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신경근골격계 초음파 논문리뷰
글쓴이 : 관리자 날짜 : 2018-07-20 (금) 10:51 조회 : 338

신경근골격계 초음파 논문리뷰

+ Sural nerve의 초음파

Sural nerve는 종아리의 피하지방층에 위치한 작은 감각신경으로 tibial nerve의 가지인 medial sural cutaneous nervecommon fibular nerve의 가지인 lateral sural cutaneous nerve가 만나 이루는 신경으로 대개는 두 가지가 종아리의 근위부나 중간 부분의 중앙에서 만나 원위부 1/3 정도에서 서서히 외측으로 주행하며 평균 직경은 3.61mm(초음파상으로는 1mm 정도)smaller saphenous vein(신경의 바로 외측에 위치)과 함께 주행한다. 저자는 sural nerve 시작부위의 정상 변이(anatomic variability)가 있는 것과, smaller saphenous vein, Achilles tendon, peroneal tendon과의 해부학적 연관성을 강조하며 이 신경에 대한 정상 초음파 소견과 표층부에 위치하여 직접적인 외상, 수술에 의한 손상에 의한 것과 신경종과 점액낭등 신경과 연관된 space occupying lesion에 관한 초음파 소견을 보여준다.

Ultrasonography of the Sural Nerve

J Ultrasound Med. 2018; 37:1257-1265

+ 대퇴직근건(Rectus Femoris tendon)에 대한 흔한 또는 흔치 않은 다양한 병변들

근위부 대퇴직근 및 힘줄의 손상은 드물지 않게 발생하며 대개는 direct and indirect (reflected) head의 두 tendinous origin에서 conjoined tendon을 형성하며 (indirect head의 아래쪽에서 제 3(third or inconstant) head가 기시하기도 한다.) anterior aponeurosis (direct)deep central aponeurosis (indirect)로 각각 연결되어 하방주행한다. head에 대한 해부학적 설명과 초음파 검사법, 그리고 초음파 사진까지 자세한 설명이 있으며, 근위부 건 파열, 부착부병증(enthesopathy), 소아의 골돌기염(apophysitis), 석회성 건염, snapping hip, indirect head tendinopathy, intratendinous ganglion cyst 등 다양한 병변에 대한 설명과 초음파 소견으로 이해를 돕는다.

Sonographic Overview of Usual and Unusual Disorders of the Rectus Femoris Tendon Origins

J Ultrasound Med. 2018; 37:1543-1553

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+ 정형외과 수술 후 발생하는 subcutaneous nerve의 손상에 관한 해부학과 초음파 소견

surgical repair가 필요한 신경손상의 17% 정도는 의인성이다. 초음파는 해상도가 뛰어나고 반대측과 비교 및 전체 신경을 검사할 수 있다는 점은 MRI 보다 우월하다. 신경 손상의 초음파 소견은 spindle neuroma, terminal neuroma, scar encasement associated with neuroma 등이며 상지에서는 요골신경의 superficial branch, lateral antebrachial cutaneous nerve, 척골신경의 dorsal branch, digital nerve에 대하여, 하지에서는 lateral femoral cutaneous nerve, saphenous nerve, superficial and deep peroneal nerve, sural nerve에 대하여 그림, 사진과 초음파 소견을 중심으로 수술 후 발생한 신경손상 케이스들을 모아 설명하고 있다.

A Review of Main Anatomical and Sonographic Features of Subcutaneous Nerve Injuries Related to Orthopedic Surgery

Skeletal Radiol 2018; 47:1051-1068


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xiaolei68 2018-12-12 (수) 10:37
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