本文關(guān)鍵詞： 磁共振間接法關(guān)節(jié)造影 肩峰下撞擊綜合征 肩關(guān)節(jié)　出處：《山西醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：通過對肩峰下撞擊綜合征患者肩關(guān)節(jié)MR平掃和MR間接法關(guān)節(jié)造影所得的圖像特點進行分析、總結(jié),探討MRI和I-MRAR在肩峰下撞擊綜合征中的診斷價值,為臨床診斷做出輔助評價并為治療方案的選擇提供影像學支持。 方法：收集就診于本院臨床懷疑肩關(guān)節(jié)損傷的患者30例,所有患者均有肩部疼痛、肩關(guān)節(jié)活動受限或者功能障礙,其中男性18例,女性12例,年齡38～82歲,平均年齡58.6歲；30例患者均進行了肩關(guān)節(jié)鏡檢查,所有患者在關(guān)節(jié)鏡檢查前完成MR平掃和MR間接法關(guān)節(jié)造影檢查。以臨床診斷和肩關(guān)節(jié)鏡手術(shù)結(jié)果為金標準,計算MR平掃及MR間接法關(guān)節(jié)造影診斷肩峰下撞擊綜合征的敏感度、特異度和診斷符合率,比較兩者對于肩峰下撞擊綜合征的診斷價值。 結(jié)果：(1)MRI與I-MRAR在診斷肩袖部分撕裂時差異具有統(tǒng)計學意義(敏感度P值0.05,診斷符合率P值0.05)；在診斷肩袖全層撕裂和肌腱炎時敏感度差異無統(tǒng)計學意義(敏感性P值0.05)。 (2)MRI和I-MRAR對SAIS間接征象診斷的差異無統(tǒng)計學意義(P0.05):MRI和I-MRAR對SAIS間接征象的診斷敏感度較高,但是并不特異。 (3)MRI和I-MRAR對盂唇撕裂的診斷差異具有統(tǒng)計學意義(P0.05)；對岡上肌萎縮、三角肌萎縮的診斷差異無統(tǒng)計學意義(P0.05),MRI和I-MRAR對岡上肌萎縮和三角肌萎縮均能做出正確診斷；I-MRAR對盂唇撕裂的診斷具有更高的敏感度。 (4)MRI和I-MRAR對SAIS病因?qū)W征象診斷的差異無統(tǒng)計學意義(P0.05),MRI和I-MRAR對肩峰形態(tài)和肩峰下通道狹窄均能做出正確診斷。 結(jié)論：磁共振平掃能夠?qū)Υ蟛糠旨绶逑伦矒艟C合征做出正確診斷,但對于由肩關(guān)節(jié)撞擊引起的岡上肌腱部分撕裂和關(guān)節(jié)盂唇撕裂的診斷作用有限；而MR間接法關(guān)節(jié)造影對岡上肌腱部分撕裂和關(guān)節(jié)盂唇撕裂的診斷具有重要價值,能夠確定診斷,可為臨床診斷做出輔助評價并為治療方案的選擇提供有力的影像學支持。
[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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R684

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