Imaging of Hip Trauma
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Šī literatūras recenzija ir pētniecības dokuments, lai labāk izprastu labākos diagnostikas rīkus katram konkrētam gūžas locītavas traumas stāvoklim, paļaujoties uz jaunākajiem radioloģiskajiem sasniegumiem. Kā arī rentgena staru, datortomogrāfijas un magnētiskās rezonanses ierobežojumu un priekšrocību izpēte. Šo pētniecības darbu raksturo pētījumi, analīze un literatūras apkopošana. Kopā ir atlasīti un apkopoti 34 avoti, izmantojot tādas E-data bāzes kā “Klīniskā atslēga” un “UptoDate” uz pierādījumiem balstītām zālēm, kā arī elektroniskas grāmatas un žurnālus ar “Access Medicine” starpniecību. Raksti un publikācijas, ko visā atslēgvārdu garumā meklē “Google Scholar”, tiek kopīgi apspriesti un minēti secīgajās lapās.
Gūžas locītavas trauma ir īpaši svarīga vairākās medicīnas aprindās sakarā ar tās milzīgo ietekmi uz veselības aprūpes ekonomiku un resursiem, pieaugošo saslimstību ar vecāka gadagājuma cilvēkiem un tās pēcoperācijas komplikācijām un saslimstību. Rentgenogrammas parasti izmanto akūtai diagnozei attiecībā uz gūžas locītavas traumu, tomēr CT un MRI ir dažādas priekšrocības attiecībā uz specifiskām gūžas locītavas patoloģijām.
Gūžas traumas galvenokārt skar pacientus, kas vecāki par 65 gadiem, un sievietes ar attiecību 3: 1, salīdzinot ar vīriešiem, jo ir lielāka osteoporozes izplatība. Gan AP, gan vardes kāju skatījumu bieži izmanto traumu gadījumos, kur novēro locītavas telpas paplašināšanos, aizmugurējo un priekšējo dislokāciju, augšstilba kakla vai starptrohantēriskos lūzumus, kā arī iegurņa vai acetila lūzumus. Augšstilba kakla lūzumi parasti ietekmē osteoporozi gados vecākiem cilvēkiem pēc mazas enerģijas traumas, bet tikai 2 –5% skar jaunus pieaugušos pēc lielas enerģijas traumas. Bieži abās vecuma grupās ir liels augšstilba kaula galvas avaskulārās nekrozes risks. Dārza klasifikācija tiek plaši izmantota augšstilba kakla intradaporālajiem lūzumiem, tomēr nav iekļauta ķermeņa daļas pārvietojums uz gūžas sānu rentgenogrāfisko skatījumu. Kā vēl viens neizdevīgs, uz sākotnējiem rentgeniem nereti nediagnosticē Dārza 1 lūzumus. Saskaņā ar Amerikas Radiologu koledžas datiem MRA ar 90% un datortomogrāfiju ar attiecīgi 70% jutību ir tikai proksimālās augšstilba kaula attēlveidošanas metodes. MRA nav daļa no parasti veiktās novērošanas gūžas traumas gadījumā, bet tikpat svarīgi var būt noteikt augšstilba kaula galvas osteohonilālās ietekmes lūzumus, labrālo iesprūšanu un ar to saistītos mīksto audu bojājumus. Arī MRA ir izšķiroša nozīme, konstatējot okultus, neizkustētus augšstilba kakla lūzumus, piemēram, dārza 1. tipa lūzumus, vai sekundāru augšstilba galvas osteonekrozi.
This literature review is a research paper for a better understanding of the best diagnostic tools for each specific condition of hip joint trauma, relying on the latest radiological advances. As well as the study of the limitations, and advantages of X-Ray, CT, and MRI. Research, analyzing and summarizing literature characterize this research paper. A sum of 34 sources have been selected and compiled, through E-data bases such as “Clinical Key” and “UptoDate” for evidence-based medicine, alongside electronical books, and journals via “Access Medicine”. Articles and publications searched by “Google Scholar” throughout the keywords, are collectively discussed, and mentioned in the consecutive pages. Hip joint trauma is of special interest among several fields of medical community due to its enormous impact on healthcare economy and resources, the increasing incidence on elderly population and its postoperative complications and morbidity. Radiographs are routinely used for acute diagnosis concerning hip injury, however, CT and MRI exhibit various advantages towards specific pathologies of the hip joint. Hip trauma mostly affects patients older than 65 years, and females in a ratio of 3:1 in comparison to men, due to the higher prevalence of osteoporosis. Both the AP and frog-leg view are often used in trauma, exhibiting the widening of joint space, posterior and anterior dislocation, femoral neck, or intertrochanteric fractures, as well as pelvic or acetabular fractures. Femoral neck fractures typically affect osteoporotic elderly after low-energy trauma, whereas only 2-5% affect young adults after exposure to a high-energy trauma. Common to both age groups is, the great risk of avascular necrosis of the femoral head. The Garden classification is widely used for femoral neck intracapsular fractures, however, displacement on the lateral radiographic view of the hip is not included. As another disadvantage, Garden 1 fractures are frequently undiagnosed on initial radiographs. MRI with 90% and CT with 70% sensitivity respectively, are considered the methods of choice of proximal femur imaging alone, according to the American College of Radiologists. MRI is not part of the routinely performed follow-up in hip trauma but may as well be crucial in detecting osteochondral impaction fractures of the femoral head, labral entrapment, and associated soft-tissue injuries. Also MRI is crucial in detecting occult, non-displaced femoral neck fractures, such as Garden type 1 fractures, or in diagnosing secondary osteonecrosis of the femoral head.
This literature review is a research paper for a better understanding of the best diagnostic tools for each specific condition of hip joint trauma, relying on the latest radiological advances. As well as the study of the limitations, and advantages of X-Ray, CT, and MRI. Research, analyzing and summarizing literature characterize this research paper. A sum of 34 sources have been selected and compiled, through E-data bases such as “Clinical Key” and “UptoDate” for evidence-based medicine, alongside electronical books, and journals via “Access Medicine”. Articles and publications searched by “Google Scholar” throughout the keywords, are collectively discussed, and mentioned in the consecutive pages. Hip joint trauma is of special interest among several fields of medical community due to its enormous impact on healthcare economy and resources, the increasing incidence on elderly population and its postoperative complications and morbidity. Radiographs are routinely used for acute diagnosis concerning hip injury, however, CT and MRI exhibit various advantages towards specific pathologies of the hip joint. Hip trauma mostly affects patients older than 65 years, and females in a ratio of 3:1 in comparison to men, due to the higher prevalence of osteoporosis. Both the AP and frog-leg view are often used in trauma, exhibiting the widening of joint space, posterior and anterior dislocation, femoral neck, or intertrochanteric fractures, as well as pelvic or acetabular fractures. Femoral neck fractures typically affect osteoporotic elderly after low-energy trauma, whereas only 2-5% affect young adults after exposure to a high-energy trauma. Common to both age groups is, the great risk of avascular necrosis of the femoral head. The Garden classification is widely used for femoral neck intracapsular fractures, however, displacement on the lateral radiographic view of the hip is not included. As another disadvantage, Garden 1 fractures are frequently undiagnosed on initial radiographs. MRI with 90% and CT with 70% sensitivity respectively, are considered the methods of choice of proximal femur imaging alone, according to the American College of Radiologists. MRI is not part of the routinely performed follow-up in hip trauma but may as well be crucial in detecting osteochondral impaction fractures of the femoral head, labral entrapment, and associated soft-tissue injuries. Also MRI is crucial in detecting occult, non-displaced femoral neck fractures, such as Garden type 1 fractures, or in diagnosing secondary osteonecrosis of the femoral head.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
gūžas locītava, gūžas trauma, dislokācija, acetabulārs, augšstilba kakls, lūzums, rentgena starojums, datortomogrāfija, MRI, Hip joint, hip trauma, dislocation, acetabular, femoral neck, fracture, X-Ray, CT, MRI