Estudio anatómico del complejo fibrocartílago triangular mediante análisis de imagenvaloración de la ecogenicidad de sus componentes

Resumen

ABSTRACT: The locomotor system pathology consumes a lot of economic and welfare resources in everyday medical practice. As important as solving this disease, it's to make a correct diagnosis, without which, certain diseases could be treated in a completely wrong way. Currently, radiology is one of the most powerful tools in the diagnosis of musculoskeletal pathology, plain radiography, magnetic resonance, computed tomography and ultrasound, are an invaluable aid in identifying the cause of the patient discomfort. Each problem requires proper diagnostic technique, and misuse of these techniques can lead to misdiagnosis. Ultrasound is an affordable, rapid technique, which allows viewing images in real time; It is helpful in the diagnosis of muscle and ligament pathology. In recent years, some teams have tried to use this technique in the diagnosis of lesions of the triangular fibrocartilage complex, more specifically for the assessment of the articular disc. However, limited published literature and disparate results, has not allowed ensure that ultrasound is useful for the diagnosis of tears in this structure. In this work, we evaluate whether ultrasound is a valid diagnostic technique for the identification and assessment of the articular disc of the triangular fibrocartilage complex. We believe that, given the anatomical basis and findings described in the studies mentioned, ultrasound is not useful for evaluating the articular disc of the complex, as the anatomical structure identified in those works as articular disc, actually correspond with the meniscus homologue. In order to validate our hypothesis, several diagnostic tests were made on 20 intact anatomical pieces, which included forearm, wrist joint, and hand held. These tests consisted of: plain radiography of the wrist joint, anteroposterior and lateral projections, simple ultrasound of the ulnar side of the wrist, with coronal prestyloid view and paracoronal longitudinal oblique view, three-compartment arthrography contrast injection, sonoarthrography with ecoguided metallic marker puncture on the anatomical structure traditionally identified by ultrasound as articular disc, and finally, anatomical dissection, as the gold standard, in order to assess the location of the metal label, and, if indeed such structure matched the articular disc. On data obtained, a statistical descriptive study was conducted to determine the distribution of frequencies, and then, a statistical analysis of the data, where the relationship between variables was studied by analyzing contingency tables with the test of ? 2 Pearson, and the McNemar test. For the assessment of the agreement between the results obtained from the various diagnostic techniques work, the kappa index was applied. We observed that there was agreement between the three-compartment arthrography and the anatomical dissection in the diagnosis of rupture of the articular disc. However, there was no correlation between ultrasound and the results obtained by arthrography and anatomic dissection; the same results were obtained with sonoarthrography. In anatomical dissection it was found that the metallic marker was staying in the homologous meniscus in 80% of the pieces used. There are different Jobs where the triangular fibrocartilage complex is studied by ultrasound, however, very few which compare with other diagnostic, or anatomical dissection techniques. The results are highly variable, however, all identified the same ultrasound structure as the articular disc of the complex. Given the results of our work, we note that such structure actually corresponds to the meniscus homologue, leaving the disk hidden by the interposition of bony structures and it's depth in the joint. Therefore, ultrasound has not proven to be a useful diagnostic technique for the evaluation of the articular disc of the triangular fibrocartilage complex.