Yadda za a Yi amfani da MRI don gano Meniscus Knee da Rauni?

Meniscus wani fibrocartilage ne mai siffar meniscus tare da sashin giciye na triangular da ke tsakanin tibial condyle da plateau, wanda ya inganta ingantaccen haɗin gwiwa na femoro-tibial kuma yana taka muhimmiyar rawa a cikin haɗin gwiwa na gwiwa.

Neman Mri Na Al'ada Kuma Mara Kyau

A kan hotuna na sagittal da na gaba, meniscus na al'ada yana da triangular a cikin hypointense. A kan mafi girman hoton sagittal na gefe, meniscus shine tsarin 'bow-tie' wanda ya ƙunshi sashin tsakiyar sagittal wanda aka haɗe da ƙahonin gaba da na baya (Hoto na 1).

Hoto 1 Alamar MRI na al'ada na meniscus na tsakiya. Proton-nauyin sagittal view: Na gaba da na baya meniscal kusurwoyi ne na hypointense triangles. Meniscus yana da siffar baka kuma ya ƙunshi sassan sashin tsakiya waɗanda ke haɗa ƙahonin gabansa a gabansa da ƙahonsa na baya a bayansa.

Yana da amfani a fahimci wasu nakasassu na jiki kamar yadda zasu iya kwaikwayi tsagawar meniscal:

• A cikin sashin sagittal, canzawa tsakanin jijiyoyi masu tsaka-tsaki da na baya;

• tarin popliteal tendon;

• Humphrey da Wrisberg's meniscus-femoral ligament sun haɗu da ƙaho na baya na meniscus na gefe zuwa tsaka-tsaki na femoral condyle;

• Jigon meniscus wanda ya zama dole, wanda lokaci-lokaci yana haɗa ƙaho na baya na meniscus zuwa ƙaho na baya na kishiyar meniscus, na iya yin kwaikwayon meniscus mai ƙaura ko rike ganga.

• Discoid meniscus wani nakasar meniscus ne da ba kasafai ba. Wannan dysplasia na meniscal yana shafar kusan meniscus na gefe. Bincikensa na 'ilimi' akan MRI ya dogara ne akan ganin ci gaban ƙahonin gaba da na baya akan hotunan sagittal a cikin aƙalla 3 a jere na 5 mm lokacin farin ciki (Fig. 2). Ana daidaita waɗannan binciken bisa tushen saitunan da aka yi amfani da su.

Hoto 2 Discoid meniscus na gefe. Hoton mai nauyin Sagittal T1. Ci gaba da sasanninta na gaba da na baya akan sassan 3 a jere na 5mm da aka gyara. Lura da ɓarnar myxoid na ƙaho na gaba na wannan discoid meniscus.

Meniscus Pathology Hoto

Al'ada ce ta gama gari don bambanta tsakanin meniscus mai rauni da meniscus degenerative. Rauni mai rauni yana haifar da aikace-aikacen ƙarfin injin da ya wuce kima zuwa meniscus mai lafiya. A cikin matasa manya, fissure yawanci yakan faru ne ta hanyar raunin valgus kai tsaye, hawan tibia kwatsam bayan juyawa na waje ko haɓakar gwiwa na gwiwa a 20 ° na juyawa. Madadin haka, lalacewa yana faruwa ne sakamakon ƙarfin injina na yau da kullun da ke aiki akan meniscus wanda ya lalace ta interstitial myxoid degeneration. Tashin hankali na tsaka-tsaki na iya tasowa ba tare da bata lokaci ba ko kuma yana iya haifar da ƙananan raunuka.

Rabewa

Dangane da alkiblar tsagewar jirgin, za a iya raba fissures zuwa ɓangarorin kwance, fissure na tsaye ko hadaddun fissures.

Fissure a kwance

Akwai tsagaggen jirgin sama daidai da tudun tibial wanda ke raba meniscus zuwa sassa na sama da na ƙasa. Wadannan raunuka a kwance suna da yawa, suna iya tasiri sosai ga meniscus na tsakiya ko na gefe, kuma ana la'akari da su barga, ko da yake tarkace da ke ƙaura zuwa cikin tsagi bayan lalacewa ga meniscus na tsakiya an kwatanta.

Fissure Tsaye

Daidaitacce zuwa jirgin tibial kuma tare da kewayen meniscus. Waɗannan sun fi shafar meniscus na tsakiya. An yi la'akari da cikakken rauni mara ƙarfi kuma yana rarraba meniscus zuwa sassan tsakiya da na gefe. Hakanan matakin duban ya haɗa da jikin meniscus na gefe da ƙaho na baya na meniscus, wanda ke da sauƙin gane kuskure a matsayin tsagewar ganga, wanda zai iya faruwa lokacin da haɗin gwiwa ya juya waje. Haɗe tare da hotuna na sagittal, ana iya yin watsi da tsagewar ganga (Hoto na 3).

A. Coronal MRI, kibiya tana nuna ƙaho na baya na meniscus na gefe, wanda ke da sauƙin ganewa kamar yadda ganga rike da fashewa; B. Lokacin yin sikanin MRI bisa ga matsayin da aka nuna ta layin dige-dige a cikin adadi, wani tsagewar ganga mai tsini zai bayyana.

Radial fissures suna daidai da kewayen meniscus kuma yawanci suna shafar gefen meniscus kyauta.

Aku Beak Hawaye

Haɗaɗɗen lahani ne a tsaye wanda ya ƙunshi ɓangaren tsayin daka da sashin radial wanda ke yin hawan keke a gefen kyauta.

A ƙarshe, akwai hadaddun raunuka na meniscal, ba tare da wani takamaiman bayani ba, wanda ya haɗa da fissures masu yawa a kwance da a tsaye.

Bayyanar Mri na Raunin Meniscus

Meniscus Hawaye

Stoller et al. an ba da shawarar maki 3 na meniscus (Hoto na 4)

Darasi na 1: Ƙunƙarar hawan jini na nodular meniscus wanda ke riƙe a saman meniscus;

Mataki na 2: Babban meniscus na sigina na sigina wanda aka riƙe akan saman meniscus;

Darasi na 3: Ƙunƙarar hawan jini ya miƙe zuwa saman bangon bangon meniscus.

Hoto 4 Sikelin Stoller. a: Darasi na 1: Ɗaya ko fiye na tsaka-tsaki na nodular hyperintensity shafukan da ke hade da farfajiyar articular na meniscus; b: Darasi na 2: Ƙunƙarar hawan jini na madaidaiciyar madaidaiciya a kan saman articular na meniscus; c: Darasi na 3: Ƙunƙarar hawan jini na madaidaiciyar madaidaiciya wanda ya miƙe zuwa Ƙaƙƙarfan fuskar meniscus.

Ko da yake bambance-bambancen tsakanin maki 2 da 3 yana da matsakaici, yana bambanta rashin ƙarfi na intrameniscal degenerative (Hoto 5) daga fissures na gaskiya. Wannan bambance-bambance tsakanin meniscus mai lalacewa da tsagewa ba koyaushe ba ne mai sauƙi, kuma akwai tushen kuskure da yawa saboda bayyanar ƙarin ko ɓacewa.

Hoto 5. Bayyanar cututtuka na meniscus. Sagittal proton view density view with fat saturation. Ana iya ganin manyan wuraren sigina ba tare da wani hoto na madaidaiciyar karaya na gaskiya ba.

Matakan kariya:

MRI yana da kyakkyawan aiki, tare da hankali da ƙayyadaddun tsakanin 90% da 95%. A kan MRI, ƙwanƙwasa meniscal yana bayyana a matsayin matsakaicin tsaka-tsakin hypointense mai tsayi zuwa ɗaya daga cikin sassan bango na meniscus (Stoller grade 3), ko kuma rashin daidaituwa na dabi'a.

Lokacin da hawaye kawai ke bayyane akan yanki guda, akwai wasu matsaloli, musamman babban haɗarin sakamako mai kyau na ƙarya. Idan hauhawar jini a cikin meniscus na layi yana tasiri sosai akan saman meniscal, watau aƙalla sassan biyu kusa da juna, ana ba da shawarar a yi la'akari da cututtukan cututtukan fata. Ya kamata a daidaita wannan ra'ayi dangane da fasahar sayan hoton da aka yi amfani da shi (sassan 3 zuwa 4 mm ko samun ƙarar 3D tare da sassan isotropic mm).

Radial meniscal clefts wasu lokuta sun fi wuya a gano su, idan aka yi la'akari da yanayin su. Waɗannan galibi suna haifar da ɓarna na morphological:

• Katsewar gefen kyauta ko yankewa akan hoton gaba;

• Katsewa ko yanke bayyanar bowtie meniscus akan hoton sagittal (Hoto 6);

Hoto 6. Radial fissure a cikin ɓangaren gaba na meniscus na tsakiya a cikin sagittal proton mai nauyi mai nauyi. Siffar al'ada ta tsaka-tsaki meniscus truncated tayen baka (kibiya).

• Bace ko 'fatalwa' meniscus tare da cikakken tazarar radial.

Rushewar meniscus tare da rike guga yana dagula kusan kashi 10% na tsayin daka na spondylolisthesis. A wannan yanayin, ƙwarewar MRI shine kusan 70%, dangane da ka'idojin bincike da aka yi amfani da su.

Binciken MRI wanda ke buƙatar kulawa:

Mafi yawan abin da aka gano shi ne hangen nesa kai tsaye na gutsuttsuran ƙaura a cikin yanki mai tsaka-tsaki: alamar alamar tazarar biyu ta baya (PCL) tana da siffa lokacin da meniscus na tsakiya ya lalace kuma ligament na gaban cruciate ya kasance cikakke. Bangaren da aka watse yana bayyana azaman arcuate hypointense band a layi daya da na yau da kullun na ligament na baya, yana samar da bayyanar 'PCL biyu' (Fig. 7). Ƙahon rake da ya wuce kima (fiye da 6 mm cikin girman) na iya nuna kasancewar rikon ganga (Hoto na 8). A wannan yanayin, guntun meniscus da aka rabu yana haɗe zuwa ƙaho na gaba mai lafiya.

Hoto 7 Bayyanar hannun meniscus na tsakiya yana da alamar 'biyu PCL'. Ra'ayi mai nauyi na Sagittal PD tare da kashe mai: Ragewar guntun meniscus (kibiya) yana kwance ƙarƙashin PCL na al'ada (kibiya) kuma yana samar da sifa 'bayanin PCL biyu'.

Hoto 8 Bayyanar ƙaton ƙaho na gaba. Sagittal proton ma'aunin nauyi mai nauyi. Bangaren gaba na ɓarke ​​​​(kibiya) an haɗa shi zuwa kusurwar meniscus na gaba (kibiya). Lura cewa ba a nuna sasanninta na baya (*).

Sauran binciken MRI:

Sauran alamun MRI an inganta su, irin su bakan baka, jujjuyawar alamar meniscus, ko ɓangarorin ɓarke ​​​​da aka yi gudun hijira kai tsaye zuwa yankin intercondylar akan hotuna na gaba na millimeter (Fig. 9) ko hotuna axial.

Hoto 9 Rigar guga da aka watse a cikin rami. Ra'ayi mai nauyin PD na gaba bayan danne mai. Guntun meniscus da aka rabu (kibiya) yana cikin hulɗa da ACL (kibiya).

Wata alamar rashin kwanciyar hankali na meniscal ita ce gano ƙaura na gefe na ɓarke ​​​​zuciya a cikin hutu na meniscal na mata ko hutun femoral-tibial. Waɗannan ƙaura sun ƙunshi kusan meniscus na likita kuma suna da rikitarwa na wasu lamurra a kwance a cikin 10% na lokuta. Sassan kuɗaɗe da ɓarna sune hanya mafi kyau don gano waɗannan guntu.

Meniscus Detachment

Ragewar meniscal yana faruwa ne sakamakon mummunan rauni na valgus kuma yana faruwa ne ta hanyar fashewar abin da ake kira capsular na meniscus. Wadannan suna shafar ƙaho na baya na meniscus na tsakiya wanda ke haɗawa da capsule na haɗin gwiwa ta hanyar yin kauri na haɗin gwiwa (jigon na baya).

Suna haifar da raguwar 5 mm zuwa maniscus mafi girma daga iyakar baya na farantin tibial a kan hotunan sagittal (Fig. 11), ko shigar da ruwa tsakanin tushe na meniscus da jirgin saman haɗin gwiwa.

Hoto 11 Rage ƙaho na baya na meniscus. Sagittal proton view density view. An raba meniscus da aka raba a baya. Akwai babban yanki na hauhawar jini (*) tsakanin gindin meniscus da capsule na baya (kibiya).

Meniscus mai iyo

Wannan shi ne sakamakon mummunan rauni kuma yana faruwa ne saboda raguwar ligament na meniscal-tibial da raguwa na tsakiya na meniscus. A kan MRI, meniscus da aka keɓe yana kewaye da ruwa gaba ɗaya kuma yana bayyana ga 'tasowa' akan tudun tibial (Hoto 12).

Hoto na 12 Meniscus mai iyo. Ra'ayin yawan proton na gaba tare da jikewar kitse. Meniscus da aka keɓe yana kewaye da ruwa, musamman tsakanin samansa na ƙasa da farantin tibial (kibiya).

Meniscus bayan tiyata

Ciwo mai maimaitawa bayan meniscectomy yana gabatar da matsalolin bincike da yawa: fissures na yau da kullum, postmeniscectomy, chondrolysis, subchondral necrosis, ko arthralgia. MRI sau da yawa ya kasa gano fissures akai-akai saboda meniscectomy yana barin matsakaicin hyperintensity wanda 'ba daidai ba' yana sadarwa tare da saman meniscus. Binciken kawai wanda aka yi la'akari da ilimin cututtuka kuma an fassara shi azaman fissure mai maimaitawa shine hawan jini na cikin jini akan hotuna masu nauyin T2. Wadannan iyakoki na MRI mai sauƙi kadai sun sa wasu mawallafa su ba da shawarar yin amfani da MRI arthroscopy, ko da yake kuma sakamakon a nan bai dace ba.

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