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운동기학 HCP#1 이관절성균관 대학교 의과대학 G2 PBL
2007313075 손의영
Tutor : 최필조 교수님
Contents
• Radiography for Knee pain
Clinical
• Rheumatoid Arthritis• Osteoarthritis
Radiology
Case Relevance
RADIOGRAPHY FOR KNEE PAIN
Radiography for Knee pain - STAN-DARD
• 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
출처 : 서울대병원 진방과
25/M Normal 50/M Knee PainDx. OA
AP View• Anatomy
Lateral View
• Evaluate Loose body & Patella alta & baja• Sup. & Inf. Osteophyte / Trochlear depth• 단점 : Inter-observer reliability
Abnormaly high Low
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 : Sulcus 와 condyle 을 연결한 선을 그어서 이등분 선을 만든다
• To : Patella 의 central ridge 와 연결한 선 Med. OR Lat. ??• Lat. 이 심할 수록 Alignment 가 많이 망가졌다고 볼 수 있다 .
Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins
Mild malalign-ment
Patella Malalignment
<BEFORE>
<AFTER Surgery>
Copyright © 2010 UW-Eau Claire and the Board of Regents of the University of Wisconsin System
Patella Malalignment
Copyright © 2010 UW-Eau Claire and the Board of Regents of the University of Wisconsin System
<BEFORE>
<AFTER Surgery(Rt)>
RADIOLOGYOsteoarthritis, Rheumatoid Arthritis
Degenerative Joint Disease – OA
• Imbalance between force across a joint and in-tegrity of articular cartilage matrix
• Systemic factors: age, obesity, occupation, activity, in-
activity, metabolic
• Local factors: trauma, malalignment, congenital or ac-
quired articular deformity, infection, RA, crystal deposi-
tion disease
Osteoarthritis
• Stressed segment (hip– superior, knee- medial compartment)– Asymmetric joint space loss– Subchondral sclerosis– Subchondral cyst
• Unstressed segment– Marginal bony spur formation (osteophyte)
• 초기에는 정상일 수 있다 .• 이미지상 중증도와 증상의 중증도가 일치하지는
않는다 .• MRI, US 는 진단적 가치가 탁월하다 ?
골극 , 뼈돌기
하얗게 보이겠네
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 osteope-nia
• Increased vascularity• Increased turn-over
– Marginal erosion• Pannus formation
• Late changes– Diffuse osteoporosis– Symmetrical joint space nar-
rowing• Cartilage destruction
– Subchondral cyst• Subchondral bone destruc-
tion
– Subluxation• Periarticular ligamentous
structure destruction
– Fibrous/bony ankylosis
Rheumatoid Arthritis
• Early changes
Soft tissue swelling
Marginal bony ero-sion
Periarticular osteope-nia
Rheumatoid Arthritis
• Late changes
Subluxation
Subchondral cyst
Rheumatoid Arthritis
Symmetric joint space narrowing
CASE RELEVANCE
Case Relevance – X-ray
• Fig1. Standing AP view
Med. : Stressed
Lat. : Un-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’