CAJ | 학술논문

目的建立肌肉骨骼超声(MSUS)观察及测量颈椎钩椎关节的方法,阐明钩椎关节及其比邻结构尤其是椎动脉(VA)在MSUS下的定位及表现.方法在人颈部骨骼和尸体标本上,采用PhilipsiU22彩色多普勒超声诊断仪的5～ 12 MHz的高频线阵探头指引钩椎关节和VA,明确钩椎关节和VA在MSUS下的定位.然后再检测颈椎病患者,观察人体上钩椎关节及其周围结构的MSUS表现,同时评估钩椎关节有无横向增生,探索MSUS测量增生钩椎关节的方法.结果患者取平卧位,颈后垫高约15 cm,头偏向检查对侧45°,探头置于颈根部胸锁乳突肌内侧,显示颈总动脉纵切面后稍向外侧移动可见椎动脉起始段,向上延续观察椎动脉至穿入横突孔,再稍向上在两个横突的强回声之间微动探头即可观察到钩椎关节和VA.MSUS下,钩椎关节位于两个横突之间(即两椎体侧后缘之间椎间盘的外侧),钩突外侧缘与椎体侧后缘回声相延续成一条直线,前方紧邻椎动脉,当钩椎关节横向增生时,钩突外侧缘则超出该条直线.此时选择测量其横径,即以通过上下颈椎椎体外缘的切线为基线,测量钩突最外侧点到该基线的垂直距离.结论 MSUS能够清晰显示钩椎关节及其与VA的关系,可用于评估钩椎关节有无横向增生,并测量增生的大小.
목적 건립기육골격초성(MSUS)관찰급측량경추구추관절적방법,천명구추관절급기비린결구우기시추동맥(VA)재MSUS하적정위급표현.방법 재인경부골격화시체표본상,채용PhilipsiU22채색다보륵초성진단의적5～ 12 MHz적고빈선진탐두지인구추관절화VA,명학구추관절화VA재MSUS하적정위.연후재검측경추병환자,관찰인체상구추관절급기주위결구적MSUS표현,동시평고구추관절유무횡향증생,탐색MSUS측량증생구추관절적방법.결과 환자취평와위,경후점고약15 cm,두편향검사대측45°,탐두치우경근부흉쇄유돌기내측,현시경총동맥종절면후초향외측이동가견추동맥기시단,향상연속관찰추동맥지천입횡돌공,재초향상재량개횡돌적강회성지간미동탐두즉가관찰도구추관절화VA.MSUS하,구추관절위우량개횡돌지간(즉량추체측후연지간추간반적외측),구돌외측연여추체측후연회성상연속성일조직선,전방긴린추동맥,당구추관절횡향증생시,구돌외측연칙초출해조직선.차시선택측량기횡경,즉이통과상하경추추체외연적절선위기선,측량구돌최외측점도해기선적수직거리.결론 MSUS능구청석현시구추관절급기여VA적관계,가용우평고구추관절유무횡향증생,병측량증생적대소.
Objective To test using musculoskeletal ultrasound (MSUS) to observe uncovertebral joints (UJs) and to explain the ultrasound images of UJs and their adjacent tissues,especially the vertebral artery (VA).Methods MSUS was used first with human skeletons and cadavers to localize the UJs and VA on the MSUS images with the aid of implanted needles.MSUS was then used with a patient clinically diagnosed with cervical spondylosis of the vertebral artery type (CSA) to detail the image of a normal UJ and its relationship with the adjacent tissues,especially the VA.Whether there was a lateral spur from the uncinate process (UP) was assessed to try to establish a method for measuring osteophytes.Results During the examination the patient was in supine,the neck was elevated 15cm with a pillow and was at 45 degrees of rotation to the contralateral side.The probe was placed at the medial border of the sternocleidomastoid muscle.When the longitudinal section of the common carotid artery was shown,the probe was slowly moved laterally until the VA first appeared,and then was moved up along the VA.Once the VA entered the transverse foramen,moving the probe slightly allowed the UJ behind the VA to be seen between two transverse processes.The UJ thus lies between two transverse processes,that is,between the lateral margins of two vertebral bodies and outside the intervertebral disc.The echo of the lateral border of the UP is on a straight line with the echo of the lateral margin of the vertebral body,with the VA in front of the line.It was noticed that the image of a UP with lateral osteophyte formation crossed the line and reached closer to the VA.The transverse diameter of the UJ was measured as the distance from a line cutting the lateral cortical margin of the cervical vertebra to the outer cortical margin of the lateral UP.Conclusion MSUS can clearly show the UJ and its adjacent tissues,especially the VA.It can be used to assess and measure UJs with lateral osteophyte formation.