Method for predicting costoclavicular syndrome

FIELD: medicine, vascular surgery.

SUBSTANCE: one should measure the width of costoclavicular space due to ultrasound scanning at simultaneous visualization of patient's clavicle and the first rib due to detecting maximal distance between them. At distance being under 5 mm one should diagnose costoclavicular syndrome. The innovation enables to detect costoclavicular space due to US scanning at calculating average value of costoclavicular space being at norm.

EFFECT: higher efficiency of diagnostics.

1 dwg, 1 ex

 

The invention relates to medicine, namely to vascular surgery.

Costoclavicular syndrome (Falconer-Weddel) - a pathological condition caused extravasal compression of the subclavian vessels and brachial plexus nerve between the clavicle and the first rib in the presence of a wide first edge, high standing, hypertrophic costoclavicular muscles. Some importance of physiological omission of the shoulder girdle, the curvature of the cervical-thoracic spine, the effects of fractures of the clavicle and the first rib with the formation of excessive bone spur and strain.

Diagnosis costoclavicular syndrome is primarily based on clinical symptoms, which are similar to symptoms of other syndromes of the upper thoracic aperture, data compression samples and the assessment of the degree of narrowing of the costoclavicular space (RCP) using x-ray examinations. X-ray analysis provides some assistance to determine the high standing of the first edge, the magnitude of the arc of the ribs in the lateral projection, the angle of the clavicle relative to the horizontal and frontal planes.

However, the methodology for determining the width of the RCP on radiographs quite subjective, are dependent on the method of installation, location of the patient to the device screen, geneticist is due to the width of the bone, require graphics computing the value of an angle and are therefore inconvenient in practice.

Closest to the claimed solution is the method of differential diagnosis of compression of the neurovascular bundle of the upper limb, the proposed Asspoint.com and co (certificate of priority No. 4677654 from 29.11.90).

This method is taken as a prototype. This method is based on measuring the width of the RCP on the radiographs from the upper edge of the front third of the first edge at its bend to the lower edge of the clavicle perpendicular to a determination of the degree of narrowing of the PKK (1 tbsp. - 4-8 mm, 2 tbsp. - 4-6 mm, 3 tbsp. - 0-3 mm) and calculate the angle formed by the axis of the middle part of the first edge and the axis of the inner half of the clavicle.

The disadvantage of the prototype method is the impossibility of precise calculation, as a clear visualization of the upper edge of the front third of the ribs is often difficult, in many cases, the shadow of the clavicle is partially overlapped with the shadow edges, which demonstrates the need for careful selection of the degree of lordosis of the patient for maximum visualization of the RCP under the control of fluoroscopy with increasing total dose of radiation.

The purpose of the invention is to develop a non-invasive method for determining the width of the RCP using ultrasound to calculate the average value of the costoclavicular interval normal.

The essential is to be inventions.

The method is illustrated in the drawing, where cl is the clavicle, cos - the first edge.

The proposed method consists in the following. Ultrasound examination of the RCP is patient is in sitting position with hands down in b-mode linear sensor with a radiation frequency of 7.5 MHz, which is located in the infraclavicular fossa. Changing the direction of the sensor at an acute angle (oblique cut), are displayed simultaneously, the clavicle and the first rib, is determined and recorded the maximum distance between these structures, which from the clavicle to the edge of the falls perpendicular.

The way to diagnose costoclavicular syndrome is to measure the width of the costoclavicular space. The measurement is performed with the help of ultrasound scanning with simultaneous visualization of the clavicle and the first rib by determining the maximum distance between them, and when the distance between them is less than 5 mm can be diagnosed costoclavicular syndrome.

This method examined 50 patients (18 males and 32 females) aged 18 to 52 years, with no signs of SUGA, and 5 patients with costoclavicular syndrome. The width of the RCP ranged from 5 to 9 mm and averaged a 7.2±0,9 mm In all patients with costoclavicular syndrome width of the RCP was less than 5 mm and was 3.6±0,4mm

On the basis of the received data is x, we can conclude, the average width of the RCP according to the U.S. less than that determined by x-ray and normal is 5 mm or more. If the width of the RCP is less than 5 mm in a patient can be diagnosed costoclavicular syndrome. The mapping of the data into the clinic and the results of Doppler ultrasound to confirm the diagnosis and determine further tactics of treatment.

A specific example of the method.

Patient lobster GT (history No. 12/0165) was admitted to the Department of vascular surgery RSC city with complaints of pain, swelling of the right hand, weakness in it, increased venous pattern. Patients consider themselves to be about 10 days, acutely ill, when after exercise pain appeared in his right hand, and by morning had severe swelling.

Objectively: General condition is satisfactory, the skin and visible mucous membranes pink, peripheral lymph nodes are not enlarged. Proper athletic. In the lungs vesicular breath, held all of the fields, the NPV - 19/min. Heart tones are clear, rhythmic, pulse rate is 72/min, BP 120/80 mm Hg Abdomen is soft, painless, peristalsis active, liver and spleen are not enlarged.

Local status: the right arm is swollen all over, the color with a bluish tinge, with comparative perimetric studies the difference in volume compared to the left 1.5-2.5 cm at different levels. There is argenna subcutaneous venous network on the right arm and right half of the thorax.

Pulsation of the radial artery at rest, distinct from both parties, when conducting samples abduction Lange weakened, but not eliminated, with the omission and lead hands ago not defined.

Laboratory values within normal limits.

On radiographs of the cervical-thoracic spine extension of the cervical ribs are not detected.

In ultrasonic dopplerography with duplex scanning and color mapping of blood flow revealed that the right subclavian vein is dilated, the blood flow in her low-amplitude, monophasic, in the lumen of the visualized thrombotic mass.

The linear velocity of blood flow in the subclavian artery alone, 38 cm/sec when moving the hands back down to 10 cm/sec.

The width of the costoclavicular interval was 3.7 mm

Diagnosis: costoclavicular syndrome, complicated by the syndrome Paget's disease of Strattera right.

Signs, distinctive features of the prototype:

1. To measure the width of the RCP used ultrasound unlike the prototype, where the evaluation is made by x-ray (no need for fluoroscopic control, and hence in the additional irradiation of the patient).

2. If the width of the RCP is less than 5 mm in a patient can be diagnosed costoclavicular syndrome. The mapping of the data into the clinic and the results of the ultrasound is howling dopplerography should confirm the diagnosis and determine further tactics and treatment of the patient. In the method prototype offers the following figures: 1 tbsp. narrowing of the RCP - 4-8 mm, 2 tbsp. - 4-6 mm, 3 tbsp. - 0-3 mm.

The positive effect from the use of the invention.

The proposed method is easy to use and does not require measuring instruments in contrast to the prototype. The way to diagnose costoclavicular syndrome allows adequate diagnosis of this pathology and to determine further tactics of conducting the patient.

The way to diagnose costoclavicular syndrome, which consists in measuring the width of the costoclavicular space, characterized in that the measurement is performed with the help of ultrasound scanning with simultaneous visualization of the clavicle and the first rib by determining the maximum distance between them and when the distance is less than 5 mm between the clavicle and the first rib can be diagnosed costoclavicular syndrome.



 

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