磁共振间接法关节造影在肩峰下撞击综合征中的诊断价值研究

发布时间：2018-02-16 04:09

本文关键词： 磁共振间接法关节造影肩峰下撞击综合征肩关节　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过对肩峰下撞击综合征患者肩关节MR平扫和MR间接法关节造影所得的图像特点进行分析、总结,探讨MRI和I-MRAR在肩峰下撞击综合征中的诊断价值,为临床诊断做出辅助评价并为治疗方案的选择提供影像学支持。方法：收集就诊于本院临床怀疑肩关节损伤的患者30例,所有患者均有肩部疼痛、肩关节活动受限或者功能障碍,其中男性18例,女性12例,年龄38～82岁,平均年龄58.6岁；30例患者均进行了肩关节镜检查,所有患者在关节镜检查前完成MR平扫和MR间接法关节造影检查。以临床诊断和肩关节镜手术结果为金标准,计算MR平扫及MR间接法关节造影诊断肩峰下撞击综合征的敏感度、特异度和诊断符合率,比较两者对于肩峰下撞击综合征的诊断价值。结果：(1)MRI与I-MRAR在诊断肩袖部分撕裂时差异具有统计学意义(敏感度P值0.05,诊断符合率P值0.05)；在诊断肩袖全层撕裂和肌腱炎时敏感度差异无统计学意义(敏感性P值0.05)。 (2)MRI和I-MRAR对SAIS间接征象诊断的差异无统计学意义(P0.05):MRI和I-MRAR对SAIS间接征象的诊断敏感度较高,但是并不特异。 (3)MRI和I-MRAR对盂唇撕裂的诊断差异具有统计学意义(P0.05)；对冈上肌萎缩、三角肌萎缩的诊断差异无统计学意义(P0.05),MRI和I-MRAR对冈上肌萎缩和三角肌萎缩均能做出正确诊断；I-MRAR对盂唇撕裂的诊断具有更高的敏感度。 (4)MRI和I-MRAR对SAIS病因学征象诊断的差异无统计学意义(P0.05),MRI和I-MRAR对肩峰形态和肩峰下通道狭窄均能做出正确诊断。结论：磁共振平扫能够对大部分肩峰下撞击综合征做出正确诊断,但对于由肩关节撞击引起的冈上肌腱部分撕裂和关节盂唇撕裂的诊断作用有限；而MR间接法关节造影对冈上肌腱部分撕裂和关节盂唇撕裂的诊断具有重要价值,能够确定诊断,可为临床诊断做出辅助评价并为治疗方案的选择提供有力的影像学支持。
[Abstract]:Objective: to evaluate the diagnostic value of MRI and I-MRAR in subacromial impingement syndrome by analyzing the features of Mr plain scan and indirect Mr arthrography in patients with subacromial impingement syndrome. To make assistant evaluation for clinical diagnosis and provide imaging support for the choice of treatment plan. Methods: thirty patients with suspected shoulder joint injury were collected. All the patients had shoulder pain, limited shoulder movement or dysfunction, including 18 males and 12 females, aged 3882 years. The average age was 58.6 years old and 30 patients underwent shoulder arthroscopy. All the patients completed Mr plain scan and Mr indirect arthrography before arthroscopy. The results of clinical diagnosis and shoulder arthroscopy were regarded as golden standard. The sensitivity, specificity and diagnostic coincidence rate of Mr plain scan and Mr indirect arthrography in the diagnosis of subacromial impingement syndrome were calculated. The diagnostic value of Mr plain scan and Mr indirect arthrography in the diagnosis of subacromial impingement syndrome was compared. Results the difference between MRI and I-MRAR in the diagnosis of partial rotator cuff tear was statistically significant (sensitivity P value 0.05, diagnostic coincidence rate P value 0.05), but there was no significant difference in sensitivity in diagnosis of rotator cuff tears and tendinitis (P value 0.05). There was no significant difference between MRI and I-MRAR in the diagnosis of indirect signs of SAIS. The sensitivity of MRI and I-MRAR in the diagnosis of indirect signs of SAIS was higher than that of I-MRAR, but it was not specific. The difference between MRI and I-MRAR in the diagnosis of pelvic lip tear was statistically significant (P 0.05). There was no significant difference in the diagnosis of deltoid atrophy. MRI and I-MRAR could make the correct diagnosis of supraconaspinar atrophy and deltoid atrophy. There was no significant difference between MRI and I-MRAR in the etiological diagnosis of SAIS. MRI and I-MRAR could make a correct diagnosis for the shape of acromion and the stenosis of subacromial passage. Conclusion: Mr plain scan can make correct diagnosis for most subacromial impingement syndrome, but it is limited in diagnosis of partial tear of supraspinatus tendon and laceration of glenoid lip caused by impact of shoulder joint. Mr indirect arthrography has important value in the diagnosis of partial tear of supraspinatus tendon and laceration of glenoid lip of joint. It can be used to confirm diagnosis, to make auxiliary evaluation for clinical diagnosis and to provide powerful imaging support for the choice of treatment scheme.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R684

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