УЗИ сканер HS70
Точная и уверенная диагностика. Многофункциональная ультразвуковая система для проведения исследований с экспертной диагностической точностью.
Введение
В современной лучевой диагностике ультрасонографии отводится ведущая роль, причем сфера ее применения постоянно расширяется. Если 15-20 лет назад ультразвуковая диагностика имела распространение лишь в классическом поясе — акушерство и гинекология, уронефрология, органы брюшной полости, то в последнее десятилетие, благодаря совершенствованию аппаратуры, разработке новых методологических приемов, стало возможным применение эхографии в тех областях, которые ранее считались недоступными для ультразвука.
Одно из таких направлений развития ультрасонографии — применение ее в травматологии и ортопедии [1-5], в частности, для обследования коленных суставов.
Методика исследования
Исследование проводится линейными или конвексными датчиками частотой от 5 до 10 МГц. При этом врач ультразвуковой диагностики должен знать не только нормальную и ультразвуковую анатомию обследуемого сустава, но и строго соблюдать предлагаемый протокол ультразвукового сканирования.
Анатомической особенностью строения коленного сустава является наличие менисков — хрящевых пластинок трехгранной формы, расположенных между суставными поверхностями, проникающих на определенное расстояние в суставную полость (рис. 1, 2). Наружный край мениска срастается с суставной сумкой, внутренний заострен в форме клина и обращен в полость сустава.
Рис. 1. Коленный сустав: а — вид спереди, б — поперечный срез.
Рис. 2. Коленный сустав: вид сбоку.
Травматические повреждения и заболевания менисков — одна из наиболее частых причин болей в коленном суставе.
В начале исследования больной находится в положении лежа на животе, ноги слегка согнуты в коленях. Датчик располагается в области подколенной ямки параллельно длинной оси нижней конечности в месте максимальной пульсации артерии, определяемой пальпаторно, и на экране монитора эта позиция служит для определения правильного положения датчика (рис. 3).
Рис. 3. Ультрасонограмма и схемы заднего отдела коленного сустава.
Под контролем руки исследователя датчик смещается по проекции суставной щели латерально до момента, когда на экране появится клиновидная эхопозитивная структура умеренной интенсивности, соответствующая заднему рогу наружного мениска (рис. 4).
Рис. 4. Ультрасонограмма и схемы проекции заднего рога мениска.
При этом до визуализации заднего рога мениска иногда выявляется сeсамоидная косточка (рис. 5).
Рис. 5. Ультрасонограмма, схема подколенной области и расположение датчика.
Затем больной поворачивается на больную сторону, нога сгибается в колене до 50-60°, датчик располагается в проекции суставной щели над промежуточной частью мениска и постепенно смещается кпереди до момента, когда на экране монитора визуализируется структура переднего рога. Аналогично исследуется медиальный мениск (рис. 6).
Рис. 6. Ультрасонограмма, схема медиального отдела коленного сустава и расположение датчика.
Исследование немного ниже подколенной области коленного сустава под углом в 60° от продольного среза позволяет визуализировать медиальную и латеральную головки m.gastrocnemius (рис. 7).
Рис. 7. Ультрасонограмма, схема подколенной области и расположение датчика.
Поворот на 90° ультразвукового датчика от продольной оси конечности в проекции бедренной кости дает возможность визуализировать медиальный и латеральный мыщелки бедра, сосуды подколенной области, частично заднюю и переднюю крестообразные связки (рис. 8).
Рис. 8. Ультрасонограмма, схема подколенной области и расположение датчика.
Исследование переднего отдела коленного сустава позволяет оценить состояние надколенника, сухожилия m.quadriceps, собственной связки надколенника, жировых тел и верхнего заворота коленного сустава (рис. 9-17).
Рис. 9. Ультрасонограмма, схема и расположение датчика при исследовании переднего отдела коленного сустава.
Рис. 10. Ультрасонограмма, схема и расположение датчика при исследовании верхнего отдела коленного сустава.
Рис. 11. Ультрасонограмма, схема и расположение датчика при исследовании нижнего отдела коленного сустава.
Рис. 12. Ультрасонограмма, схема и расположение датчика при исследовании коленного сустава в покое.
Рис. 13. Ультрасонограмма, схема и расположение датчика при исследовании коленного сустава при напряжении m.quadriceps.
Рис. 14. Ультрасонограмма, схема и расположение датчика при поперечном исследовании верхней части коленного сустава.
Рис. 15. Ультрасонограмма, схема и расположение датчика при исследовании нижнего отдела коленного сустава.
Рис. 16. Ультрасонограмма и схема нижнего отдела бедра и надколенника.
Рис. 17. Ультрасонограмма и схема места прикрепления сухожилия m.quadriceps в поперечном срезе.
Протокол УЗИ коленного сустава
В протоколе УЗИ коленного сустава должны быть отражены следующие позиции:
- Наличие выпота в верхнем завороте (есть, нет).
- Эхоструктура жидкости (однородная, неоднородная).
- Наличие инородных тел (есть, нет).
- Сухожилие прямой мышцы бедра (целостность нарушена, не нарушена).
- Надколенник — контуры (ровные, неровные), наличие бурсита (есть, нет).
- Собственная связка — целостность (нарушена, не нарушена), структура (одно родная, неоднородная, пониженной эхогенности), толщина, наличие бурсита (есть, нет).
- Состояние жировых тел (структура изменена, не изменена), гипертрофия (есть, нет).
- Состояние медиопателлярной складки — структура (изменена, не изменена), повреждение (есть, нет).
- Боковые связки — структура (изменена, не изменена), наличие/отсутствие диастаза сухожилий при проведении функционального теста.
- Суставные поверхности бедеренной и большеберцовой костей (ровные, неровные), костные разрастания (есть, нет), наличие дополнительных включений (есть, нет).
- Гиалиновый хрящ — контуры (ровные, неровные), толщина (истончен, в пределах нормы — до 3 мм).
- Мениски: наружный — форма (правильная, неправильная), структура (однородная, неоднородная), контуры (четкие, нечеткие; ровные, неровные), фрагментация (есть, нет), кальцинация (есть, нет), наличие жид костного образования в паракапсулярной зоне (есть, нет); внутренний — аналогичным образом описываются форма, структура, контуры, наличие фрагментации, кальцинации, паракапсулярная зона.
- Наличие кисты Беккера в подколенной области (есть, нет).
Литература
- Миронов С.П., Еськин Н.А., Орлецкий А.К., Цыкунов М.Б. Новый метод тестирования с помощью сонографии при повреждении связок коленного сустава // Тез. докл. VI конгресса Европейского общества спортивной травматологии и артроскопии коленного сустава. — Берлин, 1994. — С.43.
- Еськин Н.А. Комплексная оценка повреждений и заболеваний мягких тканей и суставов /Дисс. . д-ра мед. наук. — М., 2000.
- Fornage B.D. Ultrasonography of Musculs and Tendons // Springer — Verlag. NewYork, 1988. 227 p.
- Petersen L.J.,Rasmunssen O.S. ULscanning som diagnostik metode ved mistanke om menisklaesion i knaeet. Prospektiv blindet undersogelse af 52 patienter // Ugersk Laeger, 1999, 161 (41): 5679 — 5682.
- Yabe M., Suzuki M., Hiraoka N., Nakada K., Tsuda T. A case of intraarticular fracture of the knee joint with three layers within lipohemarthrosis by ultrasonography and computed tomography // Radiat Med., 2000, 18 (5): 319 — 321.
УЗИ сканер HS70
Точная и уверенная диагностика. Многофункциональная ультразвуковая система для проведения исследований с экспертной диагностической точностью.
Энциклопедия УЗИ и МРТ
Болезненные ощущения в коленях – симптом, с которым чаще всего обращаются люди к врачу. Для выявления патологий применяется ультразвуковой метод исследования. УЗИ коленного сустава позволяет на начальных этапах обнаружить разнообразные заболевания, травмы.
Немного из анатомии
Соединение коленной чашечки, бедренной и большеберцовой костей называется коленным суставом. Малоберцовая кость в его формировании не участвует. Суставообразующие поверхности покрывает хрящ, представляющий собой гладкую, скользящую поверхность.
Между большеберцовой и бедренной костями располагаются мениски. Они стабилизируют колено, играют роль амортизатора. При движении основная нагрузка приходится на мениски. Они защищают от повреждений хрящи.
Весь сустав располагается в суставной сумке. Она имеет несколько выпячиваний. Основная функция суставной сумки – защита колена от механического воздействия. Огромную роль играют связки. При нарушении их целостности ограничивается подвижность.
Преимущества УЗИ
Колено является одним из самых больших суставов человеческого тела. Соответственно, оно нередко травмируется. Для выявления патологий применяется УЗИ коленного сустава. Однако есть и другие методы диагностики – рентген, МРТ. 
Рентгенография или УЗИ?
Часто при патологиях коленного сустава проводится рентген, но у него есть существенный недостаток. Рентген не позволяет диагностировать заболевания на ранних этапах. В большинстве случаев рентген выявляет лишь те патологии, которые уже привели к поражению костных элементов.
Если сравнить ультразвуковое исследование коленного сустава и рентген, то первый метод имеет больше преимуществ. Во-первых, отсутствует лучевая нагрузка на пациента. Во-вторых, УЗИ, в отличие от рентгена, позволяет визуализировать мягкотканные компоненты сустава, выявить патологические изменения на начальных этапах.
МРТ или УЗИ?
МРТ расшифровывается как магнитно-резонансная томография. Этот метод диагностики базируется на использовании радиочастотного излучения и магнитного поля. Стоит учитывать, что у МРТ имеются противопоказания. УЗИ – более безопасный способ диагностирования патологий и травм, нежели МРТ.
Что применять для исследования сустава: МРТ или УЗИ – вопрос, на который невозможно однозначно ответить. Целесообразность проведения того или иного исследования устанавливает врач. Если специалисту нужно изучить костные ткани, то может быть сделан выбор в пользу МРТ (УЗИ чаще всего используется для исследования мягких тканей).
Показания
Ультразвуковое исследование назначается при наличии подозрительных симптомов, жалоб пациента. Показанием служат подозрения на какие-либо травмы и патологии:
- доброкачественные, злокачественные новообразования в костях, формирующих колено;
- воспалительные, дегенеративно-дистрофические заболевания сустава;
- нарушение целостности хрящевых прокладок (менисков);
- повреждения коленной чашечки;
- разрыв связок и сухожилий.
Методика
Готовиться к ультразвуковой диагностике колена не нужно. Это абсолютно простая процедура. Есть лишь одно правило: исследование не следует проводить, если больному человеку делают внутрисуставные инъекции. Лишь спустя 5 дней после лечения можно пройти УЗИ.
При сканировании задних отделов суставов больного просят лечь на живот. Исследование других отделов осуществляется в положении лежа на спине. Во время УЗИ колени разгибают. Сгибают ноги лишь в тех случаях, когда нужно лучше визуализировать мениски.
Для того чтобы исследовать все элементы сустава, врачи выполняют сканирование в нескольких проекциях:
- Передняя поперечная проекция: ультразвуковой датчик во время исследования устанавливают у верхнего края надколенника.
- Передняя продольная проекция: ультразвуковой датчик располагают над коленной чашечкой параллельно оси бедра.
- Латеральная и медиальная проекции: визуализация элементов, формирующих колено, достигается при установке датчика на боковой или медиальной поверхности сустава в продольном положении.
- Задняя поперечная проекция. Ультразвуковой датчик располагают поперечно в области подколенной ямки.
- Задняя латеральная и задняя продольная медиальная проекции. Датчик устанавливают в подколенной ямке в ее латеральной или медиальной части в косопродольном положении.
Нормальная эхо-картина и протокол исследования
Во время УЗИ коленного сустава исследуются суставная полость и оболочка, выстилающая ее, гиалиновый хрящ, суставные поверхности костей, суставные сумки, завороты. Также оцениваются мягкие ткани, и определяется отсутствие или наличие краевых костных остеофитов.
В норме при ультразвуковом исследовании состояние структур колена должно быть следующим:
- ровность и четкость контуров у суставных поверхностей костей, отсутствие деформаций;
- равномерность и однородность гиалинового хряща;
- отсутствие краевых костных остеофитов;
- отсутствие выпота в полости сустава;
- гипоэхогенность суставных сумок и заворотов, отсутствие выпота;
- отсутствие синовиальной оболочки на снимках УЗИ;
- отсутствие отека мягких тканей.
После процедуры специалист распечатывает снимки, подтверждающие наличие каких-либо патологий, и заполняет протокол УЗИ, включающий в себя описательную часть и заключение. Первая часть содержит полное описание всех осмотренных элементов коленного сустава. Завершается протокол заключением. В нем врач оценивает обнаруженные ультразвуковые признаки и ставит диагноз.
Возможные патологические изменения
УЗИ коленного сустава позволяет специалистам выявить у своих пациентов различные болезни. Очень часто диагностируется остеоартроз. Это самая распространенная форма поражения суставов. Не менее часто у людей диагностируются артриты, воспаления суставных сумок и связок.
О лечении суставов рассказал китайский врач – профессор Ляо Чан. Как вылечить даже запущенную стадию болезни и избежать ужасных последствий заболевания – читайте здесь.
Остеоартроз
Дегенеративно-дистрофическое заболевание коленных суставов, возникающее из-за поражения хрящевой ткани суставных поверхностей, врачи называют остеоартрозом. Основной симптом – это боль. На начальных этапах заболевания она возникает после нагрузки и быстро проходит во время отдыха. По мере прогрессирования остеоартроза боль начинает мучить даже в состоянии покоя.
О наличии заболевания у больного свидетельствуют следующие ультразвуковые признаки:
- неровные контуры большеберцовой и бедренной костей;
- истончение хряща;
- присутствие краевых остеофитов;
- неоднородная структура хрящевых прокладок (менисков), наличие гиперэхогенных включений.
Артрит
Что показывает УЗИ коленного сустава – вопрос, ответом на который служат названия различных заболеваний. Например, в ходе исследования может быть выявлен артрит. Этот термин объединяет заболевания колена, проявляющиеся воспалением элементов сустава. Причинами могут быть инфекции, травмы, обменные нарушения.
Все артриты сопровождаются болью. Также наблюдаются следующие симптомы: покраснение кожного покрова, ограничение подвижности, хруст костей при нагрузке.
Ревматический артрит – наиболее часто встречающаяся форма заболевания. Увеличение размеров надколенниковой сумки, утолщение синовиальной оболочки, присутствие выпота в подколенниковой сумке, задних и боковых заворотах – основные ультразвуковые признаки воспалительного процесса, протекающего при этом недуге.
Супрапателлярный бурсит
Острая и хроническая боль в колене может быть вызвана воспалением суставных сумок и связок. Эти элементы сустава поражаются при различных заболеваниях. Одно из них – супрапателлярный бурсит. Заключение, завершающее протокол УЗИ, может содержать этот диагноз.
Супрапателлярный бурсит: локализация патологии
Причиной развития недуга служит травма колена. Из-за патологического процесса, протекающего в суставе, воспаляется надколенная сумка. В ней появляется выпот.
Во время УЗИ при заболевании специалисты обнаруживают участок треугольной формы пониженной эхогенности. Этот признак свидетельствует о наличии супрапателлярного бурсита. Могут наблюдаться и фиброзные спайки в полости. Они образуются при длительно существующих выпотах.
Тендинит
Этот термин включает в себя заболевания, при которых наблюдается воспаление ткани сухожилия и дальнейшая ее дистрофия. В колене поражается собственная связка коленной чашечки Основные клинические проявления недуга – припухлость и боль в той области, в которой протекает воспаление.
Из-за тендинита связка утолщается. Ее эхогенность снижается. При воспалении хронического характера могут выявляться участки кальцификации и фиброзные включения в волокнах связки.
Травмы колена
Нагрузка, оказываемая на коленный сустав, часто приводит к возникновению травм. Повреждаются мениски, разрываются связки и происходят переломы. Любые травмы могут быть выявлены в ходе ультразвукового исследования и занесены в протокол.
О наличии повреждений свидетельствуют ультразвуковые признаки:
- при разрыве четырехглавой мышцы бедра заметно нарушение целостности волокон;
- при переломе надколенника нарушается целостность контуров коленной чашечки (на снимках видны отломки);
- при разрывах связок наблюдается нарушение целостности их волокон, выявляется гипоэхогенный участок (гематома), снижается эхогенность из-за отека тканей;
- при повреждениях менисков нарушается целостность их контуров, выявляются гипоэхогенные участки, образуется выпот, отекают мягкие ткани.
УЗИ коленного сустава – наиболее доступный и достоверный метод диагностики. К его преимуществам относится также возможность многократного проведения без вреда для пациента. Повторные УЗИ коленного сустава позволяют следить за динамикой заболевания.
Коленный сустав – это крупнейшее и самое сложное подвижное соединение в организме человека. Каждый день он испытывает тяжёлые нагрузки и выполняет рутинную однообразную работу при изменении положения ног: ходьбе, приседаниях, подъёме по лестничным ступеням. В связи с этим для предупреждения развития осложнений и организации своевременных мер назначают УЗИ коленного сустава.
Важно понимать, что с течением времени коленные сочленения истираются и стареют, испытывают негативное влияние травм и заболеваний. Некоторые необратимы, но некоторые можно исправить. И чем быстрее будут обнаружены повреждения сустава, тем действеннее и проще будет лечение.
Когда нужно делать исследование?
Есть три основных направления, при которых врач посоветует пройти УЗИ подвижного сочленения колена.
Диагностическое направление
Что показывает УЗИ коленного сустава? Диагностическое ультразвуковое обследование рекомендовано с целью выявления таких болезней сустава как:
- артрит и артроз;
- остеоартроз – отличающийся от артроза лишь механизмом развития патологии;
- синовит и тенденит;
- повреждения мениска;
- разрывы или растяжения связок;
- кровоизлияния;
- переломы любого характера;
- дисплазия и прочие врожденные суставные патологии;
- опухоли любой этиологии.
Ультразвук позволяет хирургам, ортопедам и травматологам не только определять болезни опорно-двигательного аппарата, но и получать информацию об объеме внутрисуставной жидкости.
От того, что покажет УЗИ колена, зависят дальнейшие назначаемые медицинские мероприятия.
Исследование состояния здоровья спортсменов
Для спортсменов определённых категорий (например, для тяжелоатлетов и бегунов, прыгунов) процедура УЗИ колена является обычной практикой.
Такое исследование – необходимая составляющая часть подготовки к соревнованиям или проверки организма после тяжёлых нагрузок. Однако оно имеет смысл и во время периодов отдыха от соревнований.
Больше всех рискуют повредить коленный сустав спортсмены, которые занимаются:
- гимнастикой и фигурным катанием;
- горными лыжами, конькобежным спортом и сноубордом;
- борьбой и легкой атлетикой.
Назначение УЗИ детям старше 1 года чаще всего производится при одной из следующих патологий:
- остеохондропатии любого вида;
- суставных деформациях;
- образованиях, которые можно прощупать при пальпации сустава;
- местных покраснениях и отеках;
- локальных изменениях кожи в области сустава.
Контроль лечения
В процессе терапии важно наблюдать за динамикой происходящих изменений.
Что смотрят?
Ультразвук позволяет распознать и вовремя выявить почти все известные медицине негативные изменения коленных суставов. Для каждого из них есть свои характеристики, отражающие норму и отклонения от нее, например, контур соединения может быть ровным (характерно для здорового сустава) или неровный (что свидетельствует о наличии патологического процесса).
Кроме того, доктор по результатам УЗИ отметит в протоколе:
- Состояние верхних слоев кости (может быть равномерным или утолщённым, истончённым или однородным).
- Состав внутрисуставной жидкости (однородность ее структуры или наличие включений, если да, то каких – хлопьев, нитей и пр.).
- Характеристики хрящей – толщину или истончённость, контуры и их равномерность.
- Количество синовии (синовиальной жидкости) – в норме, выше или ниже нее.
- Изменения в суставной щели: если изменена, то в сторону сужения или расширения.
- Состояния капсулы сустава – есть утолщение или нет, и если есть, то равномерное оно или частичное.
- Наличие свободных тел в полости.
- Состояние и эхогенность передней и задней частей менисков, а также их контуров.
Нередко на УЗИ выявляют:
- патологическую жидкость, содержащуюся в полости коленного соединения;
- бурсит или кисту Беккера;
- костные разрастания или иные включения;
- состояние связок, сухожилий, мышц и прилежащих к суставу тканей.
Подготовка и методика выполнения
На УЗИ стоит захватить результаты всех обследований, которые пациент проходил в ближайшее время.
Особой подготовки от пациента не требуется. Процедура ультразвукового изучения суставов обычно проводится в двух положениях: больному нужно будет лечь на спину, затем – на живот. По ходу работы врач-диагност попросит полностью согнуть ногу в колене – это нужно для оценки крестообразных связок, поверхностей сустава и менисков.
В процессе обследования врач обязательно сравнит состояние симметричных суставов, чтобы получить представление об индивидуальных особенностях пациента и определить болезни аутоиммунного характера.
Обычно процедура ультразвукового изучения суставов длится не более 15 минут, после чего доктор заполняет протокол диагностики и заносит туда все результаты исследования.
Возможности ультразвука позволяют не только выявить признаки патологии, но и узнать причины ее появления. Данные УЗИ оценивают в комплексе с клиническими показаниями.
Плюсы и минусы УЗИ
У такой процедуры в медицине есть целый ряд плюсов, что дает УЗИ коленного сустава очевидные преимущества:
- Доступность оборудования, позволяющая закупить его даже для небольших клиник в отдаленных уголках страны.
- Процедура безболезненна и комфортна.
- Мягкие ткани отлично видны врачу во всех деталях, в отличие от рентгеновского снимка, позволяющего рассмотреть лишь костные структуры.
- Безвредность и неинвазивность – качества, позволяющие проводить УЗИ столько раз, сколько нужно для контроля действенности лечения.
- Полноценная диагностика без применения других методик – за 15 минут лечащий врач может получить полное представление о суставах и их состоянии.
- Если аппарат обладает функцией допплеровского исследования, то во время одной процедуры можно увидеть ещё и особенности кровотока исследуемой области.
Есть у метода и недостатки: например, ограниченность области осмотра. Нужно отметить, что неспецифичность полученной картинки делает расшифровку патологий зависимой от опыта и квалификации сонолога, проводящего исследование.
Цена и где сделать?
Где же сделать УЗИ коленного сустава (коленей), и какая у исследования стоимость? Исследовать суставы посредством ультразвука можно как платно, так и бесплатно. Первый вариант предполагает прохождение процедуры по собственному желанию или рекомендации врача, второй – наличие направления от лечащего доктора и полис ОМС.
В поликлинике
Из чего же складывается стоимость процедуры ультразвуковой диагностики суставных соединений?
- Из стоимости и качества диагностического оборудования, которым оснащено медицинское учреждение. К примеру, есть инновационные приборы для трёх- и четырёхмерного УЗИ, они позволяют детализировать экранное изображение и уточнить все нюансы патологических процессов. Это позволяет не просто вовремя начать лечение, но и сделать его максимально эффективным.
- Из квалификационной категории специалистов. Чем выше цена за процедуру, тем более опытные и популярные врачи привлечены клиникой для ее проведения;
- Из материального оснащения клиники. В стоимость платной диагностики входит цена салфеток, простыней, одноразовых стерильных инструментов для некоторых видов манипуляций, бахил и прочего;
- Из расположения клиники на карте (и арендной платы за здание);
- Из уровня медицинского центра, его известности и репутации.
Если сравнить среднюю стоимость УЗИ в российских регионах, то станет ясно, что дороже всего медицинские манипуляции обойдутся москвичам (средняя цена УЗИ колена – от 1200 до 1500 руб.). В Санкт-Петербурге цена варьируется от 600 до 1500 руб., а в регионах составит 600 – 1000 руб.
На дому
Благодаря развитию медицинских технологий и торговли на интернет-площадках купить портативный УЗИ-аппарат и обследовать колено при помощи УЗИ у себя дома сегодня может каждый.
Однако портативные домашние аппараты не дают всей информации, необходимой для постановки диагноза.
Исчерпывающим средством может быть только полноценное обследование в специализированном учреждении.
Заключение
УЗИ остается самым доступным, достоверным и удобным методом диагностики. Именно эта процедура предоставит врачу и пациенту всю информацию без сложной подготовки и болезненных манипуляций. Повторные исследования дают возможность оперативно отследить все изменения в динамике болезни и вовремя их скорректировать.
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ssed+on.+I+don%27t+know+that+We+ever+before+actually+managed+to+get+as+much+as+the+lady.+Even+with++I+became+off+drugs%2C+she+stressed+for+a+long+time+that+i+might+get+back+in+it.+Thankfully%2C+my+drug+rehab+had+been+successful+and+I+never+ever+relapsed. 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