肩峰下撞击综合征的整合影像学诊断研究  

Study on integrated imaging in diagnosis of subacromial impingement syndrome

作　　者：何荣兴[1] 覃浩玲[1] 林尔坚[1] 赵晓晓 赖志芬 盘顺平[1] 孙海兴[1] 陈应明[1] HE Rongxing;QIN Haoling;LIN Erjian;ZHAO Xiaoxiao;LAI Zhifen;PAN Shunping;SUN Haixing;CHEN Yingming(Department of Radiology,Eastern Hospital of First Hospital Affiliated to Sun Yat-Sen University,Guangzhou,Guangdong,510700)

机构地区：[1]中山大学附属第一医院东院放射科,广东广州510700

出　　处：《实用临床医药杂志》2020年第23期92-95,共4页Journal of Clinical Medicine in Practice

摘　　要：目的比较直接数字化X线摄影(DR)联合多层螺旋CT(MSCT)或磁共振成像(MRI)对肩峰下撞击综合征(SIS)的诊断价值。方法回顾性分析临床确诊的46例SIS患者的影像学资料,观察患者采用DR联合MSCT检查或者DR联合MRI检查的肩峰形态和最短肩肱间隙(AHI)结果,比较2种方法的图像特征及SIS诊断情况。结果2种影像学检查方法对肩峰形态和AHI均有较高的检出率,差异无统计学意义(P>0.05);DR联合MRI对SIS的检出率为97.8%(45/46),高于DR联合MSCT的69.6%(32/46),差异有统计学意义(P<0.05);2种方法的诊断灵敏度和约登指数比较,差异有统计学意义(P<0.05),而2种方法的诊断特异度均为100.0%。2种方法对Ⅲ型肩峰形态的SIS检出率比较,差异无统计学意义(P>0.05),DR联合MRI对Ⅰ型与Ⅱ型肩峰形态的SIS检出率高于DR联合MSCT,差异有统计学意义(P<0.05)。2种方法对AHI<5 mm患者的SIS检出率比较,差异无统计学意义(P>0.05),DR联合MRI对AHI 5~<10 mm与AHI 10~15 mm患者的SIS检出率高于DR联合MSCT,差异有统计学意义(P<0.05)。结论与DR联合MSCT相比,DR联合MRI对SIS的诊断准确率更高,不仅可显示肩峰解剖结构、形态分类及韧带钙化,而且可清晰显示肩袖解剖结构、病变部位和病理改变与程度等直接征象和间接征象,诊断信息更为丰富,可为临床选择治疗方式提供更可靠的影像依据。Objective To compare the value of digital radiography(DR)combined with multi-slice spiral CT(MSCT)or magnetic resonance imaging(MRI)in diagnosis of subacromial impingement syndrome(SIS).Methods The image data of 46 clinically diagnosed patients with SIS was retrospectively analyzed.The acromion shape and the shortest acromial humeral interval(AHI)between DR combined with MSCT and DR combined with MRI were compared.The image characteristics and diagnostic condition of SIS were compared.Results The detectable rates of the acromion shape and AHI of two methods were higher,but the difference was not statistically significant(P>0.05).The detectable rate of SIS by DR combined with MRI was significantly higher than DR combined with MSCT[97.8%(45/46)versus 69.5%(32/46),P<0.05].The differences in sensitivity and Youden index of the two methods were significant(P<0.05),and the diagnostic specificities of the two methods were 100.0%.The detectable rates of SIS with BiglianiⅢby two methods showed no significant differences(P>0.05).The detectable rates of SIS by DR combined with MRI for BiglianiⅠand BiglianiⅡwere higher than DR combined with MSCT(P<0.05).The differences in detectable rate of SIS for AHI<5 mm by two methods were not significant(P>0.05).The detectable rates of SIS for AHI of ranging from 5 mm and above to less than 10 mm and AHI of 10 to 15 mm by DR combined with MRI were higher than DR combined with MSCT(P<0.05).Conclusion Compared to DR combined with MSCT,DR combined with MRI has a higher accuracy in diagnosing SIS,it can clearly show the anatomy and morphology of acromia,ligament calcification,clearly present the anatomy of rotator cuff,and the direct and indirect signs of SIS such as the disease region and degree.Therefore,DR combined with MRI can provide more diagnostic information and more reliable imaging basis for clinical selection of treatment methods.

关 键 词：肩峰下撞击综合征 整合影像学直接数字化X线摄影 多层螺旋CT 磁共振成像 肩峰形态 最短肩肱间隙 

分 类 号：R323.4[医药卫生—人体解剖和组织胚胎学] R445[医药卫生—基础医学]