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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Musculoskeletal system
216
Developmental dysplasia of the hip
PREPARATION
None.
POSITION
The patient is placed in a right and left lateral decubitus position for
examination of each hip; ideally in a cradle.
TRANSDUCER
Linear transducer; 7.5 MHz (newborn), 5.0–7.5 MHz (3 months).
METHOD
The infant should be as relaxed as possible (recent feed, parental presence, and examination in a darkened room are helpful). Each position
is assessed in the coronal plane by placing the transducer longitudinally
at the lateral hip. A static examination is performed with the hip in a
neutral position. For dynamic examination the hip is exed at 90
gently adducted and abducted, and gentle posteriorly directed stress is
applied to the exed, adducted hip.
APPEARANCE
On coronal images the iliac wing is seen as a horizontal high-reective
line paralleling the transducer. The bony acetabulum forms a highreective curve medially with a defect representing the normal triradiate cartilage. Prior to ossication the femoral head is low reective
with scattered specular echoes due to vascular channels. Superolateral
to the femoral head the joint capsule is seen as a high-reective line
attaching to the ilium. Just deep to this a small high-reective focus
represents condensed brocartilage at the labral tip. The remaining
labrum is seen as low-reective cartilage similar in reectivity to the
femoral head.
MEASUREMENTS
1. Graf alpha angle: Angle between the iliac line and a line along the
osseous acetabular roof on a coronal image of the hip. Normal is
°
> 60
.
2. Femoral head coverage: Relative coverage of the femoral head by
the bony acetabulum in exion. Normal is > 58%.
°
and
Developmental dysplasia of the hip
Coronal view through the pediatric hip showing the low-reective femoral head (FEM) with
scattered specular echoes lying appropriately in the acetabulum. (Dashed arrow, Iliac wing;
solid arrow, bony acetabulum; arrow head, joint capsule)
217
Coronal view through the pediatric hip showing the Graf alpha angle, which is measured
between the iliac line (solid arrow) and osseous acetabular roof (dashed arrow).
Musculoskeletal system
218
FURTHER READING
Graf R. Fundamentals of sonographic diagnosis of infant hip
dysplasia. J Pediatr Ortho. 1984; 4:735–740.
Morin C, Harcke HT, MacEwen GD. The infant hip: Real-time
US assessment of acetabular development. Radiology. 1985;
157:673–677.
Ömerog˘lu, H. Use of ultrasonography in developmental dysplasia of
the hip. J Child Orthop. 2014; 8:105–113.
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Musculoskeletal system
220
LOWER LIMB: KNEE
Anterior knee
PREPARATION
None.
POSITION
Supine for anterior structures with the knee extended for assessment of
collateral ligaments. Quadriceps and patellar tendons are examined in
exion and extension. Measurement of uid in the suprapatellar pouch
should be performed with the knee exed at 30°.
TRANSDUCER
7.0–15.0 MHz linear transducer.
METHOD
The presence of joint uid should be sought in the suprapatellar bursa
and the medial and lateral joint recesses. The quadriceps and patellar
tendons, and medial and lateral collateral ligaments are evaluated in
transversal and longitudinal planes.
APPEARANCE
The suprapatellar pouch is a low-reective band above the patella and
deep to the quadriceps tendon. It lies between the suprapatellar and
pre-femoral fat pads.
The medial collateral ligament has supercial and deep components.
The supercial ligament attaches to the medial epicondyle of the femur
and the medial tibial metaphysis.
The lateral ligamentous structures include the iliotibial band anteriorly, which inserts onto the anterolateral tibia; the bular collateral ligament, which runs obliquely from the lateral epicondyle of the femur
to insert onto the bular head in conjunction with the distal tendon of
biceps femoris; and the popliteus tendon, which attaches to the popliteal notch of the lateral femur.
Anterior knee
Longitudinal view of the suprapatellar pouch (arrows) with a normal volume of uid and
distal quadriceps tendon (QT) as it attaches to the patella (PAT) at 30° of knee exion.
The suprapatellar fat pad (SFP) and pre-femoral fat pad (PFP) lie on either side of the
suprapatellar pouch.
221
Longitudinal view of the medial collateral ligament (arrows) attaching to the medial
epicondyle of the femur (FEM) and medial tibial metaphysis (TIB).
Longitudinal view of the patella tendon (arrows) and its attachments onto the patella (PAT)
and tibia (TIB).
Musculoskeletal system
222
MEASUREMENTS
Suprapatella pouch
thickness (at 30° of knee
exion)
Medial collateral ligament
thickness
Distal quadriceps tendon
thickness (mean ± SD)
Mid-patellar tendon
thickness (mean ± SD)
Iliotibial band thickness
(mean ± SD)
4 mm
Proximal Distal
5 mm 3 mm
Males Females
5.1 ± 0.6 mm 4.9 ± 0.6 mm
Males Females
3.1 ± 0.4 mm 2.9 ± 0.5 mm
Femoral condyle Tibial condyle
1.95 mm ± 0.3 mm 3.4 mm ± 0.5 mm
Transverse view of the mid-patella tendon (arrows).
Longitudinal view of the ilio-tibial band (arrows) as it attaches onto the antero-lateral tibia.
(FEM, femur; TIB, tibia)
Anterior knee
FURTHER READING
Goh LA, Chhem RK, Wang SC, Chee T. Iliotibial band thickness:
Sonographic measurements in asymptomatic volunteers. J Clin
Ultrasound. 2003; 31:239–244.
Morris-Stiff G, Haynes M, Ogunbiyi S, Townsend E, ShettyS,
Winter RK, Lewis MH. Is assessment of popliteal artery
diameter in patients undergoing screening for abdominal aortic
aneurysms a worthwhile procedure? Eur J Vasc Endovasc Surg.
2005; 30:71–74.
Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard
reference values for musculoskeletal ultrasonography. Ann
Rheum Dis. 2004; 63:988–994.
223
Musculoskeletal system
224
Posterior knee
PREPARATION
None.
POSITION
Prone with the knee extended for assessment of the popliteal fossa.
TRANSDUCER
7.0–15.0 MHz linear transducer.
METHOD
The popliteal vessels and any cysts around the knee are evaluated in
axial and longitudinal planes. Doppler and color ow are used to
assess the popliteal vessels.
APPEARANCE
The popliteal artery and vein are aligned in a sagittal oblique plane in
the popliteal fossa, between the medial and lateral head of gastrocnemius, and appear as anechoic tubular structures with echogenic walls.
FURTHER READING
Goh LA, Chhem RK, Wang SC, Chee T. Iliotibial band thickness:
Sonographic measurements in asymptomatic volunteers. J Clin
Ultrasound. 2003; 31:239–244.
Morris-Stiff G, Haynes M, Ogunbiyi S, Townsend E, Shetty S, Winter
RK, Lewis MH. Is assessment of popliteal artery diameter in
patients undergoing screening for abdominal aortic aneurysms
a worthwhile procedure? Eur J Vasc Endovasc Surg. 2005;
30:71–74.
Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard
reference values for musculoskeletal ultrasonography. Ann
Rheum Dis. 2004; 63:988–994.
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