1. CÁC PHƯƠNG PHÁP THĂM KHÁM
1.1. X quang thường quy
Là bí quyết đơn giản nhưng đã mang thể có lại thông báo toàn bộ để chẩn đoán và định hướng điều trị trong đa phần những trường hợp.
Hình ảnh X quang thường quy cho phép phân biệt được mật độ của 4 nhóm cấu trúc: xương, phần mềm, mỡ và không khí. Bên cạnh các cấu trúc xương và vôi hoá, hình ảnh bóng mờ của các cấu trúc phần mềm, tổ chức mỡ (dưới da, dưới bao khớp…) đôi khi góp phần quan trọng vào chẩn đoán.
Ngoài việc cho phép đánh giá thay đổi về hình dạng và cấu trúc, X quang thường quy còn cho phép đánh giá tổng quan tổn thương: biến dạng các trục chi, cột sống lưng , hình thái của toàn bộ các khe khớp..
Nhược điểm của phương pháp X quang thường quy là có thể không bộc lộ được các tổn thương nhỏ, nằm sâu, bị che lấp bởi các cấu trúc khác.
X quang thường quy được chỉ định trong tất cả các bệnh lý xương khớp.
1.2. Siêu âm
Bộc lộ được cấu trúc phần mềm: áp xe, máu tụ, rách cơ, đứt gân, phì đại bao hoạt dịch… Siêu âm ngày càng được ứng dụng nhiều trong dò hỏi khớp, phần mềm. Trong trường hợp viêm xương tuỷ cấp, rất âm có khả năng mô tả được hình ảnh áp xe dưới màng xương.
1.3. Chụp hình ảnh cắt lớp vi tính (CT: Computed Tomography)
Cho phép bộc lộ các tổn thương nhỏ, nằm sâu, tổn thương lan rộng ra phần mềm… mà các hình ảnh X quang thường quy khó bộc lộ.
Tỷ trọng của tổn thương có thể giúp đưa ra chẩn đoán xác định ví dụ như trong các trường hợp u mỡ, phình mạch…
Cùng với tiêm thuốc cản quang vào ổ khớp, chụp cắt lớp vi tính cho phép đánh giá các tổn thương của các cấu trúc sụn khớp, sụn chêm và các tổn thương của bao khớp, gần liên quan…
Tiến bộ về kỹ thuật (máy nhiều hàng cảm nhận) đã nâng cao đáng kể chất lượng hình ảnh chụp cắt lớp vi tính nhất là trong các trường hợp cần đánh giá các thương tổn liên quan đến khớp như sụn khớp, dây chằng.
Hình 2. Siêu âm khớp háng, hình dịch là dải trống âm (màu đen) nằm trong phạm vi bao khớp.
Hình 4. Hình Cộng hưởng từ cột sống, lớp cắt đứng dọc (mặt phẳng sagittal) xung T2w (dịch có hình tăng tín hiệu — sáng).
Hình 6. Hình chụp khớp cản quang.
1.4. Chụp hình ảnh cộng hưởng từ (MRI–Magnetic Resonance Imaging)
Có khả năng miêu tả những thương tổn của rộng rãi thành phần giải phẫu khác nhau như: gân, cơ, dây chằng, đĩa đệm, bao khớp, xương xốp. Nhìn chung, những thành phần với chứa rộng rãi nước sở hữu thể được diễn đạt nhờ cách cùng hưởng từ.
Với điểm cộng tạo hình của cùng một cấu trúc giải phẫu từ những kiểu tín hiệu khác nhau (xung T1, T2, xoá mỡ, và nhiều kiểu xung khác), chụp cộng hưởng từ chế tạo nhiều thông tin để đánh giá tổn thương.
Ngoài các chỉ định trong các bệnh lý khối u, viêm, tổn thương phần mềm, tổn thương khớp… chụp cộng hưởng từ được chỉ định trong tìm ra các đoạn gãy xương nhỏ do vi sang chấn, di căn tới xương…
Cộng hưởng từ cho phép tạo ảnh theo bất kỳ mặt phẳng không gian nào nên có nhiều ưu điểm trong thăm dò các thành phần khác nhau của khớp.
Việc tiêm thuốc nâng cao tương phản (thuốc á từ hoặc nước) vào ổ khớp giúp tăng giá trị của bí quyết trong đánh giá những tổn thương của ổ khớp, ngoại giả bí quyết này hiện chưa được khuyến cáo áp dụng đa dạng vì lý do an toàn cho người bệnh.
1.5. Chụp xạ hình xương (scintigraphie)
Là một bí quyết thăm khám theo nguyên lý của y khoa hạt nhân. Chất đồng vị phóng xạ được tiêm vào máu, đi đến khắp nơi trong cơ thể. Máy sẽ ghi lại mức độ tụ họp của đồng vị phóng xạ trên xương của mọi cơ thể. Các ổ bệnh lý thường được mô tả bởi hai chiếc hình ảnh: vùng tăng ngấm thuốc (đồng vị phóng xạ) gặp trong những tổn thương do viêm, do u, do chấn thương; hoặc vùng ít bị ngấm thuốc, gặp trong nang xương, nhồi máu.
Chụp xạ hình xương là phương pháp sở hữu độ nhạy cao, thường sử dụng để phát hiện vị trí các tổn thương (nhất là trong các trường hợp chọn di căn xương, những ổ viêm nhỏ) và kiểm tra chừng độ chuyển hoá của tổn thương. Độ đặc hiệu của cách này thấp. Một ổ nâng cao nhất mực thuốc sở hữu thể là do u, viêm hoặc gãy xương.
1.6. Chụp khớp cản quang
Được chỉ định trong các trường hợp nghi có tổn thương của sụn khớp, sụn chêm, dây chằng, bao khớp, dị vật trong khớp và tổn thương gần liên quan. Chụp khớp cản quang có thể là thì đầu tiên chuẩn bị cho các thăm khám bằng cắt lớp vi tính, cộng hưởng từ ngày sau đó hoặc là để tiêm thẩm phân vào các ổ khớp trong điều trị giảm đau.
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