Ungayisebenzisa Kanjani I-MRI Ukuhlonza I-Knee Meniscus Nokulimala Kwe-Ligament?

I-meniscus iyi-fibrocartilage efana ne-meniscus ene-cross-section engunxantathu etholakala phakathi kwe-condyle ye-tibial kanye ne-plateau, ethuthukisa kakhulu ukuhambisana kwe-femoro-tibial futhi idlala indima ebalulekile ekuguquguqukeni kwamadolo.

Okujwayelekile Nokungajwayelekile Okutholwe nguM

Ezithombeni ze-sagittal nezingaphambili, i-meniscus evamile inonxantathu ku-hypointense. Esithombeni esingemuva kakhulu se-sagittal, i-meniscus iyisakhiwo 'i-bow-tie' ehlanganisa ingxenye emaphakathi ne-sagittal ehlanganiswe nezimpondo zangaphambili nezingemuva (Umfanekiso 1).

Umfanekiso we-1 Ukubonakala kwe-MRI evamile kwe-meniscus ephakathi. Ukubuka kwe-sagittal kwesisindo se-Proton: Ama-engeli e-meniscal angaphambili nangemuva angama-homogeneous hypointense triangle. I-meniscus inomumo womnsalo futhi iqukethe izingxenye zengxenye ephakathi ezixhuma izimpondo zayo zangaphambili phambi kwayo nezimpondo zayo ezingemuva ngemuva kwayo.

Kuwusizo ukuqonda okuthile okungavamile kwe-anatomical njengoba kungase kulingise ukuhlukana kwe-meniscal:

• Esigabeni se-sagittal, uguquko phakathi kwemigqa ephambanayo neyangaphambili;

• umgodla we-popliteal tendon;

• I-meniscus-femoral ligament ka-Humphrey kanye ne-Wrisberg ixhuma uphondo lwangemuva lwe-meniscus ehlangothini ne-condyle ye-femoral ephakathi;

• I-oblique meniscus ligament, evame ukuxhuma uphondo lwangaphambili lwe-meniscus nophondo lwangemuva lwe-meniscus ephambene, ingase ilingise i-meniscus efudukayo noma isibambo somphongolo.

• I-Discoid meniscus iwukukhubazeka okungavamile kokuzalwa kwe-meniscus. Le dysplasia ye-meniscal ithinta cishe kuphela i-meniscus yangemuva. Ukuxilongwa kwayo 'kwezemfundo' ku-MRI kusekelwe ekuboneni ukuqhubeka kwezimpondo zangaphambili nezangemuva ezithombeni ze-sagittal okungenani izingcezu eziwugqinsi ezingu-5 mm ezilandelanayo ezingu-3 (Fig. 2). Lokhu okutholiwe kulungiswa ngokusekelwe kuzilungiselelo ezingaphelele ezisetshenzisiwe.

Umfanekiso 2 I-Discoid lateral meniscus. Isithombe esinesisindo se-Sagittal T1. Ukuqhubeka kwamakhona angaphambili nangemuva ezigabeni ezigxilile ezingu-3 ezilandelanayo ezingu-5mm. Qaphela ukuwohloka kwe-myxoid kophondo lwangaphambili lwale meniscus ye-discoid.

I-Meniscus Pathology Imaging

Kuwumkhuba ovamile ukuhlukanisa ngokuyisisekelo phakathi kwe-meniscus ebuhlungu kanye ne-meniscus ewohlokayo. Ukulimala okudabukisayo kubangelwa ukusetshenziswa kwamandla emishini ngokweqile ku-meniscus enempilo. Kubantu abadala abasha, i-fissure ngokuvamile ibangelwa ukulimala okungaqondile kwe-valgus, ukuphakama okungazelelwe kwe-tibia ngemva kokujikeleza kwangaphandle noma i-hyperflexion yamadolo ku-20 ° ye-flexion. Kunalokho, ukuwohloka kwenzeka ngenxa yamandla avamile emishini asebenza ku-meniscus alinyazwa ukuwohloka kwe-interstitial myxoid. Imifantu ye-meniscal evundlile ingase ivele ngokuzenzekelayo noma ingase ibangelwe ukulimala okuncane.

Ukwahlukanisa

Ngokwesiqondiso sendiza ehlukanisayo, imifantu ingahlukaniswa ibe imifantu evundlile, imifantu eqondile noma imifantu eyinkimbinkimbi.

I-Fissure Evundlile

Kukhona indiza ehlukanisiwe ehambisana ne-tibial plateau ehlukanisa i-meniscus ibe izingxenye eziphakeme neziphansi. Lezi zilonda ezivundlile zisabalele, zingathinta kakhulu i-meniscus ephakathi noma engemuva, futhi ibhekwa njengezinzile, nakuba imfucumfucu ethuthela emgodini ngemva kokulimala kwe-meniscus ephakathi kuchazwe.

I-vertical Fissure

I-Perpendicular indiza ye-tibial futhi eduze komjikelezo we-meniscus. Lokhu kuvame ukuthinta i-meniscus emaphakathi. Ukulimala okuphelele kuthathwa njengokungazinzile futhi kuhlukanisa i-meniscus ibe amasegimenti aphakathi nendawo nangemuva. Izinga lokuskena liphinde lihlanganise umzimba we-meniscus ongasemuva kanye nophondo lwangemuva lwe-meniscus, okulula ukubhekwa ngokungalungile njengendlela yokudabula isibambo somphongolo, okungenzeka kakhulu ukwenzeka lapho idolo elihlangene lijikeleziswa ngaphandle. Kuhlanganiswe nezithombe ze-sagittal, ukudabuka kwesibambo somphongolo kungakhishwa (Umfanekiso 3).

A. I-Coronal MRI, umcibisholo ukhomba ophondweni lwangemuva lwe-meniscus engasemuva, okulula ukuhlonzwa ngokungalungile njengokuqhekeka kwesibambo somphongolo; B. Uma wenza ukuskena kwe-MRI ngokwendawo ekhonjiswe umugqa onamachashazi emfanekisweni, kuzovela isibambo sombhobho mbumbulu ukukhala.

Imifantu emisebe i-perpendicular ku-perimeter ye-meniscus futhi ngokuvamile ithinta unqenqema olukhululekile lwe-meniscus.

I-Parrot Beak Tear

Umonakalo omile oxubile ohlanganisa ingxenye ye-longitudinal kanye nengxenye yeradial enwebeka ngomjikelezo emaphethelweni amahhala.

Okokugcina, kukhona ukulimala kwe-meniscal okuyinkimbinkimbi, ngaphandle kwencazelo ecacile, ehlanganisa ukuqhekeka okuningi okuvundlile nokuqondile.

U-Mri Ukubonakaliswa Kokulimala Kwe-Meniscus

I-Meniscus izinyembezi

Stoller et al. uphakamise amamaki ama-3 we-meniscus (Umfanekiso 4)

Ibanga loku-1: I-Hyperintensity nodular meniscus egcinwe endaweni ye-meniscus;

Ibanga lesi-2: I-meniscus yomugqa wesiginali ephezulu egcinwe endaweni ye-meniscus;

Ibanga lesi-3: Umfutho wegazi ophezulu udlulela endaweni eyodwa ye-articular ye-meniscus.

Umfanekiso 4 Isikali se-Stoller. a: IBanga loku-1: Indawo eyodwa noma ngaphezulu ye-nodular hyperintensity ephakathi nendawo ehlobene ne-articular surface ye-meniscus; b: Ibanga lesi-2: I-Linear intermediate hyperintensity endaweni ye-articular ye-meniscus; c: IBanga lesi-3: I-hyperintensity emaphakathi eqondile efinyelela ku-Articular surface ye-meniscus.

Nakuba umehluko phakathi kwamabanga 2 kanye ne-3 unesizotha, uhlukanisa i-intrameniscal hyperintensity ewohlokayo (Umfanekiso 5) emifantwini yangempela. Lo mehluko phakathi kwe-meniscus eyonakele nedabukile awuhlali uqondile, futhi kunemithombo eminingi yephutha ngenxa yokubonakala kokungeziwe noma okungekho.

Umfanekiso 5. Ukubukeka okuwohlokayo kwe-meniscus. Ukubuka kwe-Sagittal proton density nge-fat saturation. Izindawo zesignali ephezulu zingabonwa ngaphandle kwanoma yisiphi isithombe somugqa wokuphuka wangempela.

Izinyathelo zokuzivikela:

I-MRI inokusebenza okuhle kakhulu, ngokuzwela nokucacisa phakathi kuka-90% no-95%. Ku-MRI, i-meniscal cleft ibonakala njengesandiso esimaphakathi somugqa we-hypointense endaweni eyodwa ye-meniscus (i-Stoller grade 3), noma ukungahambi kahle kwe-morphological okumsulwa.

Uma ukudabuka kubonakala ocezwini olulodwa kuphela, kuba nobunzima obuthile, ikakhulukazi ingozi enkulu yemiphumela emihle engamanga. Uma i-hyperintensity ngaphakathi kwe-meniscus yomugqa ithinta kakhulu indawo ye-meniscal, okungukuthi okungenani ezingxenyeni ezimbili eziseduze, kutuswa ukuba kubhekwe njenge-pathological. Lo mqondo kufanele ushintshwe kuye ngendlela yokutholwa kwesithombe esetshenzisiwe (izigaba ezi-3 kuye kwezingu-4 mm noma ukuthola ivolumu ye-3D enezigaba ze-isotropic mm).

Ngezinye izikhathi imifantu emisebe ye-meniscal kuba nzima kakhulu ukuyixilonga, uma kubhekwa ukuthi ikuphi. Lokhu ikakhulukazi kuholela ekungajwayelekile kwe-morphological:

• Ukuphazamiseka konqenqema lwamahhala noma ukunqunywa kwesithombe esingaphambili;

• Ukubukeka okungaqhubeki noma okuncishisiwe kwe-meniscus bowtie esithombeni se-sagittal (Umfanekiso 6);

Umfanekiso 6. Ukuqhekeka kwe-radial engxenyeni yangaphambili ye-meniscus emaphakathi ekubukeni okunesisindo se-sagittal proton. Ukubukeka okuvamile kwe-meniscus emaphakathi enqanyuliwe umnsalo (umcibisholo).

• I-meniscus engekho noma 'ghost' enegebe eliqinile le-radial.

Ukuqhekeka kwe-meniscus ngesibambo sebhakede kwenza kube nzima cishe u-10% we-spondylolisthesis enwebeka ngobude. Kulesi simo, ukuzwela kwe-MRI kumayelana ne-70%, kuye ngokuthi indlela yokuxilonga esetshenzisiwe.

Imiphumela ye-MRI edinga ukunakwa:

Ukuthola okuvame kakhulu ukubonwa okuqondile kwezingcezu ezifudukayo endaweni ye-intercondylar: uphawu lwendawo 'i-double posterior cruciate ligament (PCL)' luyisici lapho i-meniscus ephakathi ilimele futhi i-anterior cruciate ligament iqinile. Ingxenye ehlukanisiwe ibonakala njengebhande le-arcuate hypointense elihambisana nomsipha ovamile wangemuva we-posterior cruciate, okhiqiza ukubukeka 'i-PCL ekabili' (Fig. 7). Izimpondo zamareki ezeqile (ezingaphezu kuka-6 mm ngobukhulu) zingase futhi zibonise ukuba khona kwesibambo somphongolo (Umfanekiso 8). Kulokhu, ucezu lwe-meniscus oluhlukanisiwe lunamathele ophondweni lwangaphambili olunempilo.

Umfanekiso 7 Ukubukeka kwesibambo se-meniscus esimaphakathi kunophawu 'i-PCL ekabili'. Ukubuka okunesisindo se-Sagittal PD ngokucindezelwa kwamafutha: Ucezu lwe-meniscus olugudlukile (umcibisholo) lungaphansi kwe-PCL evamile (umcibisholo) futhi lwakha isici 'i-PCL ekabili' ukubukeka.

Umfanekiso 8 Ukubukeka kophondo olukhulu lwangaphambili. Ukubuka okunesisindo se-Sagittal proton. Ingxenye engaphambili yocezu oluhlukanisiwe (umcibisholo) inamathiselwe engeli ye-meniscus yangaphambili (umcibisholo). Qaphela ukuthi amakhona angemuva awabonisiwe (*).

Eminye imiphumela ye-MRI:

Ezinye izimpawu ze-MRI ziqinisekisiwe, njenge-bow tie engekho, isibonakaliso se-meniscus esihlanekezelwe, noma izingcezu ze-meniscal ezihanjiswe ngokuqondile esifundeni se-intercondylar ezithombeni zangaphambili ze-millimeter (Fig. 9) noma izithombe ze-axial.

Umfanekiso 9 Isibambo sebhakede esisusiwe esikhaleni. Ukubuka okunesisindo se-PD yangaphambili ngemva kokucindezelwa kwamafutha. Isiqephu se-meniscus esisusiwe (umcibisholo) sixhumene ne-ACL (umcibisholo).

Olunye uphawu olusemthethweni lokungazinzi kwe-meniscal ukuhlonza ukugudluzwa kwe-peripheral of menscal fragments ukuya e-femoral menscal recess noma i-femoral-tibial recess. Lokhu kususwa kuhilela cishe ngokukhethekile i-meniscus yezokwelapha futhi kuyinkinga kwezinye izimo zokuqhekeka okuvundlile ku-10% wezigameko. Izingxenye ze-Coronal kanye ne-transverse ziyindlela engcono kakhulu yokuhlonza lezi zingcezu.

I-Meniscus Detachment

Ukuhlukaniswa kwe-meniscal kwenzeka ngenxa yokulimala okukhulu kwe-valgus futhi kubangelwa ukuphuka kwe-meniscus' capsular appendage. Lezi zivame ukuthinta uphondo lwangemuva lwe-meniscus yangaphakathi enamathela ku-capsule ehlangene ngokusebenzisa ukuqina kwe-capsule ehlangene (i-posterior oblique ligament).

Babangela ukukhishwa kwe-5 mm ku-meniscus ephakeme kusukela emngceleni ongemuva we-tibial plate ezithombeni ze-sagittal (Umfanekiso we-11), noma ukufakwa kwamanzi phakathi kwesisekelo se-meniscus kanye nendiza ye-capsule ehlangene.

Umfanekiso 11 Ukuhlukaniswa kophondo lwangemuva lwe-meniscus. Ukubuka kwe-Sagittal proton density. I-meniscus ehlukanisiwe isuswa ngaphandle. Kukhona indawo enkulu ye-hyperintensity (*) phakathi kwesisekelo se-meniscus kanye ne-posterior capsule (umcibisholo).

I-Meniscus entantayo

Lona umphumela wokulimala okunodlame futhi kungenxa yokuqhekeka kwe-meniscal-tibial ligament kanye nokuhlukaniswa kwengxenye emaphakathi ye-meniscus. Ku-MRI, i-meniscus ehlukanisiwe izungezwe uketshezi ngokuphelele futhi ibonakala 'intanta' ethafeni le-tibial (Umfanekiso 12).

Umfanekiso 12 I-meniscus entantayo. Ukubuka kwe-frontal proton density nge-fat saturation. I-meniscus ehlukanisiwe izungezwe uketshezi, ikakhulukazi phakathi kwendawo yayo ephansi kanye ne-tibial plateau (umcibisholo).

I-Meniscus ye-Postoperative

Ubuhlungu obuphindaphindiwe ngemva kwe-meniscectomy buveza ubunzima obuningi bokuxilonga: ama-fissures aphindaphindiwe, i-postmeniscectomy, i-chondrolysis, i-subchondral necrosis, noma i-arthralgia. I-MRI ivamise ukuhluleka ukubona imifantu ephindelelayo ngenxa yokuthi i-meniscectomy ishiya umfutho ophakathi 'ongalungile' oxhumana ne-meniscus. Okuwukuphela kokutholwa okwakubhekwa njenge-pathological futhi kwahunyushwa njengokuqhekeka okuphindaphindiwe kwakuyi-fluid intrameniscal hyperintensity ezithombeni ezinesisindo se-T2. Le mikhawulo ye-MRI elula iyodwa ibangele abanye ababhali ukuthi baphakamise ukusetshenziswa kwe-MRI arthroscopy, nakuba futhi imiphumela lapha ayihambisani.

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