4. muskuloskeletal -prof mi-bimb.coass unismuh
TRANSCRIPT
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Prof.Dr.dr.Muhammad Ilyas, Sp.Rad (K)Prof.Dr.dr.Muhammad Ilyas, Sp.Rad (K)Bagian Radiologi FK-Unhas
RADIOLOGIMUSKULOSKELETAL
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Pemeriksaan Rongen Tulang memberi informasi :
1. Lesi tulang & jaringan Lunak sekitarnya
2. Aanya fraktur!an"aman fraktur patologis
#. Asal!$ifat suatu lesi%jinak!ganas
'. $ebagai guie untuk biopsi
(. )ollo* +p perjalanan penyakit
Pendahuluan
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$aat ini peralatan raiologi semakin "anggi,
misalnya :-ray/T $"an0R
$kintigrafi+$Angiografi
Pemeriksaan raiologis -Ray kon3ensional
masi, memegang peranan utama
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Tulang teriri ari ba,anba,an
4 2(5 air
#65 organik '(5 anorganik % ensitas tulang raiopak :
4 /a p,osp,at 7(5
4 /a "arbonat 1(5
Tulang menapat suplai ara, ari # sumber :1.Arteri nutrisi%lekukan a.nutri"ia p foto tulang
2.Arteri metafise & epifise%yg mensuplai langsung pmetafise & epifise
#.Art. Periost ber,ubungan langsung gn pembulu, ara,merupakan per"abangan a.nutri"ia yg menyelusurisistim 8a3ers & 9olkman p tulang2
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ANATOMI RADIOLOGI
BUKU MS!"#$ I %
&. #r'iular ar'ilag
*. Su+ar'iular of piphys
. piphysis
. piphysal lin
. M'aphysis
/. Diaphysis
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#.
2.
1.
4.
5.
6.
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KELAINAN TULANG DAN SENDI
&. #$0M#1I PRKMB#$2#$3K0$2$I4#1
*. I$FKSI
. 4R#UM# 5 FR#K4UR
. P$6#KI4 DFISI$SI 4U1#$2
. P$6#KI4 DISP1#SI# 4U1#$2
/. 4UM0R 4U1#$2
7. #8#S!U1#R $KR0SIS3#SP4IK $KR0SIS
9. P$6#KI4 D2$R#4IF S$DI3M4#B01IK
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1.ANOMALI PERKEMBANGAN /KONGENITAL
1. Art,rogriposis 0ultiple /ongenitalkegagalan
pembentukan otot
2. kstremitas atas :a. Absen tulang : ,emipelia istal
P,a"omelia proksimal
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b. $ynostosis Raius & +lna
". Tangan : ;ra",yp,alangea % penek
;ra",ya"tili %meta"arpal penek
Tubular bone panjang
Polya"tyli
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#. Pel3is :
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'. kstremitas ba*a,:
>iskolasi kongenital r "o?ae%panggul
/o?a 3ara kongenital: femur bo*ing &
memenek bilateral
Patellabipartite & multipartite
Pseuoart,rosis "ongenital Tibia & )ibula
a. 1!# tenga, ! ba*a,
b. $ering lesi p fibula
@aki & ankle :
Pes euino 3arus
;all & so",et ankle foot
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(. /olumna 3ertebralis :
/oronal "lefts 3ertebraspina bifia
8emi3ertebra
$a"ralisasi
Lumbalisasi
$"oliosis
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2.INFEKSI OSTEOMYELITIS
a.Pyogeni" ! suppurati3e
B $tafilokokus B Pneumokokus
B $treptokokus B $almonella
Penyebaran 8ematogen ari fo"us infeksi %tenggorokan& kulit
@ontaminasi luar %fraktur terbuka!operasi tulang
b. $pesifik! non suppurati3e
T;/C 3irusC an jamur
Perlangsungan lambat ibaning pyogeni"
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b. @ronis :
Terapi tiak aekuat
Raiologis
Dsteos"lerosis %banyak
>iameter tlg besar!bertamba, @ontur tulang tk rataC "orte? tebal
;isa aa osteolitik
@aangkaang terli,at sekuester
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D$TD0ELT$
a.Akut : biasanya paa anakanak
metap,ysis tulang %femur istalC tibia
proksimalC proksimal an istal ,umerus
raiusC ulna serta paa "orpus 3ertebra
Raiologi :
Dsteolitik
Periosteal rea"tion
$oft tissue s*elling
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Acute osteomyelitis
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T;/ T+LA
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;. Tipe Sentral
-Abses !"ol abses itemukan p bagian
tenga, "orpus 3ertebra
is"us lambat terkena
bila meluas ke tepi tulang proses sama
tipe marginal
/. Tipe anterior
berlangsung iba*a, periosteum meluas iba*a, lig.Longituinalis anterior
kerusakan is"us inter3ertebra lambat
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4B! 4U1#$2 P#$:#$2
Rontgen :
terutama metafise tulang panjang
osteolitik lebi, ominan
kaang2 tepi osteosklerotik ringan
periosteal rea"tion ringan tiak aa
soft tissue s*elling ringan
Primrapat i tulangS;undr,ematogen
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Tuberculosis of the knee
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Tuberculosis of right hip
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3. TRAUMA & FRAKTUR TULANG
a. 4rauma dapa' +rsifa' Ringan : 8ematoma kaang p foto tulang tiak
terli,at
;erat F subluksasiC islokasi isertai fraktur ksternal : tabrakanC jatu, nternal : kontraksi otot yg kuat & menaakC mis :
epilepsiC tetanus & renjatan listrik
+. Fra;'ur
aala, rusaknya kontinuitas tulangC kartilago atau
keuanya & isertai kerusakan jaringan.lunak
fraktur apat terbuka atau tertutup
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Kompli;asi Fra;'ur
1. Dsteomyelitis
2.
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B+rapa 'yp fra;'ur
H )r.trans3ersal
H )r. obliue!spiral!s"re*
H )r.kominutif lebi, ari 2 fragmen
H )r.a3ulsi
H )r.green sti"k %paa anakanak
H )r.kompressi 3ertebra
H )r.impressi tengkorak
H )r. linier
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Fr.transversal Fr.oblik Fr. kominutif
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Fra;'ur radius +agian dis'al
a.)raktur /olles
fr.raius bagian istal %sampai 1 mm
ibagian istal engan angulasi ke
posteriorC islokasi ke posterior an e3iasi
fragmen istal ke raial
b. )raktur $mit,
)r.raius bagian istal engan angulasi
atau islokasi fragmen istal ke 3olar
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Fra;'ur radius dan ulna
a. )r.0onteggia
fr.ulna bagian pro?imal engan islokasi
kaput raiib. )r.aleaIIi
fr.raius bagian istal engan islokasi
ulna bagian istal
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Fr. Galeazzi Fr. onteggia
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Fr. Galeazzi
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Fra;'ur Pa'ologis
1. )r.trauma berat2. )r.$pontan!patologisC mis:
tumor tlg : % primerC sekuner
infeksi: % osteomielitis1. )r.stress :
ole, trauma ringan & terus menerus
mis : fr.mar", meta"arpal fr.tibiaPenari ;allet
fr. )ibula pelari jarak jau,
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Lainlain
)r.bentuk TC 9C atau E
)r. mpa"te
)r.longituinal
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Epiphyse! i"#$%ies
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Type ! Type !!
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Type !!!
Type !"Type "
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.PENYAKIT DEFISIENSI TULANG
#. Ri;'s ("ipo
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'. @aang2 reensti"k fraktur
(. @alsifikasi subperiosteal
G. Tepi ala ossis ilii %irreguler
. >ens metap,ysial line yang normal
meng,ilang %irregulerKfraye
7. @epala: )ontanella K sutura % masi, terbuka
. Dsteoporosis
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#ickets
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B. Sur
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#. Rontgen :
1. Dsteoporosis general
2. roun lass Appearan"e
#. /orte? tipis
'. 0etafise lebar %"upping
(. Pelkens sign marginal spur formation
G. MimbergerNs sign marginal ring
"al"ifi"ation paa pusat2 osifikasi i epifise
. $ubperiosteal ,ematoma mengalamikalsifikasi
subperiosteal bone
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&curvy
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'. >iafise lebar & ekspansi
(. @aangkaang sklerotik menonjol
G. @epala : tepi sklerotikC iploe lebarC tabula
eksterna menonjol %interna jarang kenaC sklerotik
ibasis tengkorak & "rista sp,enoi serta fa"ial
bone %penebalan&sklerotik tulang2 muka & asar
tengkorakC terjai obliterasi ari sinus ma?ilaris
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B. 0s'ognsis Imprf'a %
teriri atas 2 bentuk yaitu "ongenital %sejak la,ir
an tara %gejala baru tampak *aktu anak2
Rontgen :
1. Tulang2 osteoporosis %groun glass appearan"e
2. 0ultiple fra"ture
#. ;o*ing ekstremitas inferior
'. 9ertebra bikonkaf
(. >eosifikasi tulang K iameter tlg lebarG. @epala : tabula tipis K *armian bone
. Protrusio a"etabuli
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!. #hondroplasia
$emua tulang panjang %ekstremitas memenek
seangkan /orpus 9ertebra normal panjangnya.
Rontgen :
1. Tulang2 panjang penek & simetris
%mi"romelia
2. Pro?imal lebi, penek aripaa istal
%r,iIomelia ,umerus lebi, penek ari
raiusC femur lebi, penek ari tibia
#. 0etafise lebar & "upping %istal tulang panjang
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'. Tulang jari tangan penek 5 lebarC mis jari # & '
sama panjang %trient ,an
(. Tulang belakang : *ege!baji %3ertebra lumbalCtepi belakang /orpus 9ertebrae membulat
%"on"af se,ingga foramen nter3ertebralis
lebarCiameter AnteroPosterior peikel
memenek
G. @epala membesar %bran",y"ep,aly
. )ibula ,ea lebi, panjang ari tibia %sama ,alnya
ulna ter,aap raius7. Tulang pel3is bentuk ",ampagne %a"etabular
angle menatar
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Achon%roplasia
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(. TUMOR TULANG
>apat benigna!maligna serta bisa primer!
$ekuner %metastase :
+ntuk membeakan maligna atau tiak :
1. +mur penerita
2. Lamanya gejala2 nyeri & pembengkakan serta
ke"epatan pembesaran
#. ;esar ke"ilnya tumor
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1. 6 ( t,n : neuroblastoma
2. ( 26 t,n : e*ing tumor
#. 16 2( t,n : osteosar"oma
'. 26 '6 t,n : giant "ell tumor
(. 26 6 t,n : lipoma
G. #6 '( t,n : fibrosarkoma
. #6 (6 t,n : periosteal sar"oma7. #6 G6 t,n : ",onrosar"oma
. #6 6 t,n : ,emangioma
16. '6 76 t,n : metastaseC 0ultipel 0ieloma
# 8al penting lesi paa tulang
B infeksi!neoplasma
B benigna!maligna
Bprimer!sekuner
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@lasifikasi tumor tulang :
A. >ari jaringan $keletal1. Jaringan tulang:
a. Jinak: bone islanC osteomaC osteoi
osteomaC osteoblastoma
b. anas F DsteosarkomaC periosteal
sar"oma
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2. @artilago :
a. Jinak :@,onromaC@,onroblastomaC
@,onromi?oi )ibroma
b. anas % @,onrosar"oma
#. Jaringan )ibrosa :
a. Jinak : )ibrosaC ;ro*n Tumor
b. anas : )ibrosarkoma
'. iant /ell % iant /ell Tumor
a. Jinak : /TCA;/ OAneurysma ;one /yste
b. anas : iant /ell Tumor 0aligna
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(. TUMOR TULANG
@lasifikasi Tumor Tulang :;. >ari Jaringan Lain >alam Tulang :
1. Pembulu, >ara, : 8emangiomaClomusTumorC8emagio $ar"oma
2. $araf :
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/. >ari $eni $ino3ioma
>. Tiak >iketa,ui :
a. Jinak : $olitary ;one /yst
b. anas : *ing Tumor
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4umor :ina; %
1. ;one slan % nostosis
Ro : $oliter! 0ultiple
Terletak i 0eulla % $elalu
>ensitas 8omogen
Tepi apat rreguler Terjai
$pikula ke "a3um 0euller
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&clerotic bone islan% in the %istal
femur $ pro)imal portion of tibia
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2. Dsteoma :
Ro : >apat i @epalaC $inus
Paranasalis +kuran Q 2.( /m
>ensitas TinggiC TegasC
Tepi Rata & 8omogen
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. 0s'oid 0s'oma
Pria : Manita = # : 1
>ekae 2 ! #
Preileksi :
>iafise Tulang Panjang %(65 )emur ;agian
Proksimal Tibia
$kullJarang
Ro : Area Raiolusen D3al!;ulat Tepi $klerotik >ensitas Tinggi
>iameter Q 2.( /m
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*enign osteoblastoma +Giant osteoi% osteoma,
0s'ohondroma
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. 0s'ohondroma
Pertumbu,an keluar ari tulang berasal ari "orte?
iafise tulang panjang
menjau,i seni
Ro :
Tipe peun"ulate %k,as tonjolan tulang ari
"orte?engan gambaran ari trabekula lesi masukalam meulla melalui efek ari "orte?
@alsifikasi alam lesi
+kuran Q 716 "m ara, menjau,i seni
Paa pel3is an s"apula gambaran irregulerengan ensitas tinggi memberi gambaran Bunga Kol
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2ian' !ll 4umor (0s'olas'oma)
+sia 26 4 '6 t,n
Amat jarang terjai sebelum maturitas tulang@aang2 multifokal paa tangan.
Lesi soliterC preileksi i lututC ujung istal raiusC kaangkaang
paa sa"rumC pel3is & 3ertebra.
Ro : one raiolusenC k,as terletak tepat paa "orte? iba*a,
seni
Letak eksentris paa ujung tulang panjang
Tiak aa kalsifikasi ! o""ifikasi ke"uali setela, terjaifraktur patologis
ambaran k,as : trabekulasiCberbentuk S$oap ;ubble
App'65 kasus
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Giant cell tumor of bone
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#nurysmal Bon !ys'
tiologi tiak iketa,ui@aang2 terjai sesua, fraktur
Terjai p anak2 engan preileksi paa
tulang panjang
Paa 3ertebra umur 1626 t,nC
terutama paa ar"us neuralisC jarang paa
"orpusC kebanyakan beberapa 3ertebra
kena.
R
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Ro : Area reabsorbsi tulang yang k,as engan
ekspansi tulang +kuran lesi ber3ariasi 226 "m /orte? menipis & ekspansi Tepi enosteal berbatas tegas engan "orte? S$oap ;ubble Appearan"e Terapat Iona transisi antara lesi engan meullaC
kaang2 engan seikit sklerosis. $ering miripengan osteo"lastoma. @aang2 tepi s"allopeatau irregulerC tepi sklerotik
Angiografimirip Dsteo"lastoma
>> : Dsteo"lastoma !iant /ell Tumor
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Aneurysmal bone cyst involving
the %istal metaphysis $ epiphysis
of femur
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4umor ganas
&. 0s'osaromamenurut letak %sentralCperifer
menurut lesi %osteolitikCosteosklerotikC
"ampuran
Pria U *anita
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Ro : Preileksi : istal femurC jarang tibiaC sternumC
"ostaC kepala Letak lesi : metafise ! iafise (65 sklerotikC apat osteolitikC "ampuran %tepi tiak
teratur Reaksi periosteal gambaran Ssunburst!$un
Ray @,as lain : estruksi "orte? & in3asi ke jaringan
lunak $oft tissue s*elling /oman Triangle
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-steosarcoma of lytic type involving the %istal femur
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*. Fibrosarcoma
( 5 tumor skeletal
Lo* grae pain Q 1 t,n
$ering i meulla
0etafise
765 sekitar lutut
Ro %
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Ro %
@,as osteolitik
>i meulla %k,as area raiolusen irreguler
kspansi "orte?
$oft tissue s*elling %ok perluasan jaringan lunak
Tiak aa! jarang aa reaksi periosteal
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eriosteal fibrosarcoma of forearm involving the ulna
Khondrosarcoma
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. Khondrosarcoma
+mur : #6 46 t,n
Preileksi : Pel3isC "ostaC pro?imal femurRo :
estruksi korteks lokalC batas tiak tegas
batas jaringan se,at & lesi tiak apatibeakan
sentral tumor kalsifikasi tiak teratur
erosi enostealC s"alloping
Spop"orn appearan"e
Reaksi Periosteal Lamellar
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Chon%rosarkoma
4. Ewing Tumor
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4. Ewing Tumor
Asal ari meula
+mur ( 4 26 t,nPreileksi : tulang2 panjang
Ro :
Reaksi periosteal berlapislapis %Dnion $kinAppearan"e
$egitiga /oman
$klerotik kaang2 & sebagai garis longituinal
>estruksi tulang
$oft tissue s*elling
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/(ing0s tumor
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. Sinovioma
65 ekstremitas inferior lutut
@urang #6 t,n
Amat ganas"epat metastase ke @;
Ro :
0assa jaringan lunak sekitar seni
;anyak kalsifikasi
estruksi tulang irreguler ekat seni
Penebalan sino3ia & erosi perlekatan kapsula
/. !ultiple ieloma"
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/. !ultiple ieloma"
Tumor primer ganas sumsum tulangRo :
Dsteoporosis"orte? menipis
Dsteolitik Pun", out lesion multipleC bulatC tegasC intakC
ukuran ber3ariasi
Tepi lm korte? s"alloping
@aang2 lesi ekspansif & memberi gbr Ssoap
bubble >> : metastasis
# t t i
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#. etastasis
>apat osteolitikC osteoblastik
;atas tiak tegas
Tepi irreguler & kaang2 tepi sklerotik
Preisposisi metastase urutan terbanyak :
3ertebra iga & sternum
tengkorak & pel3is
tulang2 lain
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). NEKROSIS A*ASKULER TULANG+ OSTEO,-ONDRITIS OSTEO,-ONDROSIS INFARK TULANG
Aala, suatu kelainan tulang imana satu segmen tulang
ke,ilangan suplai ara,nya se,ingga elemen sel
ialamnya mati osteonekrosis
Paa umumnyatiak aa proses infeksi
Ro :
Akut
tak tampak kerusakan $taium seang ifuse osteoporosisC ensitas
normal paa aera, a3askuler
$taium lanjut :
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$taium lanjut :
a. $eni besar %pinggang & ba,u terjai
mikrofraktur korteksC iikuti kompressi
trabekula & kolapsCse,ingga seni
menatar isertai ensitas subarti"ular
tumbu, bersamaan trabekula tertekan
kealam ruang yang lebi, ke"il
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a. nfark i metafise & subartikuler bagian sentral lusen
b. S;one *it,in ;one tampak sebagai
ensitas linier ialam & sejajar "orte?
". @elainan epifise S/one epip,yse
isebut fusi prematur
10K#SI* K1#I$#$ 0S40!"0$DRI4IS
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10K#SI* K1#I$#$ 0S40!"0$DRI4IS
1. /orpus 3erteba /al3e >isease
2. 9ertebral epip,yse $",euermann isease
#. /apitulum 8umerus Panners >isease
'. Lunatum@ienboe"k isease
(. Pro?p,langes %jari t,iemmanns isease
G. /aput meta"arpal
ietri", isease. /aput femoris "al3e leg pert,es
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1. >istal "ollum femoris
"o?a 3ara2. Tibia!apop,ysis tibia osgoo s",latter
#. /onylus meial tibia blounts isease
'. /ol"aneus apop,ysis se3er isease(.
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Os0ep%sis
>efenisi :
$uatu penyakit skeletal yang bersifat
sistemikCitanai ole, berkurangnya massa
tulang an memburuknya mikrostrukturtulang engan akibat jaringan tulang engan
akibat peningkatan kerapu,an serta
kerentanan tulang ter,aap fraktur
Pni'raan pada os'oporosis
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Pni'raan pada os'oporosis
&. Radiologi ;onual nergy -Ray Absorptiometry %>-A
. $onoensitometri
7.
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$. %STE%ART&R'T'S !%A"
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Dsteoart,rosisegeneratif joint isease
Preileksimulai paa lutut Manita U pria
Rontgen (jari2)paling sering istal interp,alangeal joint
$elalu seni menyempit Permukaan seni irreguler
8erbenens
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Ro (Lutut) :
$pur aspekposterior patella
$pur formation : "onylus tibia pro?imalCfemur
istalC eminentia inter"onyloiea tibia
$eni menyempit aspek meial
%>>.R,eumatoi : menyeluru, seni
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(. )S%R'AT'( ART&R'T'S
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>estruksi Preominant mengenai istal
interp,alangeal joint %seperti DA
Terjai ankylosing paa interp,alangeal joint
>>.
Rheumatoidpaa interp,alangeal joint
Ruang seni lebar permukaan jelas
>estruksi artritis paa interp,alangeal joint ari ibu jari
kaki
Dsteoporosis Ringan
@aki lebi, jelas menunjukkan psoriati" art,ritis0ineralisasi tulang tiak terganggu
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&-#!AT!C A#T1#!T!&
*. A+K,%S'+ S)%+*,'T'S
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0arie strumpells!3on be",tere*s!r,ematoi
sponylitis *anita = pria biasa paa orang mua
Rontgen :
$a"roiia" Joint kabur %$ melebar menyempit
sklerosing!ankylosing %bilateral
0ulai selalu i $ Joint $uaring anterior "orpus 3ertebrae
Dsteoporosis umum
@alsifikasi ligamentum K paraspinal soft tissue
;amboospine
>estruksi is"us
$ynesmop,yte formation
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E. R&E/AT%'* ART&R'T'S
Manita U pria
0ultiple & $ymetris
Paling sering terkena : proksimal interp,alangeal
jointCmeta"arpop,alangeal jointC*rist joint
%raio"arpalC tiak semua joint bisa terkena.
Rontgen : Periartikular soft tissue s*elling bentuk
fusiform %spinle s,arpe
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Dsteoporosis aera, periarti"ular
/ela, seni menyempit estruksi ra*anseni
0arginal erotion ju?ta arti"ular art,ritis
mutilans Ankylosing tulang K sublu?atio
+lnar e3iation ari jari2 Akibat sublu?atio
% fle?i e?tensi s*an ne"k Appearan"e
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#1/2AT-!3 A#T1#!T!& !T1 &C/#-3/#A
F %/T
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F. %/T
Pria U Manita
Lebi, '6 t,n
Rontgen :
Peruba,an Rontgen baru terli,at paa
serangan berulang2 Paa umumnya ,anya mengenai Ssatu joint
meta"arp,alangeal joint %tetapi seni lain tangan
& kaki bisa kena >eposit
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Dsteolitik ju?ta artikular ke"il!besar batas
tegas Aa subartikuler "ysti" area tepi sklerotik
D3er ,anging egeC>Q6C## "m atau isebut
P+ D+T ;ila aa eposit /a paa top,i top,i terli,at
$eni sempit
Dsteoporosis kurang
FOTO KEPALA
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FOTO KEPALA
nformasi!kelainan2 apat : )raktur
nfeksi
Tumor : primer
sekuner
$inus paranasalis
@ongenital
Tana2 peningkatan tekanan intra kranial :
$utura melebar
mpressiones igitatae
>estruksi sella
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