Download - Imagerie Pied Cheville Sportif
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Dr PHILIPPE ADAM Service Imagerie de la Clinique Médipole Garonne
http://www.radiologie-toulouse-garonne.com/
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Pince Tibio-Fibulaire (syndesmose) rigide Articulation Tibio-Talienne mobile
LTFAI
LCM
LCL
LCL
Vue antérieure Vue postérieure
LTFPI
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Lgts Collatéraux et Tibio-Fibulaires (CT/US/IRM)
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Interligne de Chopart Talo-Naviculaire Calcanéo-Cuboidienne Ligament en Y
TN
CC
Ligaments du Chopart
Sous-Talienne
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« Spring Ligament » (ligament calcanéo-naviculaire plantaire) Sangle sous la tête du talus (hamac)
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Tendons stabilisateurs Fibulaires Tibial postérieur
Tendons mobilisateurs Achille Tibial antérieur
«
FIB TTP TTA
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Face stricte Rotation interne
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SCANNER SIMPLE : Fractures occultes talus, chopart, sous-talienne, pilon tibial, enfant (synostose)
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LTFA fissuré, brèche non transfixiante du versant profond articulaire LTFA détendu
ARTHROSCANNER : cartilage, corps étrangers, faisceaux, thérapeutique
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1 faisceau rompu (LTFA)
2 faisceaux rompus (LTFA+LCF)
Lésions mono et bi-fasciculaires du LCL
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Rupture tri-fasciculaire LCL Fracture ostéo-chondrale talus
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Entorse externe récente Lésions du LTFA
LTFA épaissi et infiltré (perte contours normaux, signal augmenté)
LTFA épaissi et sinueux
car détendu
LTFA totalement rompu
à l’insertion talienne
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Les entorses du Chopart Entorse talo-naviculaire dorsale (ligament talo-naviculaire dorsal distendu par flexion plantaire forcée)
Les entorses du Chopart Entorse calcanéo-cuboidienne Ligament bifurqué en Y (rostre calcanéen) Avulsion et œdème du spongieux
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Entorse syndesmose (tibio fibulaire antérieur) + mono-fasciculaire du LLE
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*Séquelle d’entorse tibio-talienne collatérale latérale +/- entorse tibiofibulaire souvent associée
*Limitation (douloureuse) à la dorsiflexion par un processus cicatriciel
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Infiltration/scanner
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Ténopathie traumatique du Long Fibulaire
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Infiltration sous Echographie gaine TTP Ténopathie exsudative
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Normal Fusiforme
Bursite pré-achilléenne Fente
Nodules
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Rupture
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Coupe sagittale echo Coupes coronales IRM
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*Injections articulaires tibio-talienne : °visco supplémentation +/- corticoides
°PRP (entorses)
*Infiltrations articulaires hors tibio-talienne : °arthrose médiopied °talo-naviculaire, calcanéo-cuboidienne °sous-talienne
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*Injections péri-articulaires : echographie/scanner °Carrefour Postérieur dur (queue du talus, os trigone) °Long Fléchisseur Hallux (ténoscanner), Tibial
Postérieur °Syndrome du Tunnel Tarsien (nerf plantaire latéral,
nerf plantaire médial) °Morton/bursite
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Principes d’action du PRP
Intervient aux 3 étapes de la réparation tissulaire :
*phase inflammatoire : plaquettes s’agrègent et libèrent
les facteurs de croissance (granules alpha)
*phase proliférative : fibroblastes / Σ collagène
cellules endothéliales / angiogénèse
*épithélialisation puis remodelage
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*But : Apporter in situ dans les zones peu vascularisées les « principes actifs » autologues sanguins pour accélérer la cicatrisation : tendons, muscles, os, cartilage
*1ère indication historique : traitement des tendinopathies rebelles *Ce n’est pas du dopage (injection intramusculaire de facteurs plaquettaires retirées de la liste des produits dopants en janvier 2011) *Pas de risque de rupture tendineuse comme avec corticoides
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IGF-1 : prolifération et migration fibroblastes, production collagène HGF : prolifération cellules endothéliales, angiogénèse FGF : fibroblast growth factor Bone Morphogenic Proteins (BMPs) : consolidation osseuse après fracture
Facteurs de croissance
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1/le prélèvement Plasma Riche en Plaquettes 5 fois + que sang complet
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*Désinfection, champs, gants stériles, anesthésie locale (?)
*Injection selon les cas de 3 ou 6 cc de PRP selon la taille de la cavitation (tendon, ménisque) ou du décollement (muscle, bourse…) ou la voie d’injection (intra et péri tendineux, articulation)
*Repérage par échographie (voire scopie, scanner) : profondeur, cible, articulation, espace bursal…
2/le traitement/technique
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*si gros épanchement (muscle, morel lavallée…) vidange et injection de PRP, contrôle après vidange
*pansement compressif si muscle (élasto)
*repos 48 heures, pas d’anti inflammatoires (inhibition PRP par ralentissement inflammation)
*autres sessions selon résultats : contrôle échographique à 8 jours et seconde injection +/- 3ème à 8 jours (2 semaines en tout)
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Traitement d’une fente intra tendineuse/Achille
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http://www.radiologie-toulouse-garonne.com/