Normal tissues visualized by US 超声可探查到的正常组织 Bone 骨 Cartilage 软骨 Ligament 韧带 Entheses 附着点 Tendon 肌腱 Muscle 肌肉 Adipose tissue 脂肪组织 Skin 皮肤

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迁耸然杜
7 years ago
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1 Sonoanatomy of normal musculoskeletal tissue 正常肌肉骨骼组织的超声表现 Hilde Berner Hammer MD, PhD, Senior consultant Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

2 Normal tissues visualized by US 超声可探查到的正常组织 Bone 骨 Cartilage 软骨 Ligament 韧带 Entheses 附着点 Tendon 肌腱 Muscle 肌肉 Adipose tissue 脂肪组织 Skin 皮肤

3 Bone 骨 Normal bone is shown as a hyperechoic line 正常骨显示为一条高回声线 Radius, longitudinal, lateral arm 桡骨, 长轴, 前臂外侧 Medial knee joint space, longitudinal 膝关节内侧间隙, 长轴

4 Radius 桡骨 Radio-carpal 桡腕关节 Inter-carpal 腕骨间关节 Radio-carpal and intercarpal joint 桡腕和腕骨间关节 4

5 3. Metacarp 第 3 掌骨 3. Phalang 第 3 指骨 MCP 3 5

6 Distal humerus 肱骨远端 Radius 桡骨 Elbow, Anterior longitudinal 肘关节, 前方纵向扫描 6

7 Patella 髌骨 Femur 股骨 Knee 膝关节 7

8 Tibia 胫骨 Talus 距骨 Ankle: Talo-crural joint 踝 : 胫距关节 8

9 1. Metatars 第 1 跖骨 1. Phalang 第 1 趾骨 MTP 1 9

10 IP PIP 2 DIP 3 Osteophytes in finger joints 手指关节的骨赘 CMC 1

11 RA patient. MTP 1 joint with secondary osteoarthitis. RA 患者 MTP1 继发骨关节炎

12 Cartilage US definition 软骨的超声定义 Homogeneously anechoic layer lining the bony cortex and having superficial and deep margins that characteristically appear thin, sharp, continuous and regularly hyperechoic 骨皮质表面的均匀的无回声层, 深浅两个边缘为薄锐利连续和规则的高回声线

13 IP palmar, transverse IP 掌侧横断面 Use of high frequency probes ( 22MHz) may open for assessment of cartilage in small finger joints. 高频 ( 22MHz) 探头可探及手指关节等小关节的软骨 Palmar PIP 5 PIP5 掌侧 Palmar PIP 2 PIP dorsal, longitudinal PIP2 掌侧 DIP 3, palmar, transverse DIP3 掌侧横断面 Cartilage of healthy small finger joints 健康人手指关节的软骨

14 Cartilage of palmar PIP2, zoom. 22MHz probe. A healthy joint. 正常 PIP2 掌侧的软骨,22MHz 探头 An extensive magnification of the finger joint cartilage. 放大数倍后的指关节软骨

15 MCP 2-4, longitudinal and transverse. Normal cartilage. MCP2-4, 纵向和横断面扫描. 正常软骨

16 Cartilage in healthy knee; distal femur with maximum flexion of the knee 健康人膝关节股骨远端的软骨, 膝关节最大屈曲位

17 Pathology of cartilage 软骨病变 Cartilage of distal metacarp in MCP 2 (flexed finger) MCP2 掌骨远端的软骨 ( 指关节屈曲状态下 ) 外伤后的 MCP2 软骨损伤正常 OA Cartilage of distal femur (flexion of the knee) 股骨远端的软骨 ( 膝关节屈曲状态下 )

18 Cartilage thinning medial condyle 内侧股骨髁表面软骨变薄 Normal cartilage covering both condyles 双侧股骨髁表面软骨均正常

19 Ligaments 韧带 Hyperechoic fibrillar lines, connecting bones 高回声的纤维线, 连接骨 Often anisotropic 常出现各向异性伪像

20 Medial collateral ligament, healthy knee 正常膝关节的内侧副韧带

21 Medial collateral ligament in a patient with knee OA, from anterior to posterior 一名膝 OA 患者的内侧副韧带, 从前向后

22 The patellar tendon, functions like a ligament 髌腱, 起类似韧带的作用 Distal femur 股骨远端 Proximal tibia 胫骨近端

23 Distal femur, patellar tendon and proximal tibia 股骨远端, 髌腱和胫骨近端

24 Patellar tendon, transvers, from proximal to distal insertion 髌腱, 横断面, 从近到远

25 Enthesis 附着点 The insertion of tendons and ligaments 肌腱和韧带的附着处 Hyper-hypoechoic fibrillary pattern 高 - 低回声纤维结构

26 跟腱附着点纤维软骨的超声图像在牛类的验证和脊柱关节炎患者病变的描述 (A) 牛跟骨上的跟腱附着点, 本图是一代表性的长轴扫描附着点纤维软骨 (EF), (f) 是在骨 (b) 和附着点 (e) 之间的无回声层.(B)2A 图片所对应的解剖标本图像,EF 区域可在显微镜下看到 ( 模糊的蓝色轮廓内 ).(C) 同一份牛附着点标本的 HE 染色图像, 图中显示了附着点纤维软骨的尺寸和位置, 对应了超声图像 (D) 显微镜下的组织学切片, 放大倍数 4X,HE 染色, 显示了纤维软骨骨和附着点

27 超声下可看到跟腱附着点处的纤维软骨, 在脊柱关节炎中可以出现该处的病变这有助于我们更好的理解肌腱端病变图 1 跟腱附着点炎具有代表性的长轴扫描图像, 来自 2 个不同脊柱关节炎患者 (A) 附着点纤维软骨 (EF),(f) 是附着点处的无回声层, 紧邻骨 (b), EF 在近端比远端要厚一些 (B) 在骨侵蚀的区域内无回声层消失 (er) (C) 高倍放大厚测量 EF 的厚度

28 Insertion on the patella of the patellar tendon 髌腱附着于髌骨处 Insertion lateral epicondyle of the common extensors 伸肌总腱附着于肱骨外上髁

29 Normal Achilles insertion 正常的跟腱附着点

30 Tendons 肌腱 Hyper-echogenic fibrillary structures 高回声纤维结构 Clearly visible lines 线性结构清晰可见 Easy to make anisotropic 易出现各向异性伪像

31 A normal flexor tendon of a finger 正常的指屈肌腱

32 Flexion of the deep finger flexor 指深屈肌的屈曲

33 Anisotropy at this location because of the oblique part of the tendon 由于肌腱非垂直于探头而出现各向异性伪像 Tendon 肌腱 Quadriceps tendon in a healthy knee 正常膝关节的股四头肌腱

34 Anisotropy by tilting of the probe 探头倾斜所致的各向异性伪像

35 PsA patient; degenerative tendinitis in the Achilles tendon PsA 患者, 跟腱的退行性肌腱炎

36 Muscles 肌肉 Hyper-hypo-echogenic structures 高 - 低回声结构 Lines going horizontal or oblique 线的走行水平或倾斜 More or less tendinous parts 或多或少有一些腱性部分

37 Muscles in the arm, longitudinal scan 前臂的肌肉, 长轴扫描

38 Muscles in the arm, longitudinal scan 前臂的肌肉, 长轴扫描

39 Muscles in the arm, from elbow and distal to the wrist, palmar side 前臂的肌肉, 从肘至腕, 掌面观

40 Adipose tissue 脂肪组织 Hypo-echoic tissue 低回声组织 May be hyper-echoic lines in the tissue 组织内可伴有高回声线

41 Adipose tissue 脂肪组织 Medial and lateral joint space of the knee; meniscus and osteophytes. 膝关节内侧和外侧间隙, 半月板及骨赘

42 Pathology; Oedema of the foot 病变 : 足部水肿

43 Skin 皮肤 Hypo-hyper-echoic tissue 低 - 高回声组织 Superficial upper part of the scan 扫描的最表浅部分 Normally very thin 正常情况下非常薄

44 Normal skin 正常皮肤

45 Conclusion 总结 Knowledge of normal anatomy is the basis for understanding pathologies 认识正常组织是理解病变的基础 Use of dynamic US may increase the possibilities to detect pathology 超声动态扫描可提高病变探查的可能性

46 Thank you for your attention!

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