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’