ULTRAZVUČNI NADZOR POSTERIORNOG PRISTUPA KOD MR ARTROGRAFIJA RAMENA

Vladka Salapura, Goran Mitrovič, Mislav Čavka

Nestabilnost glenohumeralnog zgloba najčešće je posljedica ozljede struktura u zglobu. Metoda izbora za prikaz jest artrografija magnetskom rezonancijom (MRA) glenohumeralnog zgloba. Pretraga omogućava ocjenu ozljeda labralno-ligamentarnog kompleksa, ozljede unutarnjeg dijela rotatorne manšete i strukture rotatornog intervala, procjenu zglobne hrskavice i procjenu postoperativnih stanja. Na Kliničkom institutu za radiologiju u Univerzitetnom kliničkom centru ­Ljubljana proveli smo istraživanje radi ocjene učinkovitosti, dijagnostičke vrijednosti i sigurnosti MR artrografija pod kontrolom ultrazvuka. Uključili smo 67 bolesnika s nestabilnošću ili ozljedom rotatorne manšete. Ocijenili smo tehničku uspješnost, trajanje zahvata, stupanj ekstravazacije i boli te komplikacije. Tehničku uspješnost zabilježili smo u 100% slučajeva; prosječno trajanje zahvata iznosilo je 8,8 min, stupanj izrazite ekstravazacije i komplikacije bio je u oba slučaja 7,5%. Prosječan stupanj boli iznosio je 3,6 stupnjeva. Rezultati našeg istraživanja potvrđuju da su MR artrografije pod kontrolom UZ-a posteriornim pristupom vrlo dobra alternativa MR artrografijama pod fluoroskopskom kontrolom s bitnim prednostima za bolesnike.

Instability of glenohumeral joint is mostly a consequence of injury of intra-articular structures. Magnetic resonance arthrography is a method of choice for diagnostic imaging. It permits an evaluation of labral-ligamentous complex, injuries of the inner part of rotator cuff and rotator cuff interval structures, imaging of articular cartilage, and postoperative evaluation of glenohumeral joint. In Clinical Institute of Radiology, University Medical Centre Ljubljana, we conducted a study to evaluate the feasibility, diagnostic value, and safety of magnetic resonance arthrography under ultrasound guidance. We included 67 patients with glenohumeral joint instability or rotator cuff injury. We evaluated technical success rate, procedural time, extravasation and pain grades, and rate of complications. Technical success rate was 100%, average procedural time was 8.8 min, severe extravasation grade and complication rate were 7.5%, in both parameters. Average pain grade was 3.6. The results of our study confirm that ultrasound guided magnetic resonance arthrography with posterior approach to glenohumeral joint is a very good alternative technique to standard fluoroscopic guidance with significant advantages for patients.