中华肩肘外科电子杂志
中華肩肘外科電子雜誌
중화견주외과전자잡지
Chinese Journal of Shoulder and Elbow (Electronic Edition)
2013年
1期
36-39
,共4页
刘佳超%陈建海%黄伟%王天兵%姜保国
劉佳超%陳建海%黃偉%王天兵%薑保國
류가초%진건해%황위%왕천병%강보국
肩关节%肩袖%关节镜
肩關節%肩袖%關節鏡
견관절%견수%관절경
Shoulder%Rotator cuff%Arthroscopy
目的:通过比较肩关节术前 MRI检查与关节镜下肩袖所见的异同,了解 MRI 对肩袖损伤诊断的准确性,并进一步明确肩袖损伤关节镜治疗的适应证。方法回顾性分析2007年7月至2010年12月北京大学人民医院创伤骨科行关节镜检查或治疗患者的59例肩部疾病患者,将MRI表现与关节镜所见进行对照分析。结果59例患者中,术前 MRI 检查明确诊断肩袖损伤36例,经关节镜证实肩袖撕裂35例,肩袖组织关节镜下结果完整,未见明显撕裂者1例;术前 MRI 检查未发现肩袖撕裂而关节镜下见撕裂7例,MRI检查与关节镜均未见肩袖撕裂者16例。MRI 对肩袖损伤诊断的敏感度为88.3%,特异度为94.1%,阳性预测值97.2%,阴性预测值69.6%。结论 MRI 是诊断肩袖损伤的有效辅助检查,但仍存在一定程度的漏诊,关节镜检查是诊断肩袖损伤最为可靠的辅助检查手段。
目的:通過比較肩關節術前 MRI檢查與關節鏡下肩袖所見的異同,瞭解 MRI 對肩袖損傷診斷的準確性,併進一步明確肩袖損傷關節鏡治療的適應證。方法迴顧性分析2007年7月至2010年12月北京大學人民醫院創傷骨科行關節鏡檢查或治療患者的59例肩部疾病患者,將MRI錶現與關節鏡所見進行對照分析。結果59例患者中,術前 MRI 檢查明確診斷肩袖損傷36例,經關節鏡證實肩袖撕裂35例,肩袖組織關節鏡下結果完整,未見明顯撕裂者1例;術前 MRI 檢查未髮現肩袖撕裂而關節鏡下見撕裂7例,MRI檢查與關節鏡均未見肩袖撕裂者16例。MRI 對肩袖損傷診斷的敏感度為88.3%,特異度為94.1%,暘性預測值97.2%,陰性預測值69.6%。結論 MRI 是診斷肩袖損傷的有效輔助檢查,但仍存在一定程度的漏診,關節鏡檢查是診斷肩袖損傷最為可靠的輔助檢查手段。
목적:통과비교견관절술전 MRI검사여관절경하견수소견적이동,료해 MRI 대견수손상진단적준학성,병진일보명학견수손상관절경치료적괄응증。방법회고성분석2007년7월지2010년12월북경대학인민의원창상골과행관절경검사혹치료환자적59례견부질병환자,장MRI표현여관절경소견진행대조분석。결과59례환자중,술전 MRI 검사명학진단견수손상36례,경관절경증실견수시렬35례,견수조직관절경하결과완정,미견명현시렬자1례;술전 MRI 검사미발현견수시렬이관절경하견시렬7례,MRI검사여관절경균미견견수시렬자16례。MRI 대견수손상진단적민감도위88.3%,특이도위94.1%,양성예측치97.2%,음성예측치69.6%。결론 MRI 시진단견수손상적유효보조검사,단잉존재일정정도적루진,관절경검사시진단견수손상최위가고적보조검사수단。
Objective Rotator cuff, a sleeve-like structure composed of supraspinatus, infraspinatus muscle,teres minor and subscapularis,is the major anatomical structure to maintain shoulder stability.Rotator cuff pathologies are frequently encountered in patients with pain at the shoulder.The rotator cuff can be visualized with different imaging techniques such as ultrasonography (US),arthrography,arthroscopy,computed tomography (CT)and magnetic resonance imaging (MRI).MRI had quickly become the favored method for preoperative diagnosis of the rotator cuff inj ury,with high soft tissue resolution ratio,sensitivity and accuracy.It is clinically significant to correctly understand the MRI manifestation of patients with the painful shoulder.We retrospectively analyzed the MRI examination and arthroscopy findings of 5 9 rotator cuff inj uries treated in one hospital.Methods (1)Subjects:From July 2007 to December 2010,a total of 59 patients (25 males and 34 females,aged from 24 to 83 years old,mean age 54.33 years),who underwent arthroscopic surgery for their shoulder joint diseases,were selected.All the patients had shouder MRI examination before operation,we compared their preoperative MRI results with surgical findings.(2)Arthroscopic surgery:All arthroscopic surgical procedures were performed by experienced directors or deputy directors of physicians to obtain an accurate diagnosis of the rotator cuff inj ury.All patients were treated by Stryker (Stryker)arthroscopic systems for their diagnosis and treatment.Diagnosis was based on the surgical records or video records.(3 )Magnetic resonance imaging:Multi-planar MR imaging of the shoulder was performed using coronal oblique,sagittal oblique and axial sequences.All MRIs were reported by a radiologist with special trained in musculoskeletal imaging.(4)Diagnosis of rotator cuff inj ury:Based on the lannotti classification criterion, according to their pathological changes,rotator cuff inj uries can be classified as ① Tendinitis:increased tendon signal intensity,no morphological changes, and intact shoulder-deltoid bursa fat layer.②Partial-thickness tear:the increased limitations of signal intensity at the tendon,morphological changes accompanied by the discontinuity of the shoulder-deltoid bursa fat layer.③ Full thickness tear:the significantly increased tendon signal intensity,obvious morphological abnormalities such as discontinuity of the tendon, tendon-muscle belly retraction or obvious muscle atrophy,ie the increased signal intensity of the muscles,the discontinuity or disappearance of the acromion-the deltoid bursa fat layer.Results 36 out of 59 cases were diagnosed as the rotator cuff injury by MRI before operation,35 of which had been confirmed with tendinitis,partial-thickness tear or full thickness tear by arthroscopy during operation. One rotator cuff inj ury diagnosed before operation was proved to be intact arthroscopically.Seven cases with negative findings under MRI examination had been found to be rotator cuff inj uries by arthroscopy.1 6 cases (including fractures,shoulder instability or Bankart inj ury)of them presented intact in both MRI examination and arthroscopy operation.The sensitivity level of MRI examination for the rotator cuff injuries was 83.3%.The specificity level of MRI examination was 94.1%.The degree of positive prediction was 97.2%,and that of negative prediction was 69.6%.These rotator cuff injuries included 3 cases of tendinitis,13 cases of partial-thickness tear (10 of bursa side and 3 of articular side)and 22 cases of full-thickness tear.Discussion Patients with rotator cuff injury are frequently encountered.As a hub of upper limb activities,rotator cuff determines the range of the shoulder activitivy and space accuracy.The rotator cuff muscles are main strength source of the shoulder,which play a vital role in the shoulder function.Therefore,rotator cuff inj uries at the shoulder would produce different degrees of dysfunction and painfulness,and seriously affect the patient′s quality of life and activities of daily living.Firstly,we need to define that the rotator cuff inj ury is a partial-thickness tear or a full-thickness tear.Ellman divided the partial-thickness rotator cuff tears into three categories:synovial side partial-thickness tear,intra-tendon partial-thickness tear and articular side partial-thickness tear.Each category is divided into three degrees according to the depth of tear:degree Ⅰ (<3 mm),degree Ⅱ (3-6 mm),degrees Ⅲ (>6 mm),or more than 50% of the full-thickness at the tendon.Full-thickness tear classification is generally based on the size of tear:small tear (<1 cm),medium tear (1-3 cm),large tear (3-5 cm)and a massive tear (>5 cm).The imaging examination on the shoulder is indispensable in the diagnosis and classification of rotator cuff inj uries,in addition to their detailed medical history and physical examination.The non-invasive and non-radioactive MRI,with excellent anatomy repeatability and organizational control comparability, can provide multi-angle,multi-plane and multi-level scan imaging,presenting a variety of normal and abnormal tissue structure imaging,which seems to be very important for the diagnose of shoulder diseases.In our study,the sensitivity level of MRI in diagnosis of the rotator cuff injury is 83.3%. Seven cases which were negatively diagnosed in MRI examination had been proved to be rotator cuff inj uries by arthroscopy.Using arthroscopy,we can observe the rotator cuff directly to identify the scope,size,and shape of tears.And the shoulder joint synovitis,supraspinatus tendon degeneration and partial tears of the biceps tendon and other pathological changes can be also determined by arthroscopy,which can′t be comparable with other imaging techniques.Therefore,it is necessary to use arthroscopy for the patients who have long-term shoulder pain,functional limitation,long-term conservative treatment fails and other tests difficult to diagnose.Arthroscopy can provide not only the confirmation of the diagnosis,but also the treatment such as debridement of the shoulder joint synovial tissue and calcification of supraspinatus tendon and suture of the teared rotator cuff. Conclusions According to our research and literature,generally speaking,MRI examination plays an important role for the diagnosis of rotator cuff inj uries,which can provide the accurate determination of the extent,size and scope of rotator cuff inj uries,as well as the signs associated.MRI can facilitate the development of treatment programs for the rotator cuff inj uries,and eventually help patients to get timely and correct treatment.