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Ultrasonography research of knee joint injury
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Rustamova Umida Mukhtarovna, PhD, senior researcher Head of X-ray diagnostic department of the Research Institute of Traumatology and Orthopedics Uzbekistan, Tashkent E-mail: [email protected]
Ultrasonography research of knee joint injury
Abstract: Ultrasonographic studies were conducted in 468 patients with complaints of pain in the knee joint between the ages of 35 to 58 years (mean age 48 years). Traumatic injuries are identified as fractures joint, tendon ruptures quadriceps, gap lateral ligaments and the patellar tendon, meniscus damage, as well as changes that may be accompanied at these injuries. Semiotics joint damage elements are described.
Keywords: ultrasonography, knee joint, traumatic injuries, meniscus damage, synovitis, bursitis, partial tears of ligaments.
Introduction. The study of literature suggests that there is a little science-based information about the differential diagnosis of knee joint pathology. In many scientific publications, the main aspects of the use of ultrasonography in the diagnosis of injuries and other changes in the structures of the knee joint are shown (Eskin N. A., 2001; Bruhanov A. V., 2006). However, the problem of complex radiation pathology diagnosis of soft tissue structures of the knee joint remain insufficiently studied. Until now, no data regarding comparative analysis of diagnostic efficacy of ultrasonography and radiography of soft tissue injuries in the structures of the joint. Indications for use of radiographic diagnosis is not defined, clinical diagnostic algorithm of x-ray examination of patients with soft tissue injuries and bone structures of the joint is not designed. Investigation of the knee joint through the application of digital radiographic and ultrasonographic techniques, development of differentiated criteria for various types of joint pathology and put them into practical health care, in our opinion, is one of the most important preventive health trends of the population.
Purpose of research — Studying the state of elements of the knee joint during his traumatic changes.
Materials and methods of research. The basis of the research on these urgent issues is the results of comprehensive clinical, ultrasound, X-ray examination of patients with different types of traumatic changes of the knee joint structures. Ultrasonographic studies were conducted in 468 patients (574 hips) with complaints of pain in the knee joint between the ages of 35 to 58 years (mean age 48 years). Ultrasonic diagnosis conducted with MyLab-40 Company Esaote apparatus (made in Italy) by applying the method polypositional multifrequency linear transducer 7-12 MHz. During sonography of knee joint, we followed the mandatory requirements. In the beginning — the sick man on his back, knee examined first of several joint flexed about 30 degrees and in the
unbent state it, then survey the patient on his stomach with a straightened limb.
Results and discussions. Based on the study results of studies, we identified ultrasonographic changes in knee injury and the following semiotics are developed: During bone fractures of joint, hyperechoic contours are interrupted with the presence of hypo-or anechoic stripe or area, and when mixed fragments hyperechoic contour is deformed.
Gap quadriceps visualized with heterogeneous structure, while there is a violation of stroke fibers, existence of anechoic areas — hematomas, thickening of the muscle layers. Partial rupture is distinguished presence of micro hematoma and muscle thickening. Tendon rupture of the quadriceps femoris: it is not smooth contours, structure is uniformed, with the presence of anechoic areas, hematomas, and violation of interruption of the fibers, thickening of the tendon. Partial rupture of the tendon of the quadriceps femoris — contours equal or not equal, sometimes interrupted circuit on the one hand, the structure is uniformed, with the presence of micro-anechoic — micro damages, bruises, and a violation of interruption of the fibers, thickening of the tendon.
At breaks of lateral ligaments and the patellar tendon differentiated this picture: contours are not smooth, the structure — uniform, with the presence of anechoic areas, bruising, deformity and interruption of the fibers, thickening of ligaments. Partial tears of ligaments and the lateral patellar tendon looked with equal or even, sometimes discontinuous contours on the one hand, the structure with non-uniform, with the presence of micro-anechoic — micro tears, bruises, broken and interrupted the course of the fibers, ligaments thicken.
Above the knee bursitis visualized with smooth and crisp exterior contours, while often thickened synovium, the inner contour is usually uneven. Above the knee bag is extended and thickened, in-
Section 7. Medical science
ternal structure is homogeneous or heterogeneous suspension with flakes. Infrapatellar bursitis was detected less than above the knee bursitis. Its contours are always smooth and clear. Thickening of the capsule was observed in rare cases. The internal structure of the bursa is usually echofrei to liquid. In our observation, infrapatellar bursitis resolved quickly compared to above the knee bursitis. In the presence of bursal fluid was observed in the side channels, often in the medial channel.
In our practice, rarely mentioned fat-body injury (non-uniform structure with the presence of anechoic areas), more differentiated compacted areas that may have been previously associated with the transfer of trauma.
Gap (front or rear horns internal or external) of the meniscus was visualized very diverse. Contours equal or not equal — depending on the nature of the fracture line, the structure — the presence of non-uniform line fragmentation in different types: transverse, Y- shaped, longitudinal or oblique line fragmentation. Sometimes transverse fragmentation inner part of the meniscus is not rendered or visualized with the presence of diastase (as anechoic area with indistinct contours) — rupture of the type "watering can handle." Also noted a couple capsular tears. In our practice, most often observed in the anterior horn tears of the medial meniscus.
Damage to the X-shaped ligaments caused some difficulties because of the inability to trace all over. This is usually inhomogeneous structure or not visualized on the site of its visualization is defined anechoic area with indistinct contours.
The above changes of the joint elements in some cases accompanied by the following states:
Myositis quadriceps — while the structure is somewhat reduced echogenicity, perhaps its thickening. Tendinitis quadriceps tendon — smooth contours and clear, homogeneous structure may be slightly reduced echogenicity, sometimes thickened. Tenosynovitis quadriceps tendon accompanied with smooth and precise contours, usually with a homogeneous structure, the presence of anechoic rim — liquids in small quantities between the tendon and its sheath. Small cystic formation quadriceps tendon — contours smooth and crisp, with the presence of non-uniform structure anechoic area round or round-oval.
Ligament lateral ligaments and the patellar tendon — smooth contours and clear, homogeneous structure may be slightly reduced echogenicity, thickened; ligament X-shaped ligaments — smooth contours and fuzzy, homogeneous structure, the presence of anechoic rim.
Meniscal cyst is visualized in different ways: 1) on the back portion of the meniscus is determined anechoic rounded shape, 2) on the background portion of the meniscus is determined anechoic rounded-oval or irregular shape with the presence of lateral ligament strain,
3) cystic degeneration of the meniscus lateral ligament damage, and
4) near the meniscus cyst usually looked oval, often located on the lower-outer contour of the meniscus. Cystic changes were more frequently observed in the anterior horn of the lateral meniscus.
Becker's cyst visualized at the joint on the rear surface of it, often in the central segment of the domestic — is manifested in different ways: 1) round-oval, 2) longitudinally oval 3) crescent-shaped, and 4) the presence of irregular shape with an internal partition. The internal structure of the cyst more homogeneous and smooth contours and clear, at least — with the presence of cereal suspension and moderately hyperechoic thickened capsule (for chronic forms). Almost all variants can be traced link ("path") into the joint.
Having hondromic bodies (the number and size of different acoustic shadow densities depends on their localization — in the glenoid cavity).
Hygroma visualized with clear and smooth contours, mostly round or round-oval shaped anechoic internal structure.
Organized hematoma is visualized with clear and smooth, or not smooth contours, sometimes with a hyperechoic rim and inhomogeneous internal structure with the presence of hyperechoic inclusions.
Thus, on the basis of sonographic surveillance images in patients with knee injury, we came to the conclusion that this method of diagnosis allows to identify reliable criteria changes, thus giving reason to recommend it to the widespread adoption of the practice to clarify the diagnosis in conjunction with X-ray method. Described feature of the items in his knee injury helps to diagnose more fully and accurately, and improves the quality of diagnosis, allowing noninvasive and repeatedly monitor treatment.
Rustamov Bakhtiyor Baysarievich, Independent competitor Tashkent Medical Academy Irmatov Nizom Zhumakulovich, Head of the department of hygiene of children and adolescents and nutrition of the Tashkent Medical Academy
E-mail: [email protected]
Toxicological evaluation of medical and biological safety of the red palm oil «Premium caratino»
Abstact: It was found that the oil «Premium Caratino» has no negative impact on the health of the animals after prolonged entry into the body, does not cause locally-irritating to the skin, does not have sensitizing properties, non-toxic products of plant origin. Keywords: toxicology, food safety, palm oil.
Relevance. Palm kernel oil is extracted from the pulp of the with the presence therein of degradation products and transfor-fruits of oil palm by pressing and produce only refined deodorized. mation of the fatty acid, not uncommon and the presence therein Very unstable when the oil storage. At room temperature, it has a of toxic elements, pesticides, mycotoxins and other xenobiotics solid consistency. (foreign to the body substances chemical and biological etiology).
When used in nutritionally substandard, falsified or de- The presence of some of these xenobiotics can cause severe poi-layed vegetable oil develops picture toxic poisoning associated soning, and some of them are able to accumulate in the body for
