Uyisebenzisa njani i-MRI ukuze ufumane i-Knee Meniscus kunye nokulimala kweLigament?

I-meniscus yi-meniscus-shaped fibrocartilage kunye ne-cross-section ye-triangular ephakathi kwe-condyle ye-tibial kunye ne-plateau, ephucula kakhulu ukuhambelana kwe-femoro-tibial kunye nokudlala indima ebalulekileyo kwi-knee joint dynamics.

Iziphumo zikaMri eziqhelekileyo nezingaqhelekanga

Kwimifanekiso ye-sagittal kunye nangaphambili, i-meniscus eqhelekileyo i-triangular kwi-hypointense. Ngowona mfanekiso we-sagittal wecala, i-meniscus 'i-bow-tie' isakhiwo esinecandelo eliphakathi kwe-sagittal edibeneyo kunye neempondo zangaphambili kunye nezingasemva (Umfanekiso 1).

Umzobo we-1 Ukubonakala kwe-MRI eqhelekileyo ye-meniscus yangaphakathi. Ubuninzi beProton-weighted sagittal view: I-engile ye-meniscal yangaphambili nengasemva zihomogeneous hypointense triangles. I-meniscus inesaphetha kwaye iqulethwe ngamacandelo ecandelo eliphakathi elidibanisa iimpondo zalo zangaphambili phambi kwayo kunye neempondo zayo zangasemva.

Kuluncedo ukuqonda izinto ezingaqhelekanga ze-anatomical njengoko zinokulinganisa ukwahlulwa kwe-meniscal:

• Kwicandelo le-sagittal, utshintsho phakathi kwe-transverse kunye ne-ligaments yangaphambili;

• i-popliteal tendon sheath;

• I-meniscus-femoral ligament ye-Humphrey kunye ne-Wrisberg idibanisa uphondo lwangasemva lwe-meniscus esecaleni kwi-condyle ye-femal medial;

• I-oblique meniscus ligament, enokuthi ngamaxesha athile idibanise uphondo lwangaphambili lwe-meniscus kwiphondo elingasemva le-meniscus echaseneyo, inokulinganisa i-meniscus efudukayo okanye i-barrel handle.

• I-Discoid meniscus yinto enqabileyo yokuzalwa kwe-meniscus deformity. Le dysplasia ye-meniscal ichaphazela phantse ngokukodwa i-meniscus esecaleni. Ukuxilongwa kwayo 'kwezemfundo' kwi-MRI kusekelwe ekuboneni ukuqhubeka kweempondo zangaphambili kunye nezingasemva kwimifanekiso ye-sagittal ubuncinane kwii-3 ezilandelelanayo ze-5 mm ezityebileyo (umzobo 2). Ezi ziphumo zihlenga-hlengiswa ngokusekelwe kwiseto ezingaphelelanga ezisetyenzisiweyo.

Umzobo 2 Discoid lateral meniscus. Umfanekiso we-Sagittal T1-weighted. Ukuqhubekeka kweekona zangaphambili nezingasemva kwi-3 elandelelanayo ye-5mm amacandelo asisigxina. Qaphela i-myxoid degeneration yophondo lwangaphambili lwale meniscus ye-discoid.

Ukufanekisa ngeMeniscus Pathology

Kuyinto eqhelekileyo ukwahlula phakathi kwe-meniscus ebuhlungu kunye ne-meniscus ewohlokayo. Ukulimala okubuhlungu kubangelwa ukusetyenziswa kwamandla amaninzi omatshini kwi-meniscus enempilo. Kubantu abadala abancinci, i-fissure idla ngokubangelwa ukulimala kwe-valgus engathanga ngqo, ukunyuka ngokukhawuleza kwe-tibia emva kokujikeleza kwangaphandle okanye i-hyperflexion yamadolo kwi-20 ° ye-flexion. Endaweni yoko, ukuwohloka kwenzeka ngenxa yamandla omatshini aqhelekileyo asebenza kwi-meniscus eyonakaliswe yi-interstitial myxoid degeneration. I-meniscal fissures ethe tyaba ingaphuhliswa ngokuzenzekelayo okanye inokubangelwa kukwenzakala okuncinci.

Ukuhlelwa

Ngokwesalathiso senqwelomoya yokuqhekeka, iintanda zinokwahlulwa zibe ziintanda ezithe tye, iintanda ezithe nkqo okanye iintanda ezintsonkothileyo.

UkuFissure okuthe tyaba

Kukho indiza edibeneyo ehambelana ne-plateau ye-tibial eyahlula i-meniscus ibe ngamacandelo aphezulu kwaye aphantsi. Ezi zilonda ezinqamlekileyo zixhaphake, zinokuchaphazela kakhulu i-meniscus ephakathi okanye esecaleni, kwaye zibhekwa njengezinzile, nangona i-debris efudukela kwi-groove emva komonakalo kwi-meniscus ephakathi ichazwe.

I-Fissure ethe nkqo

I-Perpendicular kwi-plane ye-tibial kunye ne-circumference ye-meniscus. Oku kuchaphazela kakhulu i-meniscus yangaphakathi. Ukulimala okupheleleyo kuthathwa njengokungazinzi kwaye kwahlula i-meniscus ibe ngamacandelo aphakathi kunye necala. Inqanaba lokuskena likwabandakanya umzimba we-meniscus wecala kunye nophondo lwangasemva lwe-meniscus, olulula ukuchaneka ngokungafanelekanga njenge-barrel handle tear, enokwenzeka ukuba yenzeke xa idolo lijikeleza ngaphandle. Idibaniswe nemifanekiso ye-sagittal, i-barrel handle tear inokukhutshwa ngaphandle (Umfanekiso 3).

A. I-MRI ye-Coronal, utolo lukhomba kuphondo olungasemva lwe-meniscus esecaleni, ekulula ukuba iqondwe kakubi njenge-barrel handle crack; B. Xa usenza ukuskena kwe-MRI ngokwendawo eboniswe ngumgca onamachaphaza kumfanekiso, i-pseudo barrel handle tear iya kuvela.

I-Radial fissures i-perpendicular kwi-perimeter ye-meniscus kwaye ngokuqhelekileyo ichaphazela umda wamahhala we-meniscus.

I-Parrot Beak Tear

Ngaba ngumonakalo oxubileyo othe nkqo oquka icandelo le-longitudinal kunye ne-radial component ngebhayisekile eyandisa kumda okhululekileyo.

Ekugqibeleni, kukho ukulimala kwe-meniscal eyinkimbinkimbi, ngaphandle kwenkcazo ecacileyo, ebandakanya ii-fissures ezininzi ezithe tye kunye nezithe nkqo.

UMri iiMbonakaliso zokwenzakala kweMeniscus

Iinyembezi zeMeniscus

Stoller et al. icebise amabakala ama-3 e-meniscus (Umfanekiso 4)

IBakala 1: I-hyperintensity nodular meniscus egcinwe kwi-meniscus surface;

IBanga lesi-2: I-meniscus yomgca ophezulu wesignali ephezulu egcinwe kwi-meniscus surface;

IBakala 3: I-hypertension ifikelela kwindawo enye ye-articular ye-meniscus.

Umfanekiso we-4 Stoller scale. a: IBakala 1: Indawo enye okanye ngaphezulu ye-nodular hyperintensity ephakathi ehambelana nomphezulu we-articular we-meniscus; b: IBakala 2: I-Linear intermediate hyperintensity kumphezulu we-articular we-meniscus; c: IBakala 3: I-Linear intermediate hyperintensity eya kwi-Articular surface ye-meniscus.

Nangona ulwahlulo phakathi kwamabanga 2 kunye ne-3 luthozamile, luhlula i-intrameniscal hyperintensity ehlayo (Umfanekiso 5) kwiifissures zangempela. Lo mahluko phakathi kwe-meniscus ewohlokileyo kunye nekrazukile ayisoloko ichanekileyo, kwaye kukho imithombo emininzi yephutha ngenxa yokubonakala kweyongezelelweyo okanye engekhoyo.

Umzobo 5. Imbonakalo ewohlokayo ye-meniscus. Imbono yeproton yeSagittal kunye nokugcwala kwamafutha. Iindawo zeempawu eziphakamileyo zingabonwa ngaphandle komfanekiso ochanekileyo wokwaphuka.

Ukulumkela:

I-MRI inomsebenzi ogqwesileyo, ngovelwano kunye neenkcukacha phakathi kwe-90% kunye ne-95%. Kwi-MRI, i-meniscal cleft ibonakala njengokwandiswa kwe-hypointense ephakathi kwindawo enye ye-articular surfaces ye-meniscus (i-Stoller grade 3), okanye i-morphological abnormality ecocekileyo.

Xa ukukrazula kubonakala kuphela kwisilayi esisodwa, kukho ubunzima, ngakumbi umngcipheko ophezulu weziphumo ezingezizo zobuxoki. Ukuba i-hyperintensity ngaphakathi kwe-meniscus yomgca ichaphazela kakhulu indawo ye-meniscal, okt ubuncinane kumacandelo amabini akufutshane, kuyacetyiswa ukuba kuthathwe njenge-pathological. Lo mbono kufuneka ulungelelaniswe ngokuxhomekeke kubuchule bokufumana umfanekiso osetyenzisiweyo (amacandelo ama-3 ukuya kwi-4 mm okanye ukufumana umthamo we-3D kunye namacandelo e-isotropic mm).

Ukucandeka kwe-Radial meniscal ngamanye amaxesha kunzima kakhulu ukuyifumanisa, xa kujongwa ukuqhelaniswa kwayo. Oku kukhokelela ikakhulu kwi-morphological abnormalities:

• Ukuphazamiseka komphetho wasimahla okanye ukunqunyulwa kumfanekiso ongaphambili;

• Ukubonakala kokuyeka okanye ukunqunyulwa kwe-meniscus bowtie kumfanekiso we-sagittal (Umfanekiso 6);

Umzobo 6. I-Radial fissure kwicandelo langaphambili le-meniscus ye-medial kwi-sagittal proton ye-proton-weighted view. Imbonakalo eqhelekileyo ye-meniscus ephakathi enqunyulwe iqhina (utolo).

• I-meniscus engekhoyo okanye 'isiporho' enomsantsa weradial ongaguqukiyo.

Ukuqhekeka kwe-meniscus kunye nesiphatho sebhakethi kunzima malunga ne-10% ye-spondylolisthesis yokwandisa ixesha elide. Kule meko, ukuvakalelwa kwe-MRI malunga ne-70%, kuxhomekeke kwiindlela zokuxilonga ezisetyenzisiweyo.

Iziphumo zeMRI ezifuna ukuqwalaselwa:

Eyona nto ixhaphakileyo kukubonwa ngokuthe ngqo kweengcezu ezifudukayo kwingingqi ye-intercondylar: 'i-double posterior cruciate ligament (PCL)' uphawu luphawu xa i-meniscus ephakathi yonakaliswa kwaye i-anterior cruciate ligament ihambelana. Icandelo elichithiweyo libonakala njenge-arcuate hypointense band ehambelana nesiqhelo se-posterior cruciate ligament, evelisa 'i-PCL ephindwe kabini' ukubonakala (Umfanekiso 7). Iimpondo zehariki ezigqithisileyo (ngaphezu kwe-6 mm ngobukhulu) zinokubonisa ubukho bomqheba womphanda (Umfanekiso 8). Kule meko, i-meniscus fragment ekhutshweyo ifakwe kwiphondo langaphambili eliphilileyo.

Umfanekiso wesi-7 Inkangeleko yesiphatho semeniscus esiphakathi inophawu 'double PCL'. Imboniselo ye-Sagittal PD-weighted kunye noxinzelelo lwamafutha: Iqhekeza le-meniscus elikhutshiweyo (utolo) lala ngaphantsi kwe-PCL yesiqhelo (utolo) kwaye lwenza uphawu 'i-PCL ephindwe kabini' inkangeleko.

Umfanekiso wesi-8 Imbonakalo yophondo olukhulu lwangaphambili. Uxinzelelo lweproton yeSagittal umbono onesisindo. Inxalenye yangaphambili yeqhekeza elichithiweyo (utolo) lufakwe kwi-angle ye-meniscus yangaphambili (utolo). Qaphela ukuba iikona ezingasemva aziboniswanga (*).

Ezinye iziphumo zeMRI:

Ezinye iimpawu ze-MRI ziye zaqinisekiswa, ezifana ne-bow tie elahlekileyo, uphawu lwe-meniscus oluguquliweyo, okanye iziqwenga ze-meniscal zihanjiswe ngokuthe ngqo kummandla we-intercondylar kwimifanekiso yangaphambili ye-millimeter (Umfanekiso we-9) okanye imifanekiso ye-axial.

Umfanekiso 9 Umqheba webhakethi ochithiweyo kwindawo yokubeka. Umbono ongaphambili wePD-weighted emva kokuthotywa kwamafutha. Iqhekeza le-meniscus elikhutshiweyo (utolo) lidibene ne-ACL (utolo).

Olunye uphawu olusesikweni lokungazinzi kwe-meniscal kukuchongwa kwe-peripheral displacement yamaqhekeza e-meniscal ukuya kwi-femoral menscal recess okanye i-femoral-tibial recess. Oku kususwa kubandakanya ngokukodwa i-meniscus yezonyango kwaye yingxaki kwezinye iimeko zokucandeka okuthe tye kwi-10% yeemeko. Amacandelo e-Coronal kunye ne-transverse yeyona ndlela ingcono yokuchonga la maqhekeza.

Iqela leMeniscus

I-Meniscal detachment ivela ngenxa yokulimala okukhulu kwe-valgus kwaye kubangelwa ukuphuka kwe-meniscus 'capsular appendage. Ezi zivame ukuchaphazela uphondo lwangasemva lwe-meniscus yangaphakathi enamathele kwi-capsule edibeneyo ngokunyuka kwe-capsule edibeneyo (i-posterior oblique ligament).

Zibangela ukutshatyalaliswa kwe-5 mm kwi-meniscus ephezulu ukusuka kumda ongasemva weplate ye-tibial kwimifanekiso ye-sagittal (Umfanekiso we-11), okanye ukufakwa kwamanzi phakathi kwesiseko se-meniscus kunye nendiza ye-capsule edibeneyo.

Umzobo we-11 I-Detachment yophondo lwangasemva lwe-meniscus. Imbonakalo yoxinano lweproton yeSagittal. I-meniscus eyahluliweyo ifuduselwe ngaphandle. Kukho indawo enkulu ye-hyperintensity (*) phakathi kwesiseko se-meniscus kunye ne-capsule yangasemva (utolo).

I-Meniscus edadayo

Esi sisiphumo sokulimala okunobundlobongela kwaye kungenxa ye-meniscal-tibial ligament rupture kunye ne-detachment yecandelo eliphakathi kwe-meniscus. Kwi-MRI, i-meniscus ehlukeneyo ijikelezwe ngokupheleleyo ngamanzi kwaye ibonakala 'i-float' kwi-plateau ye-tibial (Umfanekiso 12).

Umzobo 12 Imeniscus edadayo. Imboniselo yangaphambili yoxinaniso lweproton kunye nokugcwala kwamafutha. I-meniscus ehlukeneyo ijikelezwe ngamanzi, ngakumbi phakathi kwendawo engaphantsi kunye ne-tibial plateau (utolo).

I-meniscus yasemva kokuhlinzwa

Intlungu ephindaphindiweyo emva kwe-meniscectomy ibonisa ubunzima obuninzi bokuxilonga: i-fissures ephindaphindiweyo, i-postmeniscectomy, i-chondrolysis, i-subchondral necrosis, okanye i-arthralgia. I-MRI ihlala isilela ukuqaphela ukuqhekeka okuphindaphindiweyo ngenxa yokuba i-meniscectomy ishiya i-hyperintensities ephakathi 'engalunganga' enxibelelana nomphezulu we-meniscus. Ukufunyanwa kuphela okwakuthathwa njenge-pathological kwaye itolikwa njenge-fissure ephindaphindiweyo yayiyi-fluid intrameniscal hyperintensity kwi-T2-weighted images. Le mingcele ye-MRI elula yodwa iye yabangela ukuba abanye ababhali bacebise ukusetyenziswa kwe-MRI arthroscopy, nangona kwakhona iziphumo apha azihambelani.

Uzithenga njani ii-Orthopedic Implants kunye ne-Orthopedic Instruments?

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