LIGAMENTOGRAFIYA (Latin ligamentum a sheaf + grech, grapho to write, represent) — a radiological method of a research sheaves and sinews . L. it is based on distribution of the contrast agent entered by means of a puncture on the course of sheaves, sinews and muscle fibers. For the first time it was applied by the Colour (R. Kohler, 1959) to definition of injury of an interspinal ligament of backbone.
L. use for identification of damages, dystrophic changes of interspinal ligaments of backbone and sinews of muscles of top and bottom extremities. Apply to contrasting or water-soluble iodorganic contrast agents (Urotrastum, Verografinum, triombrin), either oxygen or carbon dioxide gas (pneumography). Several types of devices for administration of contrast mediums in soft tissues are offered.
A contraindication to production of L. water-soluble iodorganic contrast means is the intolerance of iodine, acute and hron, inflammatory processes of soft tissues in the field of a research. Inflammatory processes are a contraindication and for administration of gas. Danger of an embolism excludes carrying out air L. at fractures of bones.
For carrying out L. interspinal ligaments of a backbone the Colour recommends to enter a contrast agent on both sides to the basis of an acantha at the required level. I. A. Movshovich (1963) enters a contrast agent directly into an interspinal sheaf. A. E. Dmitriyev and G. S. Yumashev, having altered a technique of the Colour, enter a contrast agent at the basis of an acantha on the one hand.
For carrying out L. the patient is stacked on a stomach. After anesthesia of skin and hypodermic cellulose at the level of damage to the basis of an acantha on both sides enter 2% of solution of novocaine and after this on 10 — 12 ml of a contrast agent on 0,5 ml. After extraction of a needle of the patient turns over on a back and to it at once make the perednezadny roentgenogram (since a contrast agent quickly resolves). If administration of contrast medium only to the area of one segment is insufficient, L. it is possible to make from 4 — 6 points (on 2 — 3 from each party).
Normal on a ligamentogramma there is no defect of an interspinal sheaf, and a contrast agent flows round on both sides acanthas and interspinal sheaves, without passing for the centerline (fig. 1). The same picture is observed at sprain. At a partial rupture of an interspinal sheaf a contrast agent through narrow defect in it passes for the centerline (fig. 2). At a complete separation of interspinal and nadostisty sheaves a contrast agent carries out not only all interspinal space, but also is imposed on the next acanthas (fig. 3). Dystrophic changes of interspinal sheaves are shown by their considerable thinning.
H.p. administration of gas most often apply to contrasting of the copular device of extremities, napr, to diagnosis of injuries of a calcaneal (akhillov) sinew, ligaments of an ankle joint, sinews of a biceps of a shoulder, etc. For this purpose from 40 to 250 ml of gas (depending on area of a research) under pressure of 0,05 atm through a needle enter into the area of a sinew. Yu. A. Vvysman by means of the special pneumographic device at a research of heelstring enters gas from several points: 8 cm higher than the place of an attachment of heelstring to a calcaneus, at the same level — in soft tissues of a kzada from a sinew and in back group of muscles of an average third of a shin. Roentgenograms should be done right after administration of gas since it resolves in 10 — 15 min.
A direct sign of a rupture of a sinew — existence of the cross strip of gas crossing a shadow of a sinew. This sign is most often observed in the first days after a gap. The indirect sign of a rupture of sinews — wrinkling of fibers of muscles, a cut is shown by a wavy contour of fibers and a characteristic arrangement of gas in them.
Bibliography: Weismann Yu. A. A X-ray pneumographic research at damages and diseases of soft tissues of musculoskeletal system, Radiology — diagnosis, t. 11, No. 1, page 81, 1970, bibliogr.; Lindenbraten L. D. and Naumov L. B. Methods of X-ray inspection of bodies and systems of the person, pages 23 3, 395, Tashkent, 1976; Yu m and sh e in G. S. and Silin L. L. Injuries of bodies of vertebrae of intervertebral disks and sheaves, Tashkent, 1971, bibliogr.; Kohler R. Contrast examination of the lumbar interspinous ligaments, Acta radiol. (Stockh.), v. 52, p. 21, 1959.
G. S. Yumashev.