Nigute wakoresha MRI kugirango umenye indwara y'amavi Meniscus na Ligament ibikomere？

Menisque ni fibrocartilage imeze nka menisque ifite igice cya mpandeshatu cyambukiranya hagati ya tibial condyle na plateau, ibyo bikaba bitezimbere cyane femoro-tibial guhuza hamwe kandi bigira uruhare runini mubikorwa byamavi.

Ibisanzwe Mri Ibisanzwe

Ku mashusho ya sagittal na imbere, menisque isanzwe ni mpandeshatu muri hypointense. Ku ishusho yegeranye cyane, meniscus ni 'umuheto-karuvati ' igizwe nigice cyo hagati cyo hagati cyahujwe n'amahembe y'imbere n'inyuma (Ishusho 1).

Igishushanyo 1 Ubusanzwe MRI igaragara ya menisque yo hagati. Ubucucike bwa proton-buremereye bwa sagittal reba: Imbere ninyuma ya meniscal ni mpandeshatu ya hypointense. Meniskus ifite umuheto kandi igizwe n'ibice by'igice cyo hagati gihuza amahembe yacyo imbere imbere n'amahembe yinyuma inyuma.

Nibyiza gusobanukirwa bimwe bidasanzwe bidasanzwe kuko bishobora kwigana gucamo ibice:

• Mu gice cya sagittal, inzibacyuho hagati ya transvers ninyuma yimbere;

• icyatsi kibisi;

• Humphrey na Wrisberg ya meniscus-femoral ligament ihuza ihembe ryinyuma rya menisque yinyuma na condyle yo hagati;

• Ligament ya oblique meniscus, rimwe na rimwe ihuza ihembe ryimbere rya menisque n'ihembe ryinyuma rya menisque itandukanye, irashobora kwigana menisque yimuka cyangwa ingunguru ya barriel

• Discoid meniscus ni ubumuga budasanzwe bwa meniscus. Iyi dysplasia ya meniscal yibasira hafi ya meniskus gusa. Isuzuma ryayo 'amasomo ' kuri MRI rishingiye ku kubona ubudahwema bw'amahembe y'imbere n'inyuma ku mashusho ya sagittal byibuze ibice 3 bikurikiranye bya mm 5 bikurikiranye (Ishusho 2). Ibisubizo byahinduwe hashingiwe ku gice cyakoreshejwe.

Igishushanyo 2 Kuraho meniskus kuruhande. Igishusho cya T1 gifite uburemere. Gukomeza kwimbere ninyuma kumurongo 3 ikurikiranye 5mm ibice byagenwe. Reba myxoid degeneration yamahembe yimbere yiyi menisque discoid.

Meniscus Pathology Kwerekana

Ni ibisanzwe gutandukanya cyane cyane meniskus ihahamuka na menisque igabanuka. Ihahamuka rituruka ku gukoresha imbaraga za mashini zikabije kuri menisque nzima. Ku rubyiruko rukuze, gutandukana mubisanzwe biterwa no gukomeretsa kwa valgus itaziguye, kuzamuka gutunguranye kwa tibia nyuma yo kuzunguruka hanze cyangwa hyperflexion yivi kuri 20 ° ya flexion. Ahubwo, kwangirika bibaho biturutse ku mbaraga zisanzwe zikora kuri menisk zangijwe no kwangirika kwa myxoide. Ibice bya menisike ya horizontal birashobora gukura ubwabyo cyangwa birashobora guterwa no gukomeretsa byoroheje.

Ibyiciro

Ukurikije icyerekezo cyindege ya clavage, ibice bishobora kugabanywamo ibice bitambitse, ibice bihagaritse cyangwa ibice bigoye.

Ibice bitambitse

Hano hari indege yacitsemo ibice ibangikanye na tibial plateau igabanya menisque mubice byo hejuru kandi biri hasi. Ibikomere bitambitse birakwiriye, birashobora kugira ingaruka zikomeye kuri menisque yo hagati cyangwa kuruhande, kandi bifatwa nkaho bihamye, nubwo imyanda yimukira muri ruhago nyuma yo kwangirika kwa menisque yo hagati.

Igice cya Vertical

Perpendicular kumurongo wa tibial no kumuzenguruko wa menisk. Ibi bikunze kugira ingaruka kuri menisk yo hagati. Imvune yuzuye ifatwa nkaho idahindagurika kandi igabanya menisque mubice byo hagati no kuruhande. Urwego rwo gusikana rurimo kandi umubiri wa menisque wuruhande hamwe nihembe ryinyuma rya menisque, byoroshye gusuzumwa nabi nkamarira ya barriel, bikaba bishoboka cyane ko bibaho mugihe ivi ryizengurutse hanze. Uhujije n'amashusho ya sagittal, amarira ya barriel amarira arashobora kuvaho (Ishusho 3).

A. Coronal MRI, umwambi werekana ihembe ryinyuma rya menisque yinyuma, byoroshye gusuzumwa nabi nkibikonjo byavunitse; B. Mugihe ukora scan ya MRI ukurikije umwanya werekanye numurongo utudomo mumashusho, amarira ya pseudo barreri azagaragara.

Ibice bya radiyo ni perpendicular kuri perimetero ya menisque kandi mubisanzwe bigira ingaruka kubusa bwa menisque.

Amarira ya Parrot

Nibyangiritse bivanze byangiritse bigizwe nibice birebire hamwe nibice bya radial bigenda byizunguruka kuruhande rwubusa.

Hanyuma, hariho ibikomere bigoye bya menici, nta bisobanuro bisobanutse neza, birimo ibice byinshi bitambitse kandi bihagaritse.

Mri Kugaragaza Gukomeretsa Meniscus

Amarira ya Meniscus

Abajura n'abandi. yatanze amanota 3 ya menisk (Ishusho 4)

Icyiciro cya 1: Hyperintensity nodular meniscus yagumanye hejuru ya menisque;

Icyiciro cya 2: Ikimenyetso kinini cyerekana umurongo menisque yagumanye hejuru ya menisque;

Icyiciro cya 3: Hyperintensity igera kumurongo umwe wa menisque.

Igicapo ca 4 Igipimo c'abajura. A. b: Icyiciro cya 2: Umurongo uri hagati ya hyperintensity kumurongo hejuru ya menisque; c: Icyiciro cya 3: Umurongo urenze intera hyperintensity igera kuri Arctular surface ya meniscus.

Nubwo itandukaniro riri hagati yicyiciro cya 2 nicya 3 ryoroheje, ritandukanya degenerative intrameniscal hyperintensity (Ishusho 5) nibice byukuri. Iri tandukanyirizo hagati ya menisque yangiritse kandi yacitse ntabwo buri gihe igororotse, kandi hariho amasoko menshi yamakosa bitewe no kugaragara kwinyongera cyangwa kubura.

Igicapo 5. Kugaragara kwangirika kwa menisk. Umuyoboro wa protoni yuzuye hamwe no kwiyuzuza ibinure. Ahantu harehare harehare hashobora kuboneka nta shusho nyayo yamenetse.

Icyitonderwa:

MRI ifite imikorere myiza, hamwe na sensitivite kandi yihariye hagati ya 90% na 95%. Kuri MRI, ibice byimisoro bigaragara nkumurongo wo hagati wa hypointense wagutse kugeza kuri imwe hejuru yimiterere ya menisque (Stoller grade 3), cyangwa ibintu bidasanzwe bya morfologiya.

Iyo amarira agaragara gusa ku gice kimwe, hari ingorane zimwe na zimwe, cyane cyane ibyago byinshi byibisubizo byiza. Niba hyperintensity iri mumurongo wa menisque igira ingaruka cyane hejuru yimisoro, ni ukuvuga byibuze ibice bibiri byegeranye, birasabwa gufatwa nkibibazo. Iki gitekerezo kigomba guhuzwa bitewe nubuhanga bwo kugura amashusho bwakoreshejwe (ibice 3 kugeza kuri 4 mm cyangwa kubona ingano ya 3D hamwe na mm isotropic mm).

Imirasire yimikorere ya radiial rimwe na rimwe biragoye kuyisuzuma, ukurikije icyerekezo cyabo. Ibi ahanini biganisha kuri morphologie idasanzwe:

• Guhagarika ubusa kubusa cyangwa gucibwa kumashusho yimbere;

• Kugaragara cyangwa guhagarikwa kugaragara kwa meniscus bowtie ku ishusho ya sakittal (Ishusho 6);

Igicapo 6. Ibice bya radiyo mubice byimbere ya menisque yo hagati muburyo bwa sagittal proton yuzuye uburemere. Ubusanzwe isura ya meniscus yo hagati yagabanije umuheto (umwambi).

• Kubura cyangwa 'umuzimu ' meniscus ifite icyuho cyuzuye cya radiyo.

Kumeneka kwa menisk hamwe nindobo bigora hafi 10% ya spondylolisthesis ndende. Muri iki kibazo, ibyiyumvo bya MRI bigera kuri 70%, ukurikije ibipimo byo gusuzuma byakoreshejwe.

Ibisubizo bya MRI bikeneye kwitabwaho:

Ikintu gikunze kugaragara cyane ni ugushushanya mu buryo butaziguye ibice byimuka mu karere ka intercondylar: Ikimenyetso cya 'double posterior cruciate ligament (PCL) ' ikiranga kiranga iyo menisque yo hagati yangiritse kandi ligamenti yimbere iba idahwitse. Igice cyimuwe kigaragara nka arcuate hypointense bande ihwanye na ligamente isanzwe yimbere, itanga 'kabiri PCL ' igaragara (Ishusho 7). Amahembe arenze urugero (hejuru ya mm 6 z'ubunini) arashobora kandi kwerekana ko hariho ikiganza cya barriel (Ishusho 8). Muri iki gihe, igice cya meniscus cyimuwe gifatanye n'ihembe ryiza ryimbere.

Igicapo 7 Kugaragara kwimikorere ya meniscus yo hagati ifite ikimenyetso 'kabiri PCL '. Indwara ya PD ifite uburemere hamwe no guhagarika ibinure: Igice cya meniscus cyimuwe (umwambi) kiri munsi ya PCL isanzwe (umwambi) kandi kigakora ibintu biranga 'kabiri PCL '.

Igicapo 8 Kugaragara kw'ihembe ry'imbere. Umuvuduko wa proton ubucucike buremereye. Igice cyimbere cyigice cyatandukanijwe (umwambi) gifatanye nu mfuruka y'imbere (umwambi). Menya ko impande zinyuma ziterekanwa (*).

Ibindi byagaragaye muri MRI:

Ibindi bimenyetso bya MRI byemejwe, nko kubura umuheto, ikimenyetso cya menisque ihindagurika, cyangwa ibice byimisoro byimuwe mu karere ka intercondylar ku mashusho y'imbere ya milimetero (Ishusho 9) cyangwa amashusho ya axial.

Igishushanyo 9 Indobo yimuwe mu mwanya. Imbere ya PD ifite uburemere nyuma yo guhagarika ibinure. Igice cya meniscus cyimuwe (umwambi) gihura na ACL (umwambi).

Ikindi kimenyetso cyemewe cyerekana ihungabana ryimisoro ni ukumenyekanisha kwimura periferiya yimitwe yimisoro mubice byubukungu bwumugore cyangwa ikiruhuko cyumugore. Iyimurwa ririmo hafi ya menisque yubuvuzi kandi ni ingorane zindwara zimwe zitambitse kuri 10%. Ibice bya Coronal na transvers ninzira nziza yo kumenya ibyo bice.

Itsinda rya Meniscus

Gutandukana kwa meniscal bibaho biturutse ku gukomeretsa bikabije bya valgus kandi biterwa no guturika kwa meniskus capsular umugereka. Ibi bikunda kugira ingaruka ku ihembe ryinyuma rya menisque yo hagati ifatanye na capsule ifatanye binyuze mubyimbye bya capsule ihuriweho (ligamenti yinyuma).

Bivamo mm 5 kurenga kuri menisque isumba iyindi kuva kumupaka winyuma wibibaho bya tibial kumashusho ya sagittal (Igicapo 11), cyangwa kwinjiza amazi hagati yigitereko cya menisque nindege ya capsule ihuriweho.

Igicapo 11 Gutandukanya ihembe ryinyuma rya menisk. Umuyoboro wa protoni yuzuye. Meniscus yatandukanijwe yimuwe imbere. Hariho umwanya munini wa hyperintensity (*) hagati yigitereko cya menisk na capsule yinyuma (umwambi).

Kureremba Meniscus

Izi ni zo ngaruka zo gukomeretsa bikabije kandi biterwa no guturika kwa meniscal-tibial ligament no gutandukana igice cyo hagati ya menisk. Kuri MRI, meniskus yatandukanijwe izengurutswe rwose n'amazi kandi bigaragara ko 'kureremba ' ku kibaya cya tibial (Ishusho 12).

Igicapo 12 Kureremba menisk. Ubucucike bwa proton imbere hamwe no kwiyuzuza ibinure. Meniscus yatandukanijwe izengurutswe n'amazi, cyane cyane hagati yubuso bwayo buto na tibial plateau (umwambi).

Meniscus

Ububabare bwisubiramo nyuma ya meniscectomie bugaragaza ingorane nyinshi zo kwisuzumisha: ibice byisubiramo, postmeniscectomy, chondrolysis, necrosis subchondral, cyangwa arthralgia. MRI ikunze kunanirwa gutahura ibice byisubiramo kuko meniscectomy isiga hyperintensité intera intera 'nabi ' ivugana nubuso bwa menisk. Icyagaragaye gusa cyafatwaga nk'indwara ya pathologiya kandi igasobanurwa nkigice cyisubiramo ni fluid intrameniscal hyperintensity kumashusho afite uburemere bwa T2. Izi mbogamizi zoroshye za MRI zonyine zatumye abanditsi bamwe basaba ko hakoreshwa arthroscopi ya MRI, nubwo na none ibisubizo hano bidahuye.

Nigute wagura imitekerereze ya orthopedie nibikoresho bya orthopedie？

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