肘关节屈肌总腱和伸肌总腱肌腱病的MRI表现及其分级初探  

MRI of tendinopathy of the common extensor tendon and common flexor tendon and its application for injury classification

作　　者：张恒 钱占华 白荣杰 詹惠荔 李亚雄 王崧铭 叶薇 Zhang Heng;Qian Zhanhua;Bai Rongjie;Zhan Huili;Li Yaxiong;Wang Songming;Ye Wei(Department of Radiology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院放射科,北京100035

出　　处：《中华全科医师杂志》2023年第10期1038-1044,共7页Chinese Journal of General Practitioners

基　　金：国家自然科学基金(82171921,81771809);北京市自然科学基金(7202063)。

摘　　要：目的探讨肘关节屈肌总腱和伸肌总腱肌腱病的磁共振成像(MRI)表现,以及是否可通过MRI判断其损伤分级。方法回顾性选取2019年8月至2022年4月在首都医科大学附属北京积水潭医院放射科进行检查的屈肌总腱和/或伸肌总腱肌腱病患者作为病例组,并招募健康志愿者作为对照组。收集入选者的一般临床资料和肘关节MRI检查资料。通过观察对照组健康志愿者的MRI图像分析MRI可否显示肘关节正常解剖结构,通过观察屈肌总腱及伸肌总腱肌腱病患者的MRI表现总结其MRI特征,并进一步探讨可否通过MRI对损伤进行分级。由2名高年资影像科医师分别进行阅片,通过κ检验检验二者诊断的一致性。结果病例组入选患者62例,对照组入选健康志愿者20人(40侧肘关节)。2名阅片医师对屈肌总腱、伸肌总腱、内侧副韧带复合体和外侧副韧带复合体诊断的κ值分别为0.645、0.657、0.615和0.653,提示诊断一致性较好。MRI可清晰显示入选人群屈肌总腱、伸肌总腱及周围软组织的解剖结构。对照组20名(40侧)健康志愿者的肘关节屈肌总腱及伸肌总腱在MRI各序列上均表现为细线样或条带状低信号,肌纤维走行连续。病例组62例患者中肘关节屈肌总腱和/或伸肌总腱肌Ⅰ级损伤者27例,MRI表现为肌腱增厚或变薄,脂肪抑制T2加权像肌腱信号增高。Ⅱ级损伤者27例,MRI表现为液体信号累及肌腱厚度的20%~80%。Ⅲ级损伤者8例,液体信号累及肌腱厚度的80%以上。结论肘关节屈肌总腱和伸肌总腱肌腱病有特征性的MRI表现,提示可通过MRI诊断此类疾病。此外,还可通过MRI判断此类疾病的损伤分级。ObjectiveTo analyze the MRI findings of tendinopathy of the common extensor tendon(CET)and common flexor tendon(CFT)and to explore its application for injury classification.MethodsSixty-two patients with elbow tendinopathy of CET and/or CFT who were examined in the Radiology Department of Beijing Jishuitan Hospital from August 2019 to April 2022 were enrolled as the case group,and 20 healthy subjects(40 elbows)were recruited as the control group.The clinical data of patients and MRI findings of elbow joint of all subjects were reviewed.The MRI of tendinopathy of CFT and CET were read by 2 senior radiologists independently,and the consistency was tested by theκtest.The MRI manifestations for injury classification were discussed.ResultsTheκvalues of CFT,CET,medial collateral ligament complex and lateral collateral ligament complex were 0.645,0.657,0.615 and 0.653 respectively.MRI clearly showed the anatomical structure of CFT,CET and surrounding soft tissue.The CFT and CET of the elbow of 20 normal volunteers(40 sides)in the control group showed thin line or banded low signal in each MRI sequence,and the muscle fibers were continuous.In 27 patients with classificationⅠinjury of CFT and/or CET of elbow joint,MRI showed thickening or thinning of tendons and increased signal intensity on fat suppression T2-weighted imaging.In 27 cases of classificationⅡinjury,MRI showed that the fluid signal involved 20%to 80%of the tendon thickness.In 8 cases of classificationⅢinjury,MRI showed that the fluid signal involved more than 80%of the tendon thickness.ConclusionsTendinopathy of CFT and CET of elbow joint has its characteristic MRI manifestations,indicating that MRI can be used for the diagnosis of tendinopathy.In addition,MRI can also be used for the injury classification.

关 键 词：肌腱病 肘关节 磁共振成像 诊断 

分 类 号：R686.1[医药卫生—骨科学] R445.2[医药卫生—外科学]