二维高频超声及能量多普勒评价2型糖尿病患者肩袖异常改变

发布时间：2018-04-17 15:35

本文选题：糖尿病2型 + 肩袖　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:探讨应用二维高频超声及能量多普勒技术评价2型糖尿病(T2DM)不同病程患者肩袖结构形态学及血流异常改变的临床价值。方法:收集60例T2DM患者,分为2组:病程≤10年(B组)30例;病程10年(C组)30例。另收集30名健康志愿者为正常对照(A组)。分别应用二维高频超声及能量多普勒技术观察3组双侧肩袖结构各肌腱及肱二头肌长头腱的回声及血流情况,测量双侧冈上肌腱(SUP)、肩胛下肌腱(SUB)、冈下肌腱(INF)、肱二头肌长头肌腱(BT)的厚度。结果:正常各肌腱长轴均显示为以纤细低回声区所间隔的多个互相平行的细线样强回声的索条样结构,在短轴切面则呈网状结构;B组中冈上肌腱出现内部回声减低、回声不均匀、肌腱边缘不规则等内部回声异常的比率大于A组(P0.05),C组中冈上肌腱、肩胛下肌腱、冈下肌腱、肱二头肌长头腱四组肌腱出现内部回声减低、不均匀、边缘不规则等内部回声异常的比率较A组均增加(P均0.05);B组、C组各肌腱内发现钙化灶比率均大于A组(P均0.05);C组中肱二头肌长头腱出现腱旁组织异常的比率大于A组(P0.05);双侧各肌腱中,B、C组与A组相对比厚度均增加,差异均有统计学意义(P均0.05);右侧冈上肌腱、肱二头肌长头腱两组肌腱C组与B组之间相对比,肌腱厚度差异均有统计学意义(P均0.05);C组中肱二头肌长头腱双侧厚度对比,差异具有统计学意义(P0.05);A、B、C组中各肌腱内可探及血流信号者为1级血流信号比率最高,各组间各级血流信号对比无显著统计学差异。结论:利用二维高频超声技术能够清晰显示肩袖结构各肌腱及其周围组织的形态学改变,能够发现T2DM患者随病程增加,其肩袖结构各肌腱更易出现肌腱内部回声局限或弥漫性减低、内部回声不均匀、肌腱边缘不规则,肌腱内钙化灶或肌腱部分撕裂等改变,并且随病程发展肌腱厚度逐渐增加。而PDI技术由于其对低速细小血流显示较为敏感的特性,能够显示各肌腱内部血流情况。因此,联合使用二维高频超声及PDI技术能够于T2DM患者出现临床症状之前早期发现其肩袖结构及周围组织的异常增厚以及异常回声等改变,可以为临床早期诊断及治疗T2DM患者肩袖病变提供重要的客观依据,在改善患者预后、提高患者生活质量等方面具有重要的临床意义。
[Abstract]:Objective: to evaluate the clinical value of two-dimensional high-frequency ultrasound and power Doppler technique in evaluating the morphological changes of rotator cuff structure and abnormal blood flow in patients with type 2 diabetes mellitus (T2DM).Methods: sixty patients with T2DM were divided into two groups: group B (30 cases) and group C (30 cases).Another 30 healthy volunteers were collected as control group A.The echo and blood flow of the tendons of bilateral rotator cuff structure and the long head tendon of biceps brachii were observed by two-dimensional high frequency ultrasound and energy Doppler technique.The thickness of bilateral supraspinatus tendons, subscapular tendons, infrascapular tendons, and long head tendons of biceps brachii were measured.Results: the long axis of normal tendons showed several parallel thin line like strong echo cable like structures separated by thin hypoechoic region. In the short axis section, the internal echo of supraspinatus tendon was decreased in group B, and in the short axis section, there was a decrease in the internal echo of the supraspinatus tendon in group B, and in the short axis section, there was a decrease in the internal echo of the supraspinar tendon.The rate of abnormal internal echo in group A was higher than that in group A (P 0.05). The rate of abnormal internal echo in group A was higher than that in group A (P 0.05). The internal echo of the tendon in group A was lower than that in group C (P 0.05), and the internal echo was not uniform in the four groups, including subscapular tendon, subscapular tendon, subscapular tendon and long head tendon of biceps brachii.The rate of abnormal internal echo in group A was higher than that in group A. The ratio of calcified lesions found in each tendon of group B was higher than that in group A and group C was higher than that of group A in group A. The rate of abnormal tendon in the long head of biceps brachii was higher than that in group A.Compared with group A, the thickness of both groups increased.There were significant differences in the thickness of tendon between group C and group B, there were significant differences in the thickness of tendon between group C and group B, there were significant differences in the thickness of tendon between group C and group B, and the thickness of the tendon of the long head of biceps brachii muscle in group C was significantly higher than that in group C (P < 0.05), and the thickness of tendon of long head of biceps brachii in group C was significantly higher than that in group B.The ratio of blood flow signal in each tendon was the highest in the group of P0.05A (P 0.05), but there was no significant difference in the comparison of blood flow signals among the groups.Conclusion: the morphological changes of tendon and surrounding tissues of rotator cuff structure can be clearly displayed by two-dimensional high-frequency ultrasound technique, and it can be found that the number of patients with T2DM increases with the course of disease.All tendons in the rotator cuff structure were more prone to the internal echo localization or diffuse decrease, uneven internal echo, irregular tendon edge, calcification focus or partial tear of tendon, and the thickness of tendon gradually increased with the course of disease.PDI can display the internal blood flow of each tendon because of its sensitivity to low velocity and small blood flow.Therefore, the combined use of two-dimensional high-frequency ultrasound and PDI can detect the abnormal thickening and echo of the rotator cuff structure and surrounding tissues before the onset of clinical symptoms in patients with T2DM.It can provide important objective basis for early diagnosis and treatment of rotator cuff disease in patients with T2DM. It has important clinical significance in improving the prognosis and quality of life of patients with T2DM.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R587.2;R684

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