphi na ixesha. I-RA yokwenyani ayiqhelekanga ebantwaneni kwaye akufuneki ibhidaniswe neJuvenile Idiopathic Arthritis
  • I-RA ihlala ichaphazela amalungu amancinci ezandla kunye neenyawo njenge-symmetrical arthritis (i-2nd 3rd MCP, i-3rd PIPs, izihlahla kunye nee-MTPs, igcina ii-DIP zeminwe neenzwane)
  • Ngezobugcisa: I-RA ibonakalisa ngokudibeneyo effusion ekhokelela kwi-hyperemia kunye ne-marginal erosions kunye ne-periarticular osteoporosis. Edolweni, i-lateral compartment ichaphazeleka ngokuphindaphindiweyo ngokukhokelela kwi-valgus deformity. Iyunifomu ye-aka concentric/symmetrical JSN ichaphazela onke amacandelo kwaye ihlala iyisitshixo se-Dx
  • Ukungabikho kwe-subchondral sclerosis kunye ne-osteophytes. I-Popliteal cyst�(i-cyst ka-Baker) inokumela i-synovial pannus kunye ne-synovitis evuthayo enwebeka kwingingqi ye-popliteal enokuthi ixwilwe kwaye yandiselwe kwi-posterior leg compartment.
  • I-NB Ukulandela ukutshabalaliswa okuhlangeneyo kwe-RA, akuqhelekanga ukuqaphela i-2nd OA ephakamileyo
  • I-Radiografi yinyathelo le-1st kodwa ukubandakanyeka kokuqala ngokubambisana kungabonakali ngo-x-ray kwaye kunokuncediswa yi-US kunye / okanye iMRI.
  • Iimvavanyo zeLab: RF, CRP, anti-cyclic citrulline peptide antibodies (anti-CCP Ab). I-CBC
  • I-Dx yokugqibela isekelwe kwi-Hx, uvavanyo lweklinikhi, iilebhu, kunye ne-radiology
  • Iiparele zonyango: izigulane ezine-RA zingabonisa ngegolo elinye elichaphazelekayo
  • Uninzi lwezigulane zinokuthi zibe nezandla / iinyawo ezilinganayo zomhlaba.
  • Umgudu wesibeletho, ngakumbi i-C1-2 ithinteke kwi-75-90% yamatyala ngexesha lonke lesi sifo
  • I-NB Ukunyanzeliswa ngokukhawuleza kwintlungu edibeneyo kwi-RA akufanelekanga ukunciphisa i-articritis ye-septic ngenxa yokuba izigulane ezine-RA ezandulele zihlala zingengozini enkulu yokugula. Iinjongo ezidibeneyo zinokunceda ngeDx.

Radiographic DDx

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • RA (ngasentla ngasekhohlo) kunye ne-OA (ngasentla)
  • RA: I-concentric (yunifomu) yokulahleka kwendawo yokudibana, ukungabikho kwe-osteophytes kunye ne-juxta-articular osteopenia.
  • Iiperile zeeKlinikhi: izigulane ezine-RA zingabonisa i-radiographically nge-subchondral sclerosis d / t i-DJD ephakamileyo. Inxalenye yokugqibela ayifanele iguqulelwe njenge-OA kodwa kunoko ithathwa njenge-OA yesibini

AP Knee Radiograph

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Qaphela ukuba i-JSN ifanelweyo, i-opiopenia ye-juxta-articular kunye neenguqulelo ze-subchondral cystic
  • Iiperile zeklinikhi: ii-subcortical cysts kwi-RA ziyakunqongophala umphetho we-sclerotic ophawulwe kwi-OA enxulumene ne-subcortical cysts.

Sensitivity

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • I-MRI ibuhlungu kakhulu kwaye inokunceda ngexesha lokuqala iDx ye-RA.
  • I-T2-fat-sitting okanye i-STIR kunye ne-T1 + C gad eyahlukileyo yokulandelana kwamanxeba anokucatshulwa
  • I-MRI Dx ye-RA: ukuvuvukala kwe-synovial / ukutshatyalaliswa, i-synovial hyperplasia, kunye nokwakheka kwe-pannus kunciphisa ubukhulu be-cartilage, i-subchondral cysts, kunye nokukhukuliseka kwamathambo
  • I-MRI iyanqabisa kakhulu ukutyhila i-somema ye-bone edrow, i-precursor to erosions
  • Iziqhekeza ze-fibrinoid ezibizwa nge-intra-articular ezibizwa ngokuthi "imizimba yamarandi" ziphawu loMM we-RA
  • Qaphela: i-T2 fat-sat sagittal MRI iveza ukudumba okukhulu kwamalungu kunye nokwanda kwe-pannus synovial (ngasentla kweentolo). Akukho bungqina be-radiographic okanye i-MRI ye-bone erosions ekhoyo. Dx: RA

I-STIR MR IiSlices

ugqirha we-arthritis ukunakekelwa kwe-chiropractic el paso tx.

 

  • Qaphela: I-STIR MR izilayi kwi-axial (phezulu komfanekiso ongezantsi) kunye neenqwelomoya ze-coronal (ngaphezulu komfanekiso ophezulu) zibonisa i-synovitis ebanzi / i-effusion (ngaphezu kweentloko zeentolo) kunye nokukhukuliseka okuphindaphindiweyo kwi-plateau ye-tibial ephakathi kunye ne-lateral (ngaphezulu kweentolo)
  • Ukongezelela, iindawo eziqhekekileyo zendawo yamathambo e-edema ziqatshelwe (ngaphezu kwe-asterisks) utshintsho lwemorrow edema lubonakaliso kunye nokuqikelela kwexesha elizayo lokungabikho kwemimoya.
  • Iinkcukacha ezongezelelweyo: inqaku elincinci kunye nokutshabalalisa i-cartilage

Knee Arthritis

 

Izikhalazo zeKnee: Indlela yokuFumanisa indlela yokujonga iziqu neNeeplasms

Izikhalazo zeKnee: Indlela yokuFumanisa indlela yokujonga iziqu neNeeplasms

by | Ukujonga kunye nokuchonga, Ukuhamba kunye nokuguquguquka

Iimpawu ze-Bone Neoplasms Izimo ezinjenge-Tumor

  • Iineoplasms zamathambo kunye neemeko ezinjenge-tumor ezichaphazelayo emadolweni inokuba buhlungu okanye ibe yingozi. Ubudala kwi-Dx bubalulekile kwi-DDx
  • Kwizigulana <40: I-Benign neoplasms yamathambo: I-Osteochondroma, i-Enchondroma zihlala ziqhelekile
  • Isiphene se-Fibrous cortical (FCD) kunye ne-non-ossifying fibroma (NOF) ikakhulu ikakhulu ebantwaneni
  • I-tumor enkulu ye-cell (GCT) yi-m / c ye-neoplasm ye-knee yegulane kwizigulane phakathi kwe-20-40 ubudala
  • Iimpawu ezinobungozi zamathambo <40: m / c Osteosarcoma kunye ne-2 m / c Ukutya i-sarcoma
  • Kwizigulane> i-40: i-neoplasms enobungozi: i-m / c i-secondary d/t bone metastasis. Ukonakala kwamathambo okuqala:�the m/c
  • IiMyeloma ezininzi (MM). Ngamaxesha amaninzi:�i-2nd�peak ye-Osteosarcoma (emva kokusasazeka kwemitha okanye iPaget), iFibrosarcoma okanye iMalignant�Fibrous�Histiocytoma�(MFH) yethambo.
  • Iiklinikhi: ubuhlungu beendolo, ukuphulwa kwesifo
  • Ezinye iimeko ezifana nethumba ezifana neFCD/Non-ossifying fibroma azibonakali kakuhle kwaye zinokuhlehla ngokuzenzekelayo. Ngamanye amaxesha i-NOF inokubonisa ngokuphuka kwe-pathologic. QAPHELA naziphi na iintlungu zedolo/amathambo emntwaneni/okwishumi elivisayo kufuneka �iphathwe ngokurhanelwa kwezonyango kwaye iphandwe ngokwaneleyo.
  • Ukucinga: I-1st inyathelo: i-radiography
  • I-MRI ene-T1 + C ibalulekile ekubonakalisweni kwesilonda / ubungakanani bengingqi, isiteji kunye nokucwangciswa kwangaphambili. I-CT inokunceda ekubhaqweni nge-pathologic Fxs. Ukuba i-neoplasms yamathambo enobungozi iqwalaselwa, i-CXR / CT, i-PET-CT yokuphanda ukusasazeka kwe-metastatic kunye nesiteji kubalulekile.

Ukucinga Ukusondela kweT Bone Neoplasms

  • Indlela yokujonga i-Dx yee-neoplasms zamathambo ibandakanya ubudala, indawo yethambo (i-epiphysis vs. metaphysis vs. diaphysis), indawo yenguqu ejikeleze isilonda, impendulo ye-periosteal, uhlobo lwe-matrix, i-permeating okanye i-nundu-etyiwa ukutshatyalaliswa vs. , njl.
  • Iimpawu eziphambili ze-x-radiography kwi-DDx enobungozi ngokuchasene ne-neoplasm yamathambo anobungozi:
  • Indawo yenguqu: isilonda yijografi esinezowuni emxinwa yotshintsho ngokuchasene.
  • Intoni uhlobo lokutshatyalaliswa kwethambo kwenzeka: ukubonakala kwe-sopha ngokubonakalayo kunye ne-osteolytic ne-osteosclerotic changes
  • Ingaba ikhona imatrix yeglasi engqukuva? Ngaba kukho umphetho ochazwe kakuhle womda we-sclerotic onokuthi uphakamise ukukhula okucothayo kunye ne-encapsulation njengeenkqubo ezininzi ezinobungozi.
  • Periosteal ukwanda: ngokuqinileyo ngokubhekiselele kwintlanzi / i-sunburst / iinwele-ekugqibeleni ekugqibeleni kunye neenxantathu ezithintekayo zendawo kunye neCodman triangle (funda isilayidi esilandelayo)
unyango ngamadolo enyango yonyango el paso tx.

I-FCD kunye neNOF

unyango ngamadolo enyango yonyango el paso tx.
  • I-FCD kunye neNOF okanye ngokufanelekileyo ngakumbi i-Fibroxanthoma yethambo ziinkqubo zamathambo ezinobungozi ezibonwa kubantwana. I-DDx esekelwe kubukhulu kunye ne-FCD ebonisa njenge <3-cm kunye ne-NOF> i-3cm isilonda esenziwe nge-fibrous heterogeneous matrix. I-FCD ayinazimpawu kwaye inokurhoxa kwiimeko ezininzi. Abanye banokuqhubela phambili kwi-NOF. Indawo: ichongiwe kummandla wamadolo njenge-eccentric cortical based lesion.
  • I-FCD kufuneka ibeyi-DDx kwi-avulsive irregularity d/t yoxinzelelo oluphindaphindiweyo ecaleni kwe-Linea aspera ngezihlunu ze-extensors
  • Dx: i-radiography
  • Ulawulo: inxeba lokushiya ndedwa. Ngamanye amaxesha i-NOF inokuqhubela phambili kwaye ikhokelele kwi-pathologic fracture efuna ukubonisana nodokotela wamathambo

Osteochondroma

unyango ngamadolo enyango yonyango el paso tx.
  • Osteochondroma: m/c neoplasm yethambo elibi. Idolo yindawo ye-m/c. Iqulethe zonke izinto zethambo kunye ne-cartilaginous cap. Ibonakaliswe njenge-pedunculated okanye i-sessile bone exostosis ekhomba kude nomdibaniso.
  • I-1% ukuchithwa kakubi kwi-chondrosarcoma ukuba i-lesion yodwa kunye ne-10-15% kwiimeko ze-HME
  • Ezinye iingxaki: ukwaphuka (umfanekiso ophezulu ekhohlo) ipseudoaneurysm ye-Popliteal artery, i-adventitious bursa formation.
  • I-Hereditary Multiple Exostosis (HME)- i-autosomal inkqubo ephezulu. Ihambisa ii-osteochondromas ezininzi (uhlobo lwe-sessile lulawula). Inokukhokelela ekutshatyalaliswa kweenyawo (iMadelung deformity, coxa valga) uxinzelelo lwe-ST osebenzayo, ukuchithwa kakubi
  • Dx: i-radiografi, i-MRI inceda kwi-Dx ukonakala okungalunganga kwi-chondrosarcoma ngotshintsho kubungakanani kunye nomsebenzi we-capilaginous cap (> 2-cm kubantu abadala banokubonakalisa ukonakala okugwenxa). I-MRI iyakunceda nakwi-Dx yeengxaki zengingqi

I-HME kunye ne-Knee Pain

unyango ngamadolo enyango yonyango el paso tx.

I-37-yo indoda ene-HME kunye neentlungu zedolo. I-Axial T1, i-T2 kunye ne-STIR MRI izilayi kwindawo ye-popliteal. I-cartilaginous cap enkulu kunye nokunyanzeliswa okunokwenzeka kwe-popliteal artery yi-osteochondroma. I-MRA yenziwa ukuvavanya i-popliteal A. pseudoaneurysm (utolo olukhulu). Isampulu ye-pathology efunyenwe kwi-cartilaginous cap ibonise ukwanda kweselula okucebisa ukonakala okuyingozi. Ukhathalelo lotyando lwacetywa

Isifo seSeli esikhulu (GCT) aka Osteoclastoma

unyango ngamadolo enyango yonyango el paso tx.
  • I-GCT- yinto eqhelekileyo yokuqaqanjelwa kwamathambo. Ubudala 25-40. M> F kancinci.
  • Indawo ye-M / C: I-femur ekude> i-tibia ehamba phambili> i-distal radius> i-sacrum
  • I-GCT yi-M / C ene-benign sacral tumor. Kwi-50% yamatyala, i-GCT iyenzeka malunga nedolo.
  • I-GCT ayinabungozi ngokwembali, kodwa i-Lung Mets inokukhula ngakumbi. ukuba kwiradiyasi ekude kunye nezandla, ihlala ibizwa ngokuba yiMalignant GCT
  • <1% ye-GCTs engaphenduliyo / ephindaphindiweyo inokuthi iqhube utshintsho olubi kwi-high-grade bone sarcoma
  • I-Pathology: histologically yakhiwe osteoclasts-multinucleated iiseli giant kunye iiseli stromal ethathwe precursors uhlobo monocyte-macrophage. Ivelisa i-cytokines kunye ne-osteolytic enzymes. I-GCT inokuqulatha igazi kwaye inxulumene ne-Aneurysmal Bone Cyst yesibini (ABC)
  • Klinikhi: ubuhlungu beedolo abuphendulanga ukunyamekela. I-Fx yePathologic inokwenzeka
  • iMifanekiso: ihlala iqala nge-radiography elandelwa yi-MRI kunye ne-biopsy yokugada ebaluleke kakhulu kwi-Dx.
  • Rx: xa isetyenziswa nge-curettage kunye nesamente, isixhobo sotyando sinokusetyenziswa ukuba ngaba i-pathological fx ikhona kunye ne-cortical breach. Kwiimeko ezinzima ngakumbi ezinye iinketho ezikhoyo

I-Radiologic-Pathologic Dx

unyango ngamadolo enyango yonyango el paso tx.
  • I-Radiologic-pathologic Dx: i-osteolytic kunye ne-soap-bubbly lesion ngokuqhelekileyo ibandakanya i-metaphysis kunye ne-epiphysis (isici esibalulekileyo se-classic) kunye nokwandiswa kwe-subarticular. Ummandla wotshintsho umxinwa kodwa ngamanye amaxesha kwizilonda ezinobundlobongela indawo ebanzi yotshintsho inokubonwa.
  • I-MRI: i-T1 ephantsi, i-highT2 / STIR, iindawo eziqhelekileyo zamanzi ezichanekileyo ezikhoyo kwi-GCT ne-ABC. I-Histology ibalulekile kwiDx.
  • I-DDx: i-ABC, i-Brown cell tumor ye-HPT (osteoclastoma), i-Telangiectatic Osteosarcoma
  • Umgaqo we-radiological: ukuba ipleyiti yokukhula kwe-physeal ikhona i-Dx ye-GCT ikhutshwe kuluhlu ngokuthanda i-chondroblastoma kunye nokunye.

Ukubonakala kwe-Soap-Ukubonakala ngokubonakalayo kweGCT

unyango ngamadolo enyango yonyango el paso tx.

ICoronal, iFat-Sat Sagittal kunye nee-Axial MRI Slices ze-GCT

unyango ngamadolo enyango yonyango el paso tx.
  • I-T1 coronal, i-T2 i-sagittal kunye ne-T2 axial i-MRI tincetu ze-GCT. Ngokuqhelekileyo: i-T1 ephantsi, i-highT2 / STIR kunye namanqanaba omlambo

Imbonakalo ye-MRI yeGCT

unyango ngamadolo enyango yonyango el paso tx.
  • Amanqanaba e-flux-fluid d / t ukwakheka okwehlukeneyo kwemveliso yehlazo lwegazi
  • I-DDx ebalulekileyo: ABC

Iimpawu ezixhatshazayo malunga neKnee

  • Kubantwana kunye nabantu abadala abancinci, i-m / c i-primary malignant neoplasm iphakathi kwe-aka intramedullary (osteogenic) osteosarcoma (OSA). Incopho yesibini ye-OS: >70 yo d/t Paget�s (1%) kunye/okanye i-OSA yokuphuma kwemitha.
  • Idolo yindawo ye-m / c ye-OSA (i-distal femur, prox. Tibia)
  • Iprayimari yabantwana ye-2nd m/c eyingozi yi-Ewing sarcoma.
  • Kubantu abadala> 40 yo m / c zaseprayimari yiMultiple Myeloma (MM) okanye iSolitary Plasmacytoma
  • Ngokubanzi i-m / c i-neoplasms yamathambo kubantu abadala d / t ithambo I-Mets esuka kwimiphunga, isifuba, i-prostate, i-renal cell, i-thyroid (ixoxiwe)
  • I-Dx: iiklinikhi kunye ne-radiological nge-biopsy yokugada
  • Ukucinga kubalulekile kwiDx. 1st inyathelo x-i-radiography. I-MRI+ gad C ibalulekile
  • I-CT ukuskena ngamanye amaxesha kunceda ukuvavanya ukuphulwa komzimba

Ephakathi (Intramedullary) i-Osteosarcoma (OSA)

unyango ngamadolo enyango yonyango el paso tx.
  • m / c yobudala: 10-20. m / c indawo: idolo, amadoda> amabhinqa. Ukwanda komngcipheko kwezinye
  • i-syndromes yomntwana kunye nokuguquka komzimba we-retinoblastoma: i-Rothmund-Thompson AR isifo.
  • I-Dx yokuqala ibalulekile i-d / t i-10-20% ikhona kunye neLung Mets kwi-Dx. I-prognosis ixhomekeke kwizigaba. Amanqanaba okuqala kunye nokuhlasela kwethambo lendawo kwaye akukho
  • imida 76% yokusinda.
  • I-Rx: iinkqubo zokulondoloza amalungu ezikhethiweyo kunye neeveki ze-8-12 ze-chemo, ukunqunyulwa ukuba kufakwe izicubu ze-neurovascular, indlela Fx, njl.
  • Ukucinga: i-radiography kunye neMRI.
  • Ngokonyango: iintlungu zamathambo, Inc. Alkaline Phosphatase
  • Isifuba CT ukuba imiphunga Mets kuqwalaselwa

I-Classic Rad Features ze-OSA

unyango ngamadolo enyango yonyango el paso tx.
  • I-Osteoid yenza i-sclerotic mass kunye neenwele ezinobundlobongela-ekupheleni / eziqikelelweyo / ze-sun-burst periosteal reaction, unxantathu we-Codman kunye nokuhlasela kwezicubu ezithambileyo. Oda i-MRI yeqonga kunye nobungakanani. I-Chest CT ibalulekile kwiLung Mets dx.

I-MRI ibaluleke kakhulu kwi-Dx / Stage

unyango ngamadolo enyango yonyango el paso tx.
  • Qaphela i-sagittal T1 (ekhohlo) kunye ne-STIR (ekunene) izilayi ze-MR: ubunzima obukhulu obusuka kwi-distal femoral metaphysis ukuya kwi-shaft eseleyo. Isignali ephantsi kwi-T1 kwaye iphezulu kwi-STIR d/t yokuhlasela umongo nge-edema, i-hemorrhaging kunye ne-tumor invasion. Uhlaselo lwe-ST lwasekuhlaleni lubonwa (iintolo ezimhlophe). Ukuphakanyiswa kwePeriosteal kunye nonxantathu weCodman (utolo oluhlaza) ziimpawu ezongezelelweyo zeneoplasm enoburhalarhume.
  • Qaphela into enomdla yokuba i-epiphysis igcinwe kwi-d / t physeal plate ekhonza okwexeshana njengesithintelo esongezelelweyo sokusasazeka kwethumba.

Ewing Sarcoma

unyango ngamadolo enyango yonyango el paso tx.

Ewing sarcoma: ubudala: 2-20, ingaqhelekanga kwizigulane ezimnyama. I-2nd m/c i-neoplasm yethambo enobungozi kakhulu ebantwaneni edla ngokuvela kwi-medullary cavity (Iithumba zeeseli ezijikelezayo). Uphawu oluphambili: iintlungu zethambo ezinokulinganisa usulelo (ESR/CRP/WBC) Kuthathelwa ingqalelo i-PNET Iqhosha Rad Dx: Izilonda ezidliwe linundu/ezinobunewunewu kwishafti yamathambo amade anohlaselo lwezicubu ezithambileyo ezinobungakanani/isiqhelo se-onion skin periostitis. Ingavelisa isoso Inokuthi ichaphazele amathambo asicaba. Inokubonakala njenge-sclerotic kwi-33%. I-Early lung Mets (25-30%) ithambo ukuya kwithambo i-Mets I-prognosis embi ukuba ilibazisekile iDx. Amanyathelo omfanekiso: Inyathelo le-1 x-rad, i-MRI i-v. ibalulekile ilandelwa yi-biopsy. CXR / CT PET-CT Rx: ukudibanisa i-rad-chemo, esebenzayo.

I-M / C I-Malignant Knee Neoplasms kwi-Adults

unyango ngamadolo enyango yonyango el paso tx.
  • I-66-yo indoda buhlungu
  • Qaphela intshutshiso yefuthe le-ostolytic lesion in the femalur metaphysis kwi-epiphysis. Akukho mpendulo ye-periosteal. Ukulandela ukuqhubeka komsebenzi kunye nesifo se-CT yesisu nesifuba, i-Dx ye-Renal cell carcinoma yasungulwa
  • I-Distal Mets ukuya kwindawo esezantsi ixhaphake kakhulu kwimiphunga, iseli yezintso, i-thyroid kunye ne-CA yebele.
  • Iseli yezintso kunye neThyroid ziya kuthi ziveze ubukhulu be-osteolytic expansile mass aka �blowout Mets.
  • Ngokubanzi, indlela yokucinga kufuneka iquka i-Radiographic knee series, ilandelwa yi-MRI ukuba i-x-ray ayivuzi.
  • I-TC99 I-scintigraphy ye-Bone yindlela yokukhetha yokuhlola isifo se-metastatic disease

I-Soft Tissue Neoplasms Nge-Knee

unyango ngamadolo enyango yonyango el paso tx.

I-hertiocytoma e-Malignant fibrous (MFH) yafakwa kwakhona njengePleomorphic Undifferentiated Sarcoma (PUS) yim/c ST sarcoma. I-MFH inamandla ngokwebhayoloji kunye ne-prognosis embi M>F (1.2:1) 30-80 kunye nencopho kwishumi le-6. I-25-40% yabo bonke abantu abadala be-sarcomas m / c iziphelo. I-Retroperitoneum elandelayo (i-prognosis embi kakhulu d / t emva kwexesha le-Dx kunye nokukhula okukhulu kweempawu ze-w / o) Klinikhi: buhlungu, ubunzima obunzima ngokuqhelekileyo malunga nedolo okanye ithanga. I-Histology: i-fibroblasts engafanelekanga / engabonakaliyo engafanelekanga, i-myofibroblasts, kunye nezinye iiseli ze-mesenchymal Ukucinga: I-MRI yindlela yokukhetha kunye ne-T1, T2, T1 + C. Ngokuqhelekileyo ibonakala njengobunzima obunobundlobongela obuphakathi ukuya kwisignali ephantsi kwi-T1 kunye nesignali ephezulu kwi-T2 eneendawo ze-necrosis kunye nophuculo kwi-T1+C. Ingabonakala ifakwe ngokulahlekisayo w/o yokwenyani capsule Ulawulo: ukusebenza ngeradiation kunye nechemotherapy. Ubunzulu bethumba bubalulekile kwi-prognosis. I-80% iminyaka eyi-5 yokuphila ukuba i-<5cm inzulu kwi-ST kunye ne-50% ukuba> i-5-cm enzulu kwi-ST.

Synovial Sarcoma

unyango ngamadolo enyango yonyango el paso tx.

Synovial sarcoma: eqhelekileyo embi ST neoplasm esp. kwizigulane ezincinci okanye kubantwana abadala / abafikisayo. I-M / C ifunyenwe kwindawo yamadolo Ngonyango: inokubonisa ngokukhawuleza njengobunzima obucacileyo kwisigxina esihlala singanakwa d / t ukukhula okucothayo Ukucinga ngundoqo: i-radiography inokutyhila i-ST. ukuxinana/ubunzima. Ezinye i-synovial sarcomas zinokubonisa ukubala kwaye ziphosakele Myositis Ossificanse okanye ukubunjwa kwamathambo e-heterotopic i-MRI ene-T1, i-T2 kunye ne-T1 + C yi-Dx indlela yokuzikhethela. Ezinye iindlela: I-US, i-CT ayithethi ngokuthe ngqo i-DDx: Ulawulo lwe-MFH: ukusebenza, i-chemo-radiation Prognosis: ukuguquguquka ngokuxhomekeke kubukhulu, ukuhlasela, i-metastasis

Uluhlu olupheleleyo lweethambo kunye neethishu zeeTissue Neoplasms

Neoplasms of the Knee

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

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

by | Ukujonga kunye nokuchonga, Ukuhamba kunye nokuguquguquka

Iindlebe zeMeniscal

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

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

Menisci Play Indima ebalulekileyo

ubuhlungu obudolo oludolova el paso tx.

 

Iindidi Indawo kunye nozinzo

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

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

I-Bucket Handle Mfutshane

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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.
ubuhlungu obudolo oludolova el paso tx.

 

Khwae Trauma

 

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

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

by | Ukujonga kunye nokuchonga, Ukuhamba kunye nokuguquguquka

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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

Ukuxilongwa kwe-ACL Tear

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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

ubuhlungu obudolo oludolova el paso tx.

 

  • 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)

ubuhlungu obudolo oludolova el paso tx.

 

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

Ulawulo lwee-ACL Izinyembezi

ubuhlungu obudolo oludolova el paso tx.

 

  • 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