Baker's Cyst gbawara agbawa vs Calf DVT vs 'ụkwụ tenis' Muscle Tear: Nnukwu Swollen Calf Triage¶

Mgbe otu nwa ehi na-ekpo ọkụ na mberede, fụrụ akpụ, siri ike, ma na-egbu mgbu ịga n'ihu, ihe mberede atọ dị ala na-eme ka nchọpụta dị iche iche pụta: ** miri emi thrombosis (DVT) **, a ** ruptured popliteal Baker's cyst (pseudothrombophlebitis) **, na ** nnukwu anya mmiri nke medial isi nke muscle (strotennis legous) N'ihi na mmiri synovial nke na-agbapụta site na cyst Baker gbawara agbawa n'azụ ikpere na-agbada n'etiti ụgbọ elu nke nwa ehi ma na-ebute mmeghachi omume mkpali siri ike, ọ na-emepụta nwa ehi na-acha uhie uhie, na-ekpo ọkụ, nke na-agbapụta agbawa nke na-enweghị ike ịmata ọdịiche dị n'akụkụ ihe ndina site na omimi Vein Thrombosis * na-enweghị venous duplex. Nke ka njọ, ** 5 ruo 10 pasent nke ndị ọrịa nwere ma Baker's cyst na ezi DVT n'otu oge , ebe ha na-enye ndị ọrịa na-ahụ maka ọbara (anticoagulants) na-enye onye ọrịa nke nwa ehi fụrụ akpụ sitere na akwara gastrocnemius gbawara agbawa ("ụkwụ tenis") ma ọ bụ Baker's cyst hemorrhagic nwere ike kpasuo ọrịa hemorrhagic hemorrhagic ** nnukwu akụkụ ọrịa syndrome . Ọ bụrụ na onye ọrịa ahụ amalite iku ume, mgbu obi pleuritic, ụkwara ọbara, isi ọwụwa, ma ọ bụ ọnụ ọgụgụ obi na-agba ọsọ n'akụkụ nwa ehi fụrụ akpụ, kpọọ nọmba mberede mpaghara gị ozugbo (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom) ma ọ bụ lelee akwụkwọ ndekọ aha anyị. nọmba mberede. Maka ihe mberede vaskụla na musculoskeletal metụtara, gụọ ntuziaka anyị na pulmonary embolism na omimi vein thrombosis (DVT) triage, akwara Achilles gbawara agbawa, ndọkasị akwara patellar, na nnukwu akụkụ akụkụ ọdịda ụkwụ, na Ụkwụ na-adịghị ahụkebe oyi na mberede na mkpọchi akwara akwara.

Mee nke a ugbu a¶

1. ** Ihuenyo ozugbo maka pulmonary embolism (PE) na Acute Compartment Syndrome na-acha uhie uhie ọkọlọtọ:** Ọ bụrụ na nwa ehi fụrụ akpụ, na-egbu mgbu na-esonyere ** mkpụmkpụ ume, mgbu obi pleuritic, nkụchi obi ngwa ngwa (karịa 100 na-akụ kwa nkeji), isi ọkụ, ma ọ bụ ụkwara ọbara **, kpọọ 911/999 chere ozugbo maka enyo enyo. pulmonary embolism. Ọ bụrụ na nwa ehi ahụ na-enwe mmetụta ** nkụ siri ike **, ihe mgbu na-afụ ụfụ mgbe ọ na-agbatị mkpịsị ụkwụ ya elu, ma ọ bụ mkpịsị ụkwụ na-enwe mmetụta ** ọgbụgbọ, oyi, ma ọ bụ charọt, gaa ozugbo na ngalaba mberede kacha nso maka ndị a na-enyo enyo. akụkụ syndrome.
2. ** Kwụsị ije n'ụkwụ, zuru ike ozugbo, na ịhịa aka n'ahụ, ụfụfụ, ma ọ bụ igwakorita nwa ehi fụrụ akpụ ọhụrụ:** Ma ihe kpatara ya bụ mkpụkọ akwara miri emi, cyst synovial gbawara agbawa, ma ọ bụ akwara nwa adọwara adọwa, ịhịa nwa ehi ahụ dị ize ndụ. N'ime ** omimi vein thrombosis (DVT)**, ịhịa aka n'ahụ miri emi nwere ike ịkpachapụ mkpụkọ venous na-esi na mgbidi popliteal ma ọ bụ femoral vein, na-ebute embolus na-egbu egbu n'ime ngụgụ. N'ime akwa ** gastrocnemius ***, ịhịa aka n'ahụ na-emepe capillaries intramuscular gbachitere ọhụrụ ma na-ebute ọbara ọgbụgba dị n'ime.
3. Ebidola ndị na-eri ọbara na-edozi ahụ (apixaban, rivaroxaban, warfarin) ma ọ bụ ọgwụ aspirin/NSAID dị elu tupu nyocha nke ultrasound: Ejila ọgwụ mgbochi ọrịa nke onye ọzọ ma ọ bụ buru ibu na aspirin, ibuprofen, ma ọ bụ naproxen ka ị na-eche nyocha. Ọ bụrụ na nwa ehi gị fụrụ akpụ bụ n'ezie ** medial gastrocnemius tear ("ụkwụ tenis")** ma ọ bụ ** hemorrhagic Baker's cyst rupture **, mgbochi ọrịa mgbochi akaghi aka na-agbanwe ọbara anụ ahụ dị nro dị n'ime ya ka ọ bụrụ hematoma na-agbasa, nke na-eyi egwu n'ime ime ụlọ.
4. ** Gaa na ngalaba mberede ma ọ bụ ebe nlekọta ngwa ngwa nke nwere otu ụbọchị Venous Duplex Compression Ultrasound:** Usoro nyocha anụ ahụ (dị ka akara Homans) enweghị ike ịmata ọdịiche dị n'ụdị DVT na cyst Baker gbawara agbawa ma ọ bụ akwa akwara. Nwa ehi ọ bụla na-ekpo ọkụ, nke na-enweghị nkọwa na-achọ ** ultrasound duplex ** ha abụọ iji nyochaa na omimi popliteal na veins femoral na-agbakọkarị na iji anya nke uche nchịkọta mmiri ọ bụla na bursa ma ọ bụ afọ muscle.
5. ** Nyochaa ọkpụkpụ ụkwụ n'ime na mpụta (malleoli) maka ọnya "Crescent Sign":** Wepụ sọks abụọ ahụ wee lelee akpụkpọ ahụ dị n'okpuru ọkpụkpụ n'ime na mpụta na n'elu ụkwụ. Akpụkpọ anụ na-acha odo odo na-acha anụnụ anụnụ na-apụta n'okpuru malleoli awa 24 ruo 72 mgbe nwa ehi na-amụba na mberede (** akara nke ọkara*) na-egosi mmiri na ọbara na-agbadata site na ụgbọ elu fasikasị site na ** ruptured Baker's cyst *** ma ọ bụ ** gastrocnemius akwa *** (ebe DVT na-enweghị mgbagwoju anya adịghị emerụ ahụ).
6. **Bulite ụkwụ ala nke ọma na ohiri isi wee tinye ngwugwu dị jụụ nke kpuchiri akwa (naanị ma ọ bụrụ na ọ na-ekpo ọkụ na ụda nkịtị): ** zuru ike na nwa ehi na-akwado ma ọ bụ ntakịrị karịa ọkwa obi iji belata nrụgide hydrostatic venous na nsochi mmiri synovial. Tinye ngwugwu dị jụụ n'azụ ikpere ma ọ bụ nwa ehi dị elu maka nkeji 15 ruo 20, ma mee ka ọ dị arọ n'ụkwụ site na iji crutches ma ọ bụrụ na ịrịda n'ala na-akpalite mgbu dị nkọ.

Osisi mkpebi: nnukwu nwa ehi fụrụ akpụ ma ọ bụ na-egbu mgbu¶

flowchart TD
    Start["Mgbu na mberede, ọzịza, njigide, ma ọ bụ ọbara ọbara n'otu nwa ehi"] --> CheckPE{"1. Mkpirisi ume ọ bụla, mgbu obi, ọbara ụkwara, ịda mba, ma ọ bụ ọnụ ọgụgụ obi karịa 100 bpm?"}

    CheckPE -->|"EE: A na-enyo enyo enyo enyo"| Call911PE["PROTOCOL PE NA-EGWU NDỤ: 1. Kpọọ 911/112/999 ozugbo 2. Nọdụ ala kwụ ọtọ ma debe ụkwụ abụọ ahụ kpamkpam 3. Agakwala n'ụgbọ ala ma ọ bụ hichaa nwa ehi ahụ."]

    CheckPE -->|"Mba: Mgbaàmà dịpụrụ adịpụ nke ụkwụ ala"| CheckSixPs{"2. Ụkwụ ahụ ọ bụ ice-oyi, nzu-ọcha, enweghị anụ ahụ, ka ọ bụ mkpịsị ụkwụ ya kpọnwụrụ akpọnwụ na nwa ehi siri ike?"}

    CheckSixPs -->|"EE: Mgbachi akwara ma ọ bụ ọrịa akụkụ"| Call911Limb["6-HOUR LIMB-SALVAGE EMERGENCY: 1. Kpọọ 911 / 112/999 ma ọ bụ Gaa ozugbo gaa n'ụlọ ọgwụ ED 2. Debe ụkwụ n'ụkwụ (Ebulila ma ọ bụ Ice Ischemic Limb) 3. Debe NPO onye ọrịa maka ịwa ahụ Fasciotomy maọbụ Vascular"]

    CheckSixPs -->|"Mba: Ụkwụ na-ekpo ọkụ na mmetụta nkịtị"| CheckOnset{"3. Olee otú ihe mgbu na ọzịza nke nwa ehi si malite?"}

    CheckOnset -->|"Ngwa ngwa 'Snap/Pop' n'oge Push-off ma ọ bụ ngụgụ"| TennisLeg["AKWỤKWỌ 'TENNIS Ụkwụ' (Medial Gastrocnemius Tear) MA ọ bụ ACHILLES KWESỊRỊ: 1. Kwụsị ibu ibu ozugbo; Ọ dịghị mgbe ịhịa aka n'ahụ 2. Mee Simmonds-Thompson Calf Squeeze Test to Check Achilles Continuity 3. Unu ewerela Ọbara Thinners ma ọ bụ Aspirin (ihe ize ndụ nke Massive Hematoma) 4. Nweta otu ụbọchị Ultrasound iji chịkwaa Concomitant DVT ma kwenye na akwa akwa akwara."]

    CheckOnset -->|"Akụkọ banyere ogbu na nkwonkwo ikpere / ọzịza nke na mberede 'na-enye ụzọ' n'azụ ikpere n'ime nwa ehi"| BakerCyst["CYST (Pseudothrombophlebitis): 1. Zuruo ike ma welie ụkwụ; Adịla ịhịa aka n'ahụ 2. Lelee ọkpụkpụ nkwonkwo ụkwụ n'okpuru maka Ecchymotic 'Crescent Sign' Bruising 3. Amanyere Amanye Otu ụbọchị Venous Duplex Ultrasound to Rule Out True DVT (Coexists in 5 to 10 Percent)"]

    CheckOnset -->|"Ihe mgbu na-agba nwayọọ nwayọọ, ịdị ike, ọkụ, ma ọ bụ ọzịza edema gafere awa ruo ụbọchị."| SuspectDVT["SUSPECTED DEEP VEIN THROMBOSIS (DVT): 1. Calculate Wells DVT Score (Surgery, Immobility, Flight, Cancer, Clot History) 2. Rest Leg Slightly Elevated; Adịla ịhịa aka n'ahụ ma ọ bụ yikwasị eriri na-adịghị mma 3. Ngalaba mberede mberede / nleta ụlọ ọgwụ maka D-Dimer na Venous Compression Ultrasound"]

Pathophysiology nke nnukwu nwa ehi atọ na-eṅomi¶

Iji ghọta ihe kpatara ọnọdụ atọ ndị a ji yie ihe dị ka n'èzí ma na-achọ ọgwụgwọ dị iche iche n'ime ụlọ ọgwụ, nyochaa ọdịdị nke ikpere azụ (** popliteal fossa **) na akụkụ elu elu nke ụkwụ ala.

1. Popliteal (Baker's) Cyst gbawara agbawa na "Pseudothrombophlebitis"¶

• Otu esi etolite cyst nke Baker:** Akpọrọ aha onye dọkịta na-awa Britain bụ William Morrant Baker, ** Baker's cyst (popliteal synovial cyst)** na ndị okenye na-abụkarị nke abụọ na ** intra-articular ikpere pathology *** dị ka ** osteoarthritis *** , ** rheumatoid ogbu na nkwonkwo *** , a ** adọwara medial meniscusut / ogwu, ma ọ bụ ihe mgbagwoju anya. ligament (ACL) mmerụ ahụ ***. Mgbe nkwonkwo ikpere na-agba ọkụ na-emepụta mmịfe synovial n'okpuru nrụgide, mmiri ahụ na-amanye azụ azụ site na ebe adịghị ike nke anụ ahụ dị n'azụ ikpere n'ime ** gastrocnemius-semimembranosus bursa ** n'akụkụ ime nke azụ ikpere.
• ** Otu ụzọ Valve Mechanism: ** Mpịakọta anụ ahụ dị warara n'etiti nkwonkwo ikpere na bursa na-eme dị ka bọl-valvụ otu ụzọ **. Mgbe ọ bụla ikpere na-atụgharị ma na-agbatị n'oge a na-eje ije, a na-agbanye mmiri nkwonkwo n'ime ọkpụkpụ azụ, ebe valvụ na-egbochi mmiri ịlaghachi na nkwonkwo ikpere. N'ime izu ole na ole, cyst ahụ na-abanye n'ime ahụ siri ike n'azụ ikpere.
• ** Gịnị na-eme mgbe cyst ruptures (Pseudothrombophlebitis):** N'oge a miri squat, ikpere ikpere, ma ọ bụ steepụ steepụ, hydraulic mgbali n'ime Baker's cyst karịrị ike tensile nke obere akpa bursal. Mgbidi cyst na-agbawa na ogwe osisi dị ala ya. Nrụgide, enzyme-ọgaranya, mmiri mmiri synovial pro-inflammatory (nke na-ejikọta ya na ọbara sitere na capillaries bursal adọwa) jets gbadata n'akụkụ ụgbọ elu fascial n'etiti ** isi nke akwara gastrocnemius ** na n'okpuru ** akwara soleus ***.
• ** Ihe kpatara o jiri na-eṅomi DVT n'ụzọ doro anya:** Mmiri Synovial n'èzí capsule nkwonkwo na-akpasu anụ ahụ dị n'okpuru anụ ahụ na nke na-akpasu iwe. N'ime nkeji 30 ruo awa ole na ole nke mgbawa, ọkpụkpụ a na-ahụ anya na mbụ n'azụ ikpere na-adịkarị nro ma ọ bụ na-apụ n'anya ("akpụkpọ ikpere na-apụ n'anya"), ebe nwa ehi na etiti na nke dị ala na-aghọ ngwa ngwa ** fụrụ akpụ, adịghị ike, na-ekpo ọkụ na aka, erythematous (red), ma dị nro **. Ndị dọkịta na-akpọ ọrịa a ** pseudothrombophlebitis *** n'ihi na ọ na-emegharị akara anụ ahụ ọ bụla nke nnukwu thrombosis miri emi.

2. Ọkpụkpụ akwara miri emi (DVT) nke nwa ehi na akwara Popliteal¶

• ** Otu venous clot si etolite (Virchow's Triad):** Ọkpụkpụ akwara miri emi na-apụta mgbe mkpụkọ ọbara (thrombus) na-etolite n'ime sistemu akwara miri emi nke ụkwụ, nke *Virchow's triad na-ebugharị: (1) ** venous stasis ** (ụgbọ elu ogologo oge ma ọ bụ ụgbọ ala na-agba ọsọ karịa awa 4), ihe nkedo (ihe nkedo) ma ọ bụ ihe nkedo 2. mmerụ ahụ *** (ịwa ahụ ikpere / hip na-adịbeghị anya orthopedic, trauma ụkwụ, ma ọ bụ tupu DVT), na (3) ** hypercoagulability ** (ọrịa cancer na-arụ ọrụ, ime ime/ọnọdụ postpartum, ọgwụgwọ estrogen, ịṅụ sịga, oke ibu, ma ọ bụ ọrịa nke ketara eketa dị ka Factor V Leiden).
• ** Distal (Nwa ehi) vs Proximal (Popliteal/Femoral) DVT:** Ọtụtụ DVT dị ala na-amalite n'ime veins nke miri emi (** tibial azụ, peroneal, soleal, ma ọ bụ gastrocnemius veins ). N'ihi na akwara na-aga n'ihu na-ebunye ọbara ọkụ n'ime ụkwụ ebe a na-egbochi ọkpọkọ na-asọpụta venous, nrụgide hydrostatic na-alaghachi na akwa capillary. Mmiri na-adaba n'ime anụ ahụ interstitial ( pitting edema **), veins dị elu na ntan ahụ na-agbaze, nwa ehi na-azakwa site na 2 ruo 5 centimeters (0.8 ruo 2 inch) n'okirikiri nwere nkụda mmụọ, mgbu mgbu na-akawanye njọ mgbe ọ na-eguzo.
• ** Kedu ihe kpatara DVT nwa ehi a na-agwọghị ji aghọ ihe na-egbu egbu:** Ọ bụrụ na eleghara anya DVT vein nwa ehi dị anya, pasent 15 ruo 25 na-agbasa elu n'ime veins popliteal na femoral ** n'azụ na n'elu ikpere n'ime izu 1 ruo 2. Ozugbo clot batara na nnukwu veins dị nso, enwere ihe ize ndụ ** 40 ruo 50 percent ** na iberibe ga-agbaji n'efu wee gbanye akwara pulmonary (** pulmonary embolism**), nke nwere ike ibute njide obi mberede n'ime nkeji nkeji.

3. Medial Gastrocnemius Muscle Tear ("ụkwụ tenis")¶

• ** Njikọ na-adịghị ike anatomical na nkwụsị nke musculotendinous: ** Ihe mgbagwoju anya nke nwa ehi (** triceps surae ***) bụ nke nwere njikọ miri emi nke otu akụkụ ** soleus muscle ** na nkwonkwo abụọ nke elu ** gastrocnemius muscle ** (nke na-agafe ma ikpere na nkwonkwo ụkwụ tupu ịbanye n'ime Achilles). N'ihi na gastrocnemius na-agafe nkwonkwo abụọ ma nwee ọnụ ọgụgụ dị elu nke eriri na-agba ọsọ ngwa ngwa (Ụdị II), ọ na-enweta oke nkwụsịtụ dị egwu mgbe ọ bụla mmadụ ** gbatịa ikpere ya n'otu oge na-emegharị nkwonkwo ụkwụ ya n'otu oge (na-awụpụ ụkwụ azụ na tennis ma ọ bụ pickleball, sprinting, ma ọ bụ na-apụ na mgbochi).
• ** Ihe mere isi na-agbaji agbaji: ** Na 85 ruo 90 pasent nke ikpe, akwa ahụ na-apụta na ** musculotendinous junction (MTJ) nke isi (n'ime) isi nke gastrocnemius ** n'ime ndị okenye dị afọ 35 ruo 60. N'oge nkwụsịtụ, onye ọrịa ahụ na-enwe mmetụta mberede ** "snap," "pop" ma ọ bụ na-atụgharị mgbe niile. kwenye na mmadụ tụbara bọọlụ ma ọ bụ nkume n'ụkwụ ha.
• Hematomas na mkpokọta mmiri na-egbu oge: N'ime awa ole na ole, ọbara ọgbụgba sitere na eriri akwara dọwara adọwa na nkwụsị nke aponeurosis n'etiti gastrocnemius medial na soleus na-emepụta hematoma mmiri n'akụkụ nwa ehi dị n'ime. N'ime awa 24 ruo 48, nwa ehi na-aza aza, na-esi ike n'ime ihe ọkụkụ (na-egbochi ikiri ụkwụ ka ọ ghara imetụ ala ala aka n'enweghị ihe mgbu dị nkọ), wee malite ọnya na-acha odo odo nke na-aga n'ihu na nkwonkwo ụkwụ.

Ntụle n'akụkụ n'akụkụ: DVT vs Ruptured Baker's Cyst vs "Tennis Leg" vs Achilles Rupture vs Cellulitis¶

Otu esi agbakọ ihe gbasara ahụike nke DVT: ụkpụrụ Wells Score¶

Tupu inye iwu nyocha ọbara ma ọ bụ onyonyo ultrasound, ndị dọkịta mberede na-eji ** Wells Clinical Prediction Rule for Deep Vein Thrombosis ***:

1. ** Ọrịa cancer na-arụ ọrụ ** (ọgwụgwọ na-aga n'ihu, n'ime ọnwa 6, ma ọ bụ ihe na-egbu mgbu): +1 isi
2. **Mkpọnwụ akpọnwụ, paresis, ma ọ bụ plasta na-adịbeghị anya na-eme ka ọkpụkpụ dị ala: +1 isi
3. Dịkịta na nso nso a maka ụbọchị 3 ma ọ bụ karịa, ma ọ bụ ** nnukwu ịwa ahụ n'ime izu iri na abụọ ***: +1 isi
4. ** nro dị n'akụkụ ** n'akụkụ sistemu venous miri emi (azụ nwa ehi ma ọ bụ popliteal fossa): +1 isi
5. ** Ụkwụ dum fụrụ akpụ** (site n'apata ụkwụ ruo na nkwonkwo ụkwụ): +1 isi
6. ** Ọzịza nwa ehi ma ọ dịkarịa ala 3 centimita (1.2 sentimita) buru ibu** karịa ụkwụ asymptomatic (a tụrụ ** 10 centimita (inch 4) n'okpuru tuberosity tibial **): +1 isi
7. Pitting edema etinyere n'ụkwụ mgbaàmà: +1 isi
8. ** veins elu elu** (na-abụghị varicose): +1 isi
9. **DVT edegoro na mbụ: +1 isi

10. ** Nchọpụta ọzọ dị ma ọ dịkarịa ala dị ka DVT *** (dị ka "pop" kpochapụwo n'oge tennis ma ọ bụ cyst Baker a maara): **-2 isi ***

11. ** Otu ụlọ ọgwụ si akọwa akara: *** Akara 2 ma ọ bụ karịa ("DVT Eleghị anya") na-enye iwu ozugbo ** venous compression duplex ultrasound**. Ọbụlagodi na akara ahụ bụ ** 1 ma ọ bụ dị ala (“DVT Eleghị anya”)** n'ihi na ọkpụkpụ Baker gbawara agbawa ma ọ bụ dọka ahụ akwara wepụrụ isi 2, nyocha ọbara D-dimer ** ga-alọghachikarị n'ọnọdụ abụọ ahụ n'ihi na fibrin gbajiri n'ime cysts gbawara agbawa na n'ime ọnya ahụ. N'ihi ya, ** ihe fọrọ nke nta ka ọ bụrụ onye ọrịa ọ bụla nwere nnukwu nwa ehi fụrụ akpụ chọrọ ultrasound **.

Ihe kpatara "Akara ngosi ọnwa" na nkwonkwo ụkwụ bụ ihe ama ama maka nyocha mmiri ma ọ bụ ọbara¶

Mgbe ị na-enyocha onye ọrịa nke nwa ehi ya zara awa 24 ruo 72 gara aga, lelee akpụkpọ ahụ n'akụkụ nkwonkwo nkwonkwo ụkwụ n'okpuru afọ akwara nwa:

1. Ụzọ anatomical nke akara ọnwa¶

Na ma a ** ruptured Baker's cyst ** na ** medial gastrocnemius tear **, mmiri efu (hemorrhagic synovial fluid sitere na ikpere bursa ma ọ bụ ọbara sitere na muscle aponeurosis adọwara adọwa) na-agbapụ n'etiti fascia elu elu na akwara nwa ehi. N'ịbụ nke ike ndọda na-akpali, mmiri a na-agbada n'etiti gastrocnemius na akwara soleus ruo na nkwonkwo ụkwụ ** retinaculum , ebe pigmenti hemoglobin na-abanye n'ime akpụkpọ ahụ dị n'okpuru ** medial malleolus (ọkpụkpụ nkwonkwo n'ime ime) , ** mpụta malleolus (ọkpụkpụ ụkwụ dị n'èzí), ma ọ bụ na-eme ka ọkpụkpụ na-acha odo odo - "blue" akara nke ọkara).

2. Ihe kpatara akara akara ọnwa nke ọnwa ji dị mkpa na ngalaba mberede¶

• DVT na-enweghị mgbagwoju anya anaghị ebute ọnya nkwonkwo ụkwụ na mberede tupu amalitere ihe na-ebelata ọbara, n'ihi na mkpụkọ ahụ dị n'ime akwara miri emi.
• Ya mere, ịhụ ihe ịrịba ama na-acha odo odo ** na nkwonkwo ụkwụ na onye ọrịa na-enweghị mgbochi na-eme ka onye dọkịta na-ahụ maka mberede aka na ** ruptured Baker's cyst ** ma ọ bụ ** gastrocnemius/plantaris tear **, na-adọ onye dọkịta aka na ntị ** ọ bụghị *** ịgbanye heparin dị ala-molecular dị arọ tupu ịmalite ultrasound duplex.

Kedu ihe na-eme n'oge ultrasound nke ụlọ ọgwụ na otu esi emeso ọnọdụ ọ bụla¶

Mgbe ị bịarutere na ngalaba mberede ma ọ bụ ụlọ ọgwụ vaskụla, onye na-ese ihe na-eme ihe na-adịghị egbu mgbu ** doppler duplex dị ala na musculoskeletal ultrasound **:

1. Na-akwado ma ọ bụ ewepu Deep Vein Thrombosis (Mkpakọ Ultrasonography)¶

• Nnwale Ọkọlọtọ ọla edo: Onye dọkịta ahụ na-edobe nyocha ultrasound linear nke dị elu n'azụ ikpere (popliteal fossa), na ukwu (ụbụrụ femoral nkịtị), na ala veins nwa ehi, na-etinye nrụgide ala ala kwa 1 ruo 2 centimeters. Akpụkpọ anụ nkịtị, nke na-enweghị mkpichi ** dara ada kpamkpam n'okpuru nrụgide nyocha. Ọ bụrụ na vein ** jụ ịgbakọ ewepụghị ***, mkpụkọ ọbara (DVT) na-ejupụta lumen.
• ** Ọgwụgwọ ma ọ bụrụ na akwadoro DVT:**
• ** DVT proximal (popliteal, femoral, ma ọ bụ iliac vein) ma ọ bụ Distal Calf DVT dị elu: ** Onye ọrịa na-amalite ** ọgwụ mgbochi ọgwụgwọ ** ozugbo, nke na-abụkarị ọgwụ mgbochi ọnụ (** DOAC** dị ka apixaban ma ọ bụ rivaroxaban, ma ọ bụ obere molecular-weight) maka opekempe nke ** ọnwa atọ ***.
• ** Ọ bụrụ na a na-egbochi obere mkpụkọ dị na veins miri emi dị n'okpuru ikpere na onye ọrịa enweghị ọrịa kansa na-arụ ọrụ ma ọ bụ mgbaàmà siri ike, ** obi ** ntuziaka na-enye ohere ka ọ bụrụ ọgwụ mgbochi ozugbo maka ọnwa 3 ma ọ bụ nyochagharị ultrasound n'ime izu 1 na izu abụọ.

2. Nchọpụta ultrasound na ọgwụgwọ maka Cyst Baker gbawara agbawa¶

• ** Ihe ultrasound na-egosi: *** Onye na-ese ihe na-ahụ anya n'olu **"ụkpụrụ rikoma" n'olu nke Baker's cyst na-apụta n'etiti ** isi nke gastrocnemius ** na akwara semimembranosus n'azụ ikpere. Mgbe ọ gbawara, ọnụ ala ya na-egosi na ọ tụrụ atụ ma ọ bụ na-adịghị agbanwe agbanwe, yana traktị mmiri na-agbasa ala n'elu gastrocnemius n'elu ikpere ụkwụ.
• ** Usoro ọgwụgwọ maka Cyst Baker gbawara agbawa:**
• ** Nlekọta nwa ehi na-adịghị agbanwe agbanwe:** Mmiri synovial efu n'ime anụ ahụ nwa bụ nke usoro lymphatic na-emegharịghachi ya na nkịtị n'ime izu abụọ ruo 4 ***. Welie ụkwụ gị elu mgbe ị nọ ọdụ, tinye mkpọ ice maka nkeji 15 ruo 20 ugboro atọ kwa ụbọchị, yikwasị ngwaahịa mkpakọ dị nro (otu oge na-ewepụ DVT), ma jiri crutches mee ụbọchị 2 ruo 5 ma ọ bụrụ na ije ije na-afụ ụfụ.
• ** Ịkwụsị isi iyi n'ime nkwonkwo ikpere (Intra-articular corticosteroid injection):** N'ihi na a na-enye cyst Baker nri site na nkwonkwo ikpere site na valvụ otu ụzọ, ịkwanye cyst naanị nwere nnukwu nlọghachi azụ. Otu ugboro septic ogbu na nkwonkwo Akwụsịla ya, onye ọkachamara n'ọkpụkpụ ma ọ bụ onye na-ahụ maka ọrịa reumatologist na-emekarị ** ihe na-eduzi ultrasound na intra-articular corticosteroid injection n'ime nkwonkwo ikpere **, na-emechi synovitis ka cyst ahụ na-adaba ma mechie n'ime ụbọchị.

3. Nchọpụta nke ultrasound na nhazigharị maka "ụkwụ tenis" (Medial Gastrocnemius Tear)¶

• ** Ihe ultrasound na-egosi: ** Ultrasound na-ahụ anya nkwụsị nke eriri ebe ** isi isi nke gastrocnemius ** na-etinye n'ime aponeurosis miri emi, tinyere hematoma mmiri nke dị n'etiti gastrocnemius medial na soleus mọzụlụ.
• ** Usoro ọgwụgwọ maka "ụkwụ tenis":**
• ** Oge dị oke njọ (Ụbọchị 1 ruo 7):** Akwụsịla anya mmiri nwa ehi ọhụrụ site n'iweli mkpịsị ụkwụ gị elu ma ọ bụ kwụpụ ikiri ụkwụ gị n'otu nzọụkwụ, n'ihi na nke a na-adọka eriri na-agwọ ọrịa ma na-abawanye hematoma.
• ** N'ihi na ịhapụ ikiri ụkwụ na-adaba adaba na-agbatị gastrocnemius a dọwara adọwa, ndị dọkịta na-edepụta ma ọ bụ ** akpụkpọ ụkwụ na-eje ije na obere ihe ọkụkụ ** ma ọ bụ ** 1 ruo 1.5 centimita (0.4 ruo 0.6 inch) kpuchiri ikiri ụkwụ nwere akpụkpọ ụkwụ abụọ jikọtara ya na izu 4. ruo mgbe ije na-enweghị mgbu.
• ** Mgbapụ hematoma na-eduzi Ultrasound (ma ọ bụrụ na ọ buru ibu): ** Ọ bụrụ na ultrasound na-ekpughe nchịkọta ọbara mmiri mmiri karịrị 2 ruo 3 centimeters gbara ọkpụrụkpụ na-ekewa gastrocnemius na soleus, ndị dọkịta na-ahụ maka egwuregwu egwuregwu na-achọ hematoma mmiri mmiri mgbe ụfọdụ n'okpuru nduzi ultrasound na-adịghị mma n'ime izu 1 ruo 2 mbụ iji mee ngwa ngwa mgbakwunye anụ ahụ ma gbochie scarcanitis.

Ngosipụta dị ụkọ ma dị oke egwu: Plantaris rupture, Popliteal artery Aneurysm, na ọrịa akụkụ¶

Mgbe ị na-enyocha nwa ehi na-egbu mgbu, ndị dọkịta na-enyochakwa ọnọdụ vaskụla dị elu na ọnọdụ nhazi atọ:

1. Aneurysm Popliteal Artery Aneurysm gbawara agbawa ma ọ bụ gbawara agbawa:**
2. Okpokoro na-akpụ akpụ n'azụ ikpere abụghị ** ọ bụghị cysts Baker; ọ bụ ** aneurysm artery popliteal ** (na-emetụta ndị okenye, pasent 50 n'ime ha nwere aneurysm popliteal contralateral na pasent 30 ruo 40 n'ime ha nwere ** abdominal aortic aneurysm**).
3. Ọ na-egosipụtakarị site na ** ịgbachichi ma ọ bụ ịgbanye thromboemboli n'ime akwara tibial ***, na-akpata nnukwu akụkụ ụkwụ ischemia (ụkwụ oyi, nke na-acha ọcha, nke na-adịghị ahụkebe), ma ọ bụ mgbe ụfọdụ na-agbawa n'ime hematoma na-akụ ụda n'azụ ikpere na-achọ ịwa ahụ vaskụla mberede.
4. ** Ọkụkụ Plantaris Tendon:**
5. ** Plantaris *** bụ obere akwara vestigial nke sitere n'azụ ikpere mpụta nke akwara dị gịrịgịrị na-aga n'etiti gastrocnemius na mọzụlụ soleus. Ọ bụ ezie na ihe karịrị pasenti 90 nke "ụkwụ tenis" bụ anya mmiri medial gastrocnemius, mgbawa n'osisi dịpụrụ adịpụ na-akpata ọgba aghara n'etiti nwa ehi na ọzịza dị nro na mgbake n'ime izu 1 ruo 3.
6. ** Ọrịa dị n'azụ ụlọ site na anya mmiri nwa ehi anaghị agbachi agbachi:**
7. Ọ bụrụ na onye nrịanrịa na-ewere ihe na-ebelata ọbara kwa ụbọchị na-enwe akwa gastrocnemius ma ọ bụ gbawara Baker cyst, ma ọ bụ ọ bụrụ na a na-ehie ụzọ nye akwa nwa ehi ihe na-edozi ọbara na-enweghị ultrasound, ọbara ọgbụgba n'ime akụkụ azụ nwere ike ibuli nrụgide intracompartmental gafere 30 mmHg.
8. ** Ọkọlọtọ na-acha uhie uhie nke mberede: ** Lelee ** ihe mgbu na-elele anya na nyocha **, nwa ehi siri ike nke bọọdụ ***, ** ihe mgbu na-egbu mgbu na mkpịsị ụkwụ na-agafe agafe *, na ** ọnụọgụ na ọbụ ụkwụ (mkpakọ akwara tibial), chọrọ ịwa ahụ mberede ** fasciotomy.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States na Canada: Kpọọ 911 ozugbo ma ọ bụrụ na nwa ehi fụrụ akpụ na-esonyere ya na mkpụmkpụ ume, mgbu obi, nkụda mmụọ, ma ọ bụ ụkwụ oyi na-enweghị isi. Maka nnukwu ọzịza nwa ehi dịpụrụ adịpụ na-enweghị nsogbu iku ume, gaa na ** Ngalaba Mberede ** ma ọ bụ nnabata ** Nlekọta ngwa ngwa na saịtị Venous Duplex Ultrasound ** (kpọọ n'ihu iji nyochaa nnweta ultrasound, n'ihi na ọtụtụ ụlọ ọgwụ na-ejegharị enweghị onye na-ahụ maka akwara vaskụla na-arụ ọrụ mgbe elekere 17:00 ma ọ bụ na ngwụsị izu).
• United Kingdom: Kpọọ 999 maka ihe ịrịba ama nke pulmonary embolism ma ọ bụ nnukwu ischemia. Maka nnukwu nwa ehi na-ekpo ọkụ, fụrụ akpụ na-enweghị mgbaàmà obi, kpọọ ** NHS 111 ** ma ọ bụ gaa nso gị kacha nso ** Otu ụbọchị nlekọta mberede (SDEC) / Ambulatory DVT Clinic ** ma ọ bụ ụlọ ọgwụ ** A&E ngalaba , ebe ** NICE Guideline NG158 nyere iwu proxy Wells akara ntule na otu ụbọchị (ma ọ bụ n'ime ụbọchị 24 nwere ike igbochi muscle). proximal ụkwụ vein ultrasound.
• European Union: Kpọọ 112 n'ofe mba ndị otu EU niile maka mgbawa akpa ume ma ọ bụ ihe mberede vaskụla a na-enyo enyo.
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand maka njem ụgbọ ihe mberede mberede, ma ọ bụ kpọọ Healthdirect (1800 022 222 na Australia) / Healthline (0800 611 116 na New Zealand) iji chọta ngalaba mberede kacha nso na 24 gnostic nke ultrasound.
• India na Asia-Pacific: Kpọọ 112********** na India,995 na Singapore,119 na Japan na South Korea, ma ọ bụ 999 na Hong Kong na Malaysia.

Ajụjụ a na-ajụkarị¶

Gịnị kpatara na dọkịta enweghị ike ịmata ọdịiche dị n'etiti cyst Baker gbawara agbawa na DVT naanị site n'inyocha ụkwụ m?¶

Mgbe cyst nke Baker gbawara n'azụ ikpere, mmiri nkwonkwo nrụgide na-agbadata n'etiti mọzụlụ nwa ehi na-ebute oke mbufụt. Nke a na-emepụta kpọmkwem otu ihe ịrịba ama anụ ahụ a na-ahụ na thrombosis miri emi: nwa ehi n'otu akụkụ na-arị elu karịa 3 centimeters, ọkụ, ọbara ọbara, na ịdị nro dị omimi. Ọbụna ule ọbara maka mkpụkọ (D-dimer) na-atụgharị nke ọma na cyst gbawara agbawa. Naanị nyocha ultrasound duplex nwere ike ịhụ anya ma veins na-agbakọ nke ọma ma ọ bụ nwee mkpụkọ.

Kedu ihe ga - eme ma ọ bụrụ na onye nwere ahụ ike nwa ehi gbawara agbawa ("ụkwụ tenis") ma ọ bụ ruptured cyst Baker na-ehie ụzọ na-enye ndị na-edozi ọbara maka DVT a na-enyo enyo?¶

Ọ bụrụ na a na-enye ndị ọrịa anticoagulants ọgwụgwọ (dị ka enoxaparin, apixaban, ma ọ bụ rivaroxaban) bụ onye nwa ehi fụrụ akpụ bụ n'ezie medial gastrocnemius tear ma ọ bụ hemorrhagic Baker's cyst, ọgwụ na-egbochi arịa intramuscular dọwara adọwa ka ọ ghara imechi. Nke a na-ebute mgbasawanye ngwa ngwa nke nnukwu hematoma intramuscular nwa ehi, nkwarụ na-adịte aka, na nke nwere ike eyi nnukwu ihe mgbu na-eyi nnukwu akụkụ azụ nke na-achọ ka fasciotomy ịwa ahụ mberede.

Ị nwere ike ịnweta cyste Baker na ezigbo thrombosis miri emi n'otu oge?¶

Ee. Nnyocha ultrasound nke akwara ọbara na-egosi na pasent 5 ruo 10 nke ndị ọrịa nwere ihe mgbaàmà ma ọ bụ ruptured Baker's cyst nwekwara enwekwa ezigbo thrombosis Deep Vein n'otu ụkwụ. Ọkpụkpụ siri ike dị n'azụ ikpere na-akpakọba akwara popliteal dị n'akụkụ, na-ebelata nlọghachi venous (stasis) na ịkpalite mkpụkọ. Ọ bụ ya mere onye na-ese ụda ga-eji nyochaa osisi venous nke dị omimi ọbụlagodi mgbe ọ hụchara cyst nke Baker.

Gịnị bụ “ihe ịrịba ama ọnwa abụọ” na nkwonkwo ụkwụ, gịnịkwa ka ọ pụtara?¶

Ihe nrịbama nke ọnwa a bụ ọnya na-acha odo odo-acha anụnụ anụnụ (ecchymosis) na-apụta n'okpuru ọkpụkpụ ụkwụ n'ime ma ọ bụ n'èzí 1 ruo 3 ụbọchị mgbe oke mgbu nwa ehi malitere. Ọ na-eme mgbe ọbara na mmiri synovial sitere na cyst Baker gbawara agbawa ma ọ bụ gastrocnemius anya mmiri na-agbada site na ike ndọda na n'ọbọ fascial ruo mgbe agbakọta na retinaculum nkwonkwo ụkwụ. N'ihi na DVT na-enweghị mgbagwoju anya anaghị akpata ọnya nkwonkwo ụkwụ, ịhụta akara nrịanrịa na-arụtụ aka na mgbawa cyst ma ọ bụ dọkasị ahụ ike.

Kedu ihe kpatara mkpụkpọ ahụ n'azụ ikpere m ji pụọ ozugbo nwa ehi nke ala m zara aza ma na-egbu mgbu?¶

N'ime ndị ọrịa nwere njupụta n'azụ ikpere ha site na cyst Baker na-adịghị ala ala, mwepu na mberede ma ọ bụ ime ka ọkpụkpụ ahụ dị nro n'otu oge na ihe mgbu dị nkọ na ọzịza nwa ehi dị ngwa bụ akara mbinye aka nke nnukwu ọnya cyst. Mgbe mgbidi bursal na-apụta, mmiri na-asọba n'ime akụkụ nwa ehi, na-ebelata nrụgide n'azụ ikpere mgbe ị na-ewepụ pseudothrombophlebitis na ụkwụ ala.

Ogologo oge ole ka ọ na-ewe maka cyst Baker gbawara agbawa ma ọ bụ akwa ahụ akwara "ụkwụ tenis" iji gwọọ ozugbo a kwụsịrị DVT?¶

Ozugbo ultrasound na-achịpụta DVT, mmiri mmiri synovial n'efu sitere na cyst Baker gbawara agbawa na-emegharịghachi site na lymphatics nwa ehi n'ime izu 2 ruo 4 na elu elu, ice, mkpakọ dị nro, na mgbe mgbe ntanye steroid na-eduzi ultrasound n'ime nkwonkwo ikpere. Anya gastrocnemius medial na-achọkarị izu 2 ruo 3 nke echedoro iji ikiri ụkwụ na-ebuli ma ọ bụ na-eje ije tupu ije ije na-enweghị mgbu na-alọghachi, yana izu 6 ruo 8 nke ọgwụgwọ anụ ahụ tupu ịlaghachi n'egwuregwu ụlọ ikpe.

Ntuziaka emetụtara¶

• Mmụba nke akpa ume na thrombosis miri emi (DVT).
• Akaịkụ Achilles gbawara agbawa, akwa akwara patellar, na nnukwu akụkụ akụkụ ọdịda ụkwụ
• Mkpọpịa mmerụ ahụ na akụkụ syndrome enyemaka mbụ
• Ụkwụ na-adịghị ahụ oyi na mberede na mkpọchi akwara akwara

Isi mmalite na nduzi ọchịchị¶

• ** National Institute for Health and Care Excellence (NICE, United Kingdom): *** Ọrịa Thromboembolic Venous: Nchọpụta, Nlekọta na Nnwale Thrombophilia (NG158), Abụọ-Level Wells DVT Score na Proximal Leg Vein Ultrasound Pathways *.
• ** American College of Chest Physicians (CHEST, United States):** * Ọgwụgwọ Antithrombotic maka Ọrịa VTE: Ntuziaka CHEST na Nkwupụta Ndị Ọkachamara (Management of Distal Distal DVT vs Proximal DVT)*.
• ** American College of Radiology (ACR, United States):** * ACR Nchọpụta Kwesịrị Ekwesị: A na-enyo enyo na Ọkpụkpụ akwara miri emi nke dị n'okpuru ala na nyocha Ultrasound nke Popliteal Mass / Pseudothrombophlebitis*.
• ** American Academy of Orthopedic Surgeons (AAOS, United States):** Nduzi nlekọta ahụike na Popliteal (Baker's) Cyst Rupture, Medial Head of Gastrocnemius Tear ("ụkwụ tenis"), na nnukwu ọrịa n'azụ ngalaba.
• British Society for Hematology (BSH) na European Society for Vascular Surgery (ESVS): * Usoro ọgwụgwọ ahụike gbasara nchọpụta na njikwa nke nnukwu akwara miri emi thrombosis na nchọpụta dị iche iche nke nnukwu Swollen nwa ehi *.