Transcript HCP#1
성균관 대학교 의과대학 G2 PBL 2007313075 손의영 Tutor : 최필조 교수님 Contents Clinical • Radiography for Knee pain Radiology • Rheumatoid Arthritis • Osteoarthritis Case Relevance RADIOGRAPHY FOR KNEE PAIN Radiography for Knee pain - STANDARD • AP weight-bearing View • Lateral View • Merchant View AP View • • • • Antero-Posterior, Frontal View OA 뿐 아니라 Knee pain 시 Routine 하게 찍는 편 임상소견과 이미지소견이 꼭 일치하는 것은 아님!! Bipartite patella or Patella fracture 관찰 가능 25/M Normal 50/M Knee Pain Dx. OA 출처 : 서울대병원 진방과 AP View • Anatomy Lateral View Abnormaly high Low • Evaluate Loose body & Patella alta & baja • Sup. & Inf. Osteophyte / Trochlear depth • 단점 : Inter-observer reliability Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins Lateral View • Anatomy Merchant View Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins Merchant View • Patello-Femoral Components 와 Patella 관찰 • Evaluate for Patella alignment Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins Merchant View – Patella Alignment 평가하기 • From : Sulcus와 condyle 을 연결한 선을 그어서 이등분 선을 만든다 • To : Patella의 central ridge와 연결한 선 Med. OR Lat. ?? • Lat. 이 심할 수록 Alignment가 많이 망가졌다고 볼 수 있다. Mild malalignment Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins Patella Malalignment <BEFORE> <AFTER Surgery> Copyright © 2010 UW-Eau Claire and the Board of Regents of the University of Wisconsin System Patella Malalignment <BEFORE> <AFTER Surgery(Rt)> Copyright © 2010 UW-Eau Claire and the Board of Regents of the University of Wisconsin System Osteoarthritis, Rheumatoid Arthritis RADIOLOGY Degenerative Joint Disease – OA • Imbalance between force across a joint and integrity of articular cartilage matrix • Systemic factors: age, obesity, occupation, activity, inactivity, metabolic • Local factors: trauma, malalignment, congenital or acquired articular deformity, infection, RA, crystal deposition disease Osteoarthritis • Stressed segment (hip– superior, knee- medial compartment) – Asymmetric joint space loss – Subchondral sclerosis – Subchondral cyst 하얗게 보이겠네 • Unstressed segment – Marginal bony spur formation (osteophyte) 골극, 뼈돌기 • 초기에는 정상일 수 있다. • 이미지상 중증도와 증상의 중증도가 일치하지는 않 는다. • MRI, US 는 진단적 가치가 탁월하다? No! Osteoarthritis Rheumatoid Arthritis • 40-50 세, M < F, RF (+) • Synovial proliferation, Pannus formation • Bilateral symmetric involvements • Begin in small peripheral joints (hands, feet) & C-spine, knees, hips, shoulder, elbows • MCP, PIP & carpal joints, 4th & 5th MTP Rheumatoid Arthritis • Early changes – Soft tissue swelling • Synovial inflamation – Periarticular osteopenia • Increased vascularity • Increased turn-over – Marginal erosion • Pannus formation • Late changes – Diffuse osteoporosis – Symmetrical joint space narrowing • Cartilage destruction – Subchondral cyst • Subchondral bone destruction – Subluxation • Periarticular ligamentous structure destruction – Fibrous/bony ankylosis Rheumatoid Arthritis • Early changes Soft tissue swelling Periarticular osteopenia Marginal bony erosion Rheumatoid Arthritis • Late changes Subchondral cyst Subluxation Rheumatoid Arthritis Symmetric joint space narrowing CASE RELEVANCE Case Relevance – X-ray • Fig1. Standing AP view Lat. : Unstressed Med. : Stressed Asymmetric joint space loss Case Relevance – X-ray • Fig2. Lateral View Osteophyte?? Subchondral sclerosis Case Relevance – X-ray • Fig3. Rt. Weight-bearing View More Stressed Case Relevance – X-ray • Fig4. Merchant View 왼쪽도 Mild malalignment Reference • Harrison's Principle on Internal Medicine, 17th ed., McGraw Hill Inc., 2008 • Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins • Copyright © 2010 UW-Eau Claire and the Board of Regents of the University of Wisconsin System • 윤영철 교수님 강의록 ‘관절염의 영상의학적 소견’