Haigusjuht. Helen Kikerpill II a arst-resident radioloogia

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1 Haigusjuht Helen Kikerpill II a arst-resident radioloogia

2 Kliinilised andmed: valu paremas puusas [Manaster et al]

3 MRT uuring lülisamba nimmeosast Olulist spinaalkanali ahenemist ega konkreetset närvijuurte kompressiooni muutused ei põhjusta. MRT; T2FRFSE; axiaalne L4/L5; sagitaalne

4 2013 sügis Sisemine rotatsioon Drehmann i märk Välimine rotatsioon

5 Reieluu pea extrusion index (N 25%) Wibergi nurk (N ) Dex 4 % Sin 7% Promineeruv tagaserv? Atsetabulaarindeks (N positiivne)

6 MRT parem puusaliiges SAG PD FS ja vaagen T2FRSE

7 MRT uuring AX T2 FRFSE; COR PDFS IP M. Iliopsoas OE M.Obturator externa Q M. Quadratus femoris G= m. gluteus max H= hamstring kõõlus noolepea = n ishiaticus dex

8 Iliopsoase bursiit [Anastasiadou et al ] Patogenees: - liigeseõõne vedeliku liigtootmine - otsene ühendus liigesega - bursa epiteeli hüpertroofia Kliiniline leid: - valu kubemes, mis kiirgub anteromediaalselt reielt põlveni/ kiirgub selga/puusa - palpeeritav mass ingvinaalsel - närvi/veeni kompressioonist tingitud sümptomid Diferentsiaaldiagnostika: - ingvinaalne lümfadenopaatia - kubemesong - laskumata testis - m. psoas e abstsess - femoraalarteri aneurüsm Ravi: - aspiratsioon - NSAID/kortikosteroid - venitusharjustused - bursektoomia/sünovektoomia/tep Diagnostika: UH, KT, MRT

9 A Ischiofemoral space (IFS) N: 20 mm Lühim vahemaa istmikuluu köbrukese ja reieluu väikese trohanteri mediaalse korteksi vahel. B Quadratus femoris space (QFS) Lühim vahemaa reie harmstringlihaste kõõluste ja iliopsoase kõõluse või väikese trohanteri vahel. m. iliopsoas e kõõlus m. quadratus femoris reie harmstringlihaste kõõlused [Torriani et al]

10 Ishiofemoraalne pitsumissündroom [Torriani et al; Atul et al] Sümptomid: -Krooniline valu seljas, kubemepiirkonnas, puusas; kiirgub reie tagaküljele -Liigese lukustumine, naksumine, krepitatsioon Kliiniline leid: Valu suureneb puusaliigese painutusel/sirutusel; sisemisel/välimisel rotatsioonil; adduktsioonil/abduktsioonil Palpatsioonil valu puusa taga Etioloogia Kaasasündinud/asendist sõltuv Valgus- seis Omandatud: Traumajärgne Tuumor OA Diferentsiaaldiagnostika: radikulopaatia, harmstring lihaste vigastus, MQF rebend, adduktorite tendiniit, piriformis sündroom, naksuva puusa sündroom, FAI Radioloogilised tunnused: Röntgenülesvõte: Reieluu väikese pöörla ja istmikuluu köbrukese vaheline distants lühenenud Subkondraalsed tsüstid Istmikuluu köbrukesel sklerootilised alad MRT Signaalimuutus m. Iliopsoase, reie harmstringlihaste kõõluste piirkonnas Bursa sarnased vedelikukogumid M. quadriceps femoris e keskosa turse; atroofia, rasvdegeneratsioon.

11 Kokkuvõte Diagnoosid: Ishiofemoraalne pitsumissündroom Femoroatsetabulaarne pitsumine (tagumine) Koksartroos (I/II aste Tönnise järgi) Coxa profunda le viitav leid Iliopsoase ja obturator externa bursiit

12 Kasutatud kirjandus Anastasiadou K, Karatziou C, Karakozoglou T, Karatziou H, Palladas P. A case of bilateral bursitis of the hip joints (Online). URL: Atul K. Taneja, MD, Miriam A. Bredella, MD, Martin Torriani, MD, MSc. Ischiofemoral Impingement. Magn Reson Imaging Clin N Am :65 73 Manaster B.J et al. Adult Chronic Hip Pain: Radiographic Evaluation RadioGraphics 2000; 20(10): S3-S25. Torriani M, Souto SCL, Thomas BJ, et al. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. Am J Roentgenol 2009;193(1): Thiel G, Harris J. et al. Age-Related Differences in Radiographic Parameters for Femoroacetabular Impingement in Hip Arthroplasty Patients. Arthroscopy: The J of Arthroscopic & Related Surg 2013; 29(7): Tosun O, Algin O, Yalcin N, et al. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal Radiol 2011;41(5):

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