Mashandisiro Ekushandisa MRI Kuongorora Knee Meniscus uye Ligament Kukuvara?

Iyo meniscus inonzi meniscus-shaped fibrocartilage ine triangular cross-section iri pakati petibial condyle uye nzvimbo, iyo inovandudza zvakanyanya femoro-tibial joint consistency uye inoita basa rinokosha mumabvi akabatanidzwa.

Normal Uye Abnormal Mr Zvawanikwa

Pamifananidzo yesagittal uye yepamberi, yakajairika meniscus ine triangular mu hypointense. Pamusoro pemufananidzo wekupedzisira wesagittal, meniscus i 'bow-tie' chimiro chinosanganisira chikamu chepakati-sagittal chakasanganiswa neanterior uye posterior nyanga (Mufananidzo 1).

Mufananidzo 1 Yakajairika MRI kutaridzika kwemukati memeniscus. Proton density-weighted sagittal view: The anterior and posterior meniscal angles are homogeneous hypointense triangles. Iyo meniscus yakaita seuta uye ine zvikamu zvechikamu chepakati chinobatanidza nyanga dzayo dzepamberi pamberi payo uye nyanga dzayo kumashure kumashure kwayo.

Izvo zvinobatsira kuti unzwisise zvimwe anatomical abnormalities sezvavanogona kutevedzera meniscal kupatsanurwa:

• Muchikamu che sagittal, shanduko pakati pe transverse uye anterior ligaments;

• popliteal tendon sheath;

• Humphrey naWrisberg's meniscus-femoral ligament inobatanidza nyanga yepashure ye lateral meniscus kune yepakati femoral condyle;

• Iyo oblique meniscus ligament, iyo nguva nenguva inobatanidza nyanga yepamberi yemeniscus kune posterior nyanga ye meniscus yakatarisana, inogona kutevedzera meniscus inotama kana barrel handle.

• Discoid meniscus chinhu chisingawanzo congenital meniscus deformity. Iyi meniscal dysplasia inobata zvinenge chete lateral meniscus. Yayo 'yedzidzo' kuongororwa paMRI inobva pakuona kuenderera mberi kwenyanga dzepamberi nepamusoro pamifananidzo ye sagittal mune zvishoma 3 zvakatevedzana 5 mm makobvu zvimedu (Fig. 2). Izvi zvakawanikwa zvinogadziriswa zvichienderana nechikamu chezvirongwa zvakashandiswa.

Mufananidzo 2 Discoid lateral meniscus. Sagittal T1-inorema mufananidzo. Kuenderera mberi kwemakona ekumberi uye kumashure pane 3 inoteedzana 5mm yakagadziriswa zvikamu. Cherechedza kuderera kwe myxoid yenyanga yepamberi yeiyi discoid meniscus.

Meniscus Pathology Imaging

Yakajairika tsika kusiyanisa pakati pekushungurudza meniscus uye degenerative meniscus. Kukuvara kunorwadza kunobva pakushandiswa kwesimba rakawandisa remagetsi kune meniscus ine hutano. Muvanhu vechidiki, kuputika kunowanzokonzerwa nekukuvara kwevhavha isina kunanga, kukwira kamwe kamwe kwetibia mushure mekutenderera kwekunze kana hyperflexion yemabvi pa20 ° yekuputika. Pane kudaro, kuderera kunoitika semugumisiro wezvakajairwa magetsi masimba anoshanda pane meniscus yakakuvadzwa neiyo interstitial myxoid degeneration. Horizontal meniscal fissures inogona kukura yega kana inogona kukonzerwa nekukuvara kudiki.

Classification

Zvinoenderana negwara rendege ye cleavage, fissures inogona kukamurwa kuita yakachinjika fissures, vertical fissures kana yakaoma fissures.

Horizontal Fissure

Kune ndege yakakamukana yakaenzana netibial plateau inoparadzanisa meniscus muzvikamu zvepamusoro uye zvakaderera. Izvi zvipembenene zvakakomberedzwa zvakapararira, zvinogona kukanganisa zvakanyanya meniscus yepakati kana yepakati, uye inonzi yakagadzikana, kunyange zvazvo marara anotamira mugomba mushure mekukuvadza kune meniscus yepakati yakatsanangurwa.

Vertical Fissure

Perpendicular to the tibial plane uye pamwe nedenderedzwa re meniscus. Izvi zvinonyanya kukanganisa medial meniscus. Kukuvara kwakakwana kunoonekwa sekusina kugadzikana uye kunoparadzanisa meniscus muzvikamu zvepakati uye nechemberi. Chiyero chekuongorora chinosanganisirawo lateral meniscus body uye posterior nyanga ye meniscus, iyo iri nyore kuti irege kuongororwa sechigadziko chekubata kubvarura, izvo zvinowanzoitika kana mabvi akabatanidzwa kunze achitenderedzwa. Yakasanganiswa nemifananidzo ye sagittal, chirongo chinobata kubvarura chinogona kubviswa (Mufananidzo 3).

A. Coronal MRI, museve unonongedza kune posterior nyanga ye lateral meniscus, iyo iri nyore kuti iongororwe zvisizvo sebarel handle crack; B. Paunenge uchiita MRI scanning maererano nechinzvimbo chinoratidzwa neine dotted mutsara mumufananidzo, pseudo barrel mubato wemisodzi uchaonekwa.

Radial fissures iri perpendicular kune perimeter ye meniscus uye inowanzobata mahara emucheto we meniscus.

Parrot Beak Tear

Kukuvadzwa kwakamira kwakasanganiswa kunosanganisira chikamu chelongitudinal uye radial chikamu chinotenderera chichienda kumucheto wemahara.

Pakupedzisira, kune kukuvara kwakaoma kwemeniscal, pasina chero tsanangudzo yakajeka, inosanganisira mafisi akawanda akatwasuka uye akatwasuka.

Mr Manifestations eMeniscus Injury

Meniscus Tear

Stoller et al. yakaratidza 3 mamakisi e meniscus (Mufananidzo 4)

Giredhi 1: Hyperintensity nodular meniscus yakachengetwa pamusoro pe meniscus;

Giredhi 2: High signal linear meniscus yakachengetwa pamusoro pe meniscus;

Giredhi 3: Hyperintensity inosvika kune imwe articular pamusoro pe meniscus.

Mufananidzo 4 Stoller scale. a: Giredhi 1: Imwe kana kupfuura yepakati nodular hyperintensity nzvimbo dzakabatana nearticular surface ye meniscus; b: Giredhi 2: Linear intermediate hyperintensity pane articular surface ye meniscus; c: Giredhi 3: Linear intermediate hyperintensity inosvika kune An articular surface ye meniscus.

Kunyange zvazvo musiyano pakati pemagiredhi 2 ne3 une mwero, unosiyanisa degenerative intrameniscal hyperintensity (Mufananidzo 5) kubva kune chokwadi fissures. Musiyano uyu pakati pemeniscus yakasakara uye yakabvaruka hausi wakatwasuka nguva dzose, uye pane zvakawanda zvinopa kukanganisa nekuda kwekuonekwa kwekuwedzera kana kushaikwa.

Mufananidzo 5. Chimiro chinoderera che meniscus. Sagittal proton density maonero ane mafuta saturation. Nzvimbo dzechiratidzo dzepamusoro dzinogona kuoneka pasina chero yechokwadi fracture linear mufananidzo.

Zvekungwaririra:

MRI ine basa rakanakisa, nekunzwa uye hunyanzvi pakati pe90% ne95%. PaMRI, meniscal cleft inoratidzika seyepakati mutsara hypointense yekuwedzera kune imwe yearticular surfaces ye meniscus (Stoller giredhi 3), kana yakachena morphological abnormality.

Kana iyo kubvarura ichingoonekwa pachidimbu chimwe chete, pane zvimwe zvinonetsa, kunyanya njodzi yakakura yemhedzisiro yenhema. Kana hyperintensity mukati memutsara meniscus inokanganisa zvakanyanya meniscal pamusoro, kureva mune zvikamu zviviri zviri pedyo, zvinokurudzirwa kuti zvionekwe kuti pathological. Iyi pfungwa inofanirwa kugadziridzwa zvichienderana nemaitiro ekutora mifananidzo anoshandiswa (3 kusvika 4 mm zvikamu kana kuwana vhoriyamu ye3D ine isotropic mm zvikamu).

Radial meniscal clefts dzimwe nguva yakanyanya kuoma kuongororwa, zvichipihwa maitiro avo. Izvi zvinonyanya kutungamira kune morphological abnormalities:

• Kuvhiringwa kwemahara kana kudimburwa pamufananidzo wepamberi;

• Discontinuous kana truncated kuonekwa kwe meniscus bowtie pamufananidzo we sagittal (Mufananidzo 6);

Mufananidzo 6. Radial fissure muchikamu chepamberi chemukati memeniscus mu sagittal proton density-weighted view. Kuonekwa kwakajairika kwemukati memeniscus truncated bow tie (museve).

• Yakashaikwa kana 'ghost' meniscus ine intact radial gap.

Kutsemuka kwemeniscus ine mubato webucket kunokanganisa inenge 10% ye longitudinally extending spondylolisthesis. Muchiitiko ichi, kunzwisiswa kweMRI inenge 70%, zvichienderana nemaitiro ekuongorora anoshandiswa.

MRI zviwanikwa zvinoda kutarisirwa:

Chinonyanya kuwanikwa ndechekuona kwakananga kwezvimedu zvinotama munharaunda ye intercondylar: 'double posterior cruciate ligament (PCL)' chiratidzo chinoratidzika apo meniscus yepakati yakakuvadzwa uye anterior cruciate ligament yakasimba. The dislocated segment inoratidzika se arcuate hypointense band parallel to the normal posterior cruciate ligament, ichigadzira 'double PCL' kuonekwa (Fig. 7). Kuwedzeredza nyanga dzerake (kupfuura 6 mm muhukuru) kunogona kuratidzawo kuvepo kwemubato wedhiramu (Mufananidzo 8). Muchiitiko ichi, iyo meniscus fragment yakabviswa inosungirirwa kune hutano hwepamberi nyanga.

Mufananidzo 7 Kuonekwa kwemubato wepakati meniscus ine 'double PCL' chiratidzo. Sagittal PD-yakaremerwa maonero nekudzvinyirirwa kwemafuta: Iyo yakabviswa meniscus chidimbu (museve) inorara pasi peyakajairwa PCL (museve) uye inoumba hunhu 'mbiri PCL' chitarisiko.

Mufananidzo 8 Kuonekwa kwenyanga huru yepamberi. Sagittal proton density yakayerwa maonero. Chikamu chepamberi chechidimbu chakabviswa (museve) chakabatanidzwa kune anterior meniscus angle (museve). Ziva kuti makona ekumashure haana kuratidzwa (*).

Zvimwe zveMRI zvakawanikwa:

Zvimwe zviratidzo zveMRI zvakasimbiswa, zvakadai sekushayikwa kwehuta, chiratidzo che meniscus inverted, kana meniscal fragments yakadzingwa zvakananga munzvimbo ye intercondylar pamifananidzo ye millimeter frontal (Fig. 9) kana axial mifananidzo.

Mufananidzo 9 Yakabviswa bhaketi mubato mune slot. Frontal PD-yakaremerwa maonero mushure mekudzvinyirirwa kwemafuta. The dislocated meniscus fragment (museve) iri kusangana ne ACL (museve).

Chimwe chiratidzo chechimiro chekusagadzikana kwemeniscal ndiko kuzivikanwa kwekutamiswa kwezvimedu zvemeniscal kuenda kufemoral meniscal recess kana femoral-tibial recess. Kutamiswa uku kunosanganisira kungoita meniscus yekurapa uye idambudziko remamwe akachinjika cleft makesi mu10% yezviitiko. Zvikamu zveCoronal uye zvakachinjika ndiyo nzira yakanakisa yekuziva zvidimbu izvi.

Meniscus Detachment

Meniscal detachment inoitika semugumisiro wekukuvara kwakanyanya kwevalgus uye kunokonzerwa nekuputika kwemeniscus 'capsular appendage. Izvi zvinowanzokonzera nyanga yemashure ye meniscus yepakati iyo inonamatira kune capsule yekubatana kuburikidza nekuwedzera kwejojo ​​capsule (iyo posterior oblique ligament).

Vanoita kuti 5 mm inogadziriswa kune meniscus yepamusoro kubva kumuganhu wekupedzisira wetibial plate pamifananidzo ye sagittal (Fig. 11), kana kuiswa kwemvura pakati penheyo ye meniscus uye ndege yejojo ​​capsule.

Mufananidzo 11 Detachment of the posterior nyanga ye meniscus. Sagittal proton density maonero. Iyo meniscus yakaparadzaniswa inotamiswa pamberi. Pane nzvimbo yakakura ye hyperintensity (*) pakati penheyo ye meniscus uye posterior capsule (museve).

Inoyangarara Meniscus

Ichi ndicho chigumisiro chekukuvara kwechisimba uye kunokonzerwa nemeniscal-tibial ligament rupture uye kuvharwa kwechikamu chepakati che meniscus. PaMRI, meniscus yakaparadzana yakakomberedzwa zvachose nemvura uye inoratidzika 'kutenderera' pane tibial plateau (Mufananidzo 12).

Mufananidzo 12 Meniscus inoyangarara. Frontal proton density maonero ane mafuta saturation. Iyo meniscus yakaparadzaniswa yakakomberedzwa nemvura, kunyanya pakati payo yakaderera pasi uye tibial plateau (museve).

Postoperative Meniscus

Kurwadziwa kunowanzoitika mushure memeniscectomy kunopa matambudziko akawanda ekuongorora: kudzokorora fissures, postmeniscectomy, chondrolysis, subchondral necrosis, kana arthralgia. MRI kazhinji inotadza kuona kuputika kunowanzoitika nekuti meniscectomy inosiya yepakati hyperintensities iyo 'zvisizvo' inotaurirana nepamusoro pemeniscus. Kungowanikwa chete kwainzi pathological uye kududzirwa seyakadzokororwa fissure yaive fluid intrameniscal hyperintensity paT2-inorema mifananidzo. Izvi zvisingakwanisi MRI zviri nyore chete zvakaita kuti vamwe vanyori vataure kushandiswa kweMRI arthroscopy, kunyange zvazvo zvakare zvigumisiro pano zvisingaenderani.

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