超声引导下肩峰下滑囊造影对肩袖损伤的诊断价值

发布时间：2017-12-26 19:17

本文关键词：超声引导下肩峰下滑囊造影对肩袖损伤的诊断价值　出处：《川北医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的:开展一项新的超声检查技术—超声引导下肩峰下滑囊造影(Ultrasound-guided Subacromial Bursography,USB),以关节镜检查作为金标准,探讨USB对肩袖损伤的诊断价值,并总结不同类型肩袖损伤的USB图像特征。方法:收集2014年3月至2015年6月于四川省人民医院就诊且怀疑为肩袖损伤的患者263例行肩关节超声检查,其中105例随后接受USB检查,最终40例患者进行了关节镜手术治疗。所有检查结果分为肩袖肌腱炎(无撕裂)、肩袖部分撕裂和全层撕裂三类,分析并总结肩袖损伤的USB图像特征,采用确切概率法比较US和USB对肩袖部分撕裂和全层撕裂检出率的差异,通过计算敏感性、特异性、准确性、阳性预测值(PPV)、阴性预测值(NPV)及Youden’s指数比较两种检查方法的诊断效能。结果:本研究中所有进行USB检查的患者在检查过程中及检查后1个月均未见并发症及不良反应发生。经关节镜证实,肩袖全层撕裂者25例,US准确诊断17例,USB准确诊断24例,差异具有统计学意义(P=0.039)。US诊断全层撕裂的敏感性、特异性和准确率分别为68%、100%和77.5%,USB诊断全层撕裂的敏感性、特异性和准确率分别为96%、100%和80%。肩袖部分撕裂者10例,US准确诊断6例,USB准确诊断8例,差异无统计学意义(P=0.05);肩袖无撕裂者5例,US准确诊断3例,USB准确诊断4例。结论:1、超声引导下肩峰下滑囊造影是一项新的、安全有效的检查方法,开拓了血管外超声造影技术的临床应用,为滑囊造影提供了一种新方法。2、超声引导下肩峰下滑囊造影能用于评估肩袖损伤,根据造影剂是否进入肩袖肌腱可判断肩袖有无撕裂(滑囊面部分撕裂或全层撕裂);根据造影剂是否分布于肌腱全层,即是否达肱骨头表面,或进入关节腔内,可判断全层撕裂或滑囊面部分撕裂;此外,可根据造影剂分布的面积评估肩袖撕裂的范围,这对肩袖损伤患者治疗方案的选择具有重要意义。但由于造影剂是从滑囊内注入,超声引导下肩峰下滑囊造影对肩袖肌腱内部分撕裂和关节面部分撕裂并不敏感。3、超声引导下肩峰下滑囊造影对肩袖全层撕裂的敏感性和特异性明显高于二维超声,提高了超声在肩袖损伤诊断中的应用价值,值得临床推广应用。
[Abstract]:Objective: to develop a new ultrasound technology, ultrasound-guided subacromial bursa angiography (Ultrasound-guided Subacromial Bursography, USB), using arthroscopy as the gold standard, to explore the value of USB in diagnosis of rotator cuff injury, and summarize the characteristics of USB images of different types of rotator cuff injury. Methods: from March 2014 to June 2015, 263 patients who were suspected of rotator cuff injury in Sichuan Provincial People's Hospital were examined by shoulder joint ultrasound. Of them, 105 underwent USB examination, and 40 patients underwent arthroscopic surgery. All patients were divided into tendinitis (no tear), partial tear of the rotator cuff and full-thickness tear class three, USB image analysis and summary of rotator cuff injury, US and USB the difference in detection rate of rotator cuff tear and full-thickness tears of the exact probability method, through the calculation of sensitivity and specificity, accuracy, positive predictive value, negative predictive value (PPV) and Youden (NPV) diagnostic efficiency s index comparison of two methods of inspection. Results: all USB patients in this study had no complications and adverse reactions during the examination and 1 months after examination. By arthroscopy, 25 cases of total rotator cuff tear, 17 cases with accurate diagnosis of US and 24 cases with accurate diagnosis of USB were found, the difference was statistically significant (P=0.039). The sensitivity, specificity and accuracy of US for diagnosing full-thickness tear were 68%, 100% and 77.5%, respectively. The sensitivity, specificity and accuracy of USB for diagnosing full-thickness tear were 96%, 100% and 80%, respectively. There were 10 cases of partial tears of the rotator cuff, 6 cases were accurately diagnosed by US, 8 cases were accurately diagnosed by USB, the difference was not statistically significant (P=0.05), 5 cases of rotator cuff without tear, 3 cases of US accurate diagnosis, 4 cases of USB accurate diagnosis. Conclusion: 1. Ultrasound-guided acromion cysts is a new, safe and effective examination method. It opens up the clinical application of extravascular ultrasound and provides a new method for bursiography. 2, under the guidance of ultrasound imaging can be used to assess the subacromial bursa of rotator cuff injury, according to whether the contrast agent into the rotator cuff tendons can judge the rotator cuff without tearing (sliding surface or partial tear sac full-thickness tear); according to the contrast is distributed in the whole layer of tendon, the humeral head surface, or into the joint cavity that can be a partial tear judgment full-thickness tear or bursa; in addition, according to the scope of the distribution of contrast agent area evaluation of rotator cuff tear, which is of important significance for patients with rotator cuff injury treatment options. However, as the contrast agent is injected from the capsule, the ultrasonic guided acromion cysts are not sensitive to the partial tearing of the rotator cuff tendon and the partial tear of the articular surface. 3. The sensitivity and specificity of ultrasound guided acromion cysts contrast to the full thickness tear of the rotator cuff is significantly higher than that of two-dimensional ultrasound, which improves the value of ultrasound in the diagnosis of rotator cuff injury, and is worthy of clinical application.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.1;R684

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