RU2284149C2 - Method for detecting the depth and the scope of osteonecrosis in patients with initial stages of knee joint's osteochondritis dissecans for carrying out arthroscopic operations - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with matching the type and the way of arthroscopic interference in case of initial stages of knee joint's osteochondritis dissecans. Before the onset of operation it is necessary to carry out magnetic resonance tomographic inspection along with intravenous contrasting to detect the depth and the scope osteonecrosis. At the first stage of the disease mentioned one should fulfill osteoperforations in area of pathological process for the value being equal to the depth of osteonecrosis. At the second stage of the disease and at the depth of necrosis focus being not above 10 mm one should carry out microfracturing along with abrasive chondroplasty. At the second stage and the depth of necrosis focus being above 10 mm it is necessary to perform osteoperforation of pathological focus for the whole value of its depth. The innovation enables to match necessary operative interference depending upon the depth and the scope of osteonecrosis observed.

EFFECT: higher accuracy of detection.

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Description

The invention relates to medicine, in particular to traumatology and orthopedics and radiation diagnostics, and can be used in traumatology and orthopedics to select the type and conduct of arthroscopic surgery by determining the depth and prevalence of lesions of bone and cartilage in the knee joint by means of magnetic resonance imaging in patients with the initial stages of dissecting osteochondritis. A known method for the diagnosis of dissecting osteochondritis of the knee joint using radiography (Arthroscopy and arthrography of the knee joint. Mironova Z.S., Faleh F.YU. M .: Medicine, 1982, S. 65-72). Based on an X-ray examination, the first stage of the disease is determined when determining the focus of enlightenment in the condyle of the femur, with the possible presence of a bone body inside the focus, and the absence of a violation of the integrity of the closure plate in the projection of the focus of osteonecrosis, while initial changes in the structure of bone tissue and depth are not taken into account and prevalence of lesion.

The prototype is the method of x-ray computed tomography (General Guide to Radiology. Editor Holger Petterson. Moscow, PA "Spas", 1996, p. 374). The disadvantage of this method is that it does not allow to detect early structural changes in the cartilage and bone tissue and to reveal the clear prevalence and depth of the osteonecrosis zone in the bone tissue, necessary for endoscopic intervention in the area of the pathological focus. In addition, both methods involve radiation exposure of patients and, therefore, expose patients to health risks, which makes it difficult to assess the nature of pathological changes in dynamics.

The invention is directed to the choice of type and arthroscopic intervention by identifying early manifestations of dissecting osteochondritis of the knee joint (stages I and II). This is achieved by conducting harmless magnetic resonance imaging using a typical patient placement and applying a contrast agent from the group of gadolinically-containing, neiodo-containing - Magnevista (dimeglumine gadopentonate), which is administered to the patient intravenously 10-20 minutes before magnetic resonance imaging, as a result which determines the depth of the lesion and the prevalence of pathological changes in the bone and cartilage tissue using a graphic diagram of the condyles and the femur. The standard “protocol” consists of sagittal T1 and T2 - weighted tomograms, as well as pulse sequences FISP, GRAS, GRE. On simple radiographs and with x-ray computed tomography, these changes are not detected. Dissecting osteochondritis in magnetic resonance imaging is a low signal on the T1 image protocol and heterogeneous mixed low and high signal on the T2 protocol. In this case, a demarcation line is clearly identified, which has a low signal at T1 and delimits a healthy bone structure from the osteonecrosis zone. This determines the internal boundaries and depth of the pathological focus. The data obtained during magnetic resonance imaging studies are expressed in the form of a graphical diagram of a skigram for the prevalence and depth of osteonecrosis, expressed in millimeters (figure 1). To determine the external borders of the focus detected by visual examination, the diagnostic part of the arthroscopic operation is performed. The use of a diagram-diagram of the prevalence and depth of osteonecrosis of the femoral condyle with high accuracy allows us to determine the location and size of the lesion in the bone and cartilage tissue necessary for the main stage of arthroscopic intervention and the choice of the method of endoscopic surgery: at stage I of the disease, osteoperforation in the prevalence of pathological process by an amount equal to the depth of the focus; at stage II of dissecting osteochondritis with a depth of the pathological focus not exceeding 8-10 mm, microfracturing with abrasive chondroplasty is performed, and at a depth of osteonecrosis exceeding 10 mm, osteoperforation of the pathological focus is carried out by its depth.

The research was carried out on a Magneton OPEN magnetic resonance imager with a magnetic field strength of 0.2 T. The cut thickness was 4 mm without gaps, the FOV was 180 mm, and the image matrix was 256 × 256. The duration of the study is 26 minutes.

Clinical example 1.

Patient A., 21 years old, case history No. 5165, was in the clinic RosNIIITO them. R.R. Vredena in April 2003

Upon receipt of a complaint of pain in the right knee joint after physical and sports exercises for 3 months. He is actively engaged in oriental martial arts. No injuries leading to the onset of the onset of pain were revealed from the anamnesis. On the presented radiographs of bone pathology of the knee joint was not detected (figure 2).

To clarify the diagnosis, the patient underwent magnetic resonance imaging with intravenous contrasting magnevist (figure 3). The tomograms of the right knee joint revealed pronounced changes in the bone structure of the medial condyle of the femur (lamellar picture of the zoning of the osteonecrosis focus, depth of the pathological focus 42 mm, prevalence 19 mm), initial changes in thinning in the articular cartilage in the osteonecrosis region. Magnetic resonance imaging data of the knee joint are expressed as a schematic diagram of the femoral condyle for determining the depth and prevalence of the osteonecrosis focus. Based on the prevalence and depth of dissecting osteochondritis of the knee joint of the first stage, the patient underwent arthroscopic surgery by osteoperforation of the pathological focus by values equal to the depth and prevalence of osteonecrosis using the Kirschner needle through articular cartilage to viable areas of the bone (demarcation line in the diagram diagram) aimed at stimulating reparative processes, revascularization, stopping the disease and preventing its progression.

Clinical example 2.

Patient D., 34 years old, case history No. 5944, was in the clinic RosNIIITO them. R.R. Vredena in April 1999

Upon receipt of a complaint of pain and restriction of flexion in the left knee joint during the year. He plays football as an amateur. A history of 2 minor injuries of the left knee joint. To clarify the diagnosis, the patient underwent magnetic resonance imaging with intravenous contrasting magnevist (figure 4). Tomograms of the left knee joint revealed changes in the bone structure of the medial condyle of the femur (depth of the pathological focus 8 mm, prevalence 15 mm), changes in the articular cartilage in the osteonecrosis zone. Magnetic resonance imaging data of the knee joint are expressed as a schematic diagram of the femoral condyle for determining the depth and prevalence of the osteonecrosis focus. The patient received arthroscopic surgery using microfracturing with abrasive chondroplasty of the pathological focus by values equal to the depth and prevalence of osteonecrosis according to the prevalence and depth of the dissecting osteochondritis of the knee joint of stage II.

Clinical example 3.

Patient B., 15 years old, No. 6128 medical history, was in the clinic RosNIIITO them. R.R. Vredena in May 1999

Upon receipt of a complaint of pain and swelling with prolonged walking in the right knee joint for 2 years. Not involved in sports. There was no history of injuries. To clarify the diagnosis, the patient underwent magnetic resonance imaging with intravenous contrast magnevist (figure 5). The tomograms of the right knee joint revealed significant changes in the bone structure of the medial condyle of the femur (depth of the pathological focus 22 mm, prevalence 27 mm), destructive changes in the articular cartilage in the area of the pathological focus. Based on the prevalence and depth of dissecting osteochondritis of the knee joint of the second stage, the patient underwent arthroscopic surgery by osteoperforation of the osteonecrosis zone.

Claims (1)

The method of choosing the type and carrying out arthroscopic intervention in the initial stages of dissecting osteochondritis of the knee joint, characterized in that prior to the operation, magnetic resonance imaging with intravenous contrast is performed and the prevalence and depth of osteonecrosis are determined, at the first stage of the disease, osteoperforation is performed in the prevalence of the pathological process by the amount equal to the depth of osteonecrosis; in the second stage and the depth of the focus of necrosis, not exceeding 10 mm, microfracturing is performed with abrasive chondroplasty, in the second stage and the depth of the focus of necrosis exceeding 10 mm, osteoperforation of the pathological focus is carried out by its depth.

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