MR 3D-FIESTA序列对肩部喙肱韧带增厚的诊断价值

【摘要】目的：探讨磁共振3D-FIESTA序列对肩关节黏连性关节囊炎喙肱韧带增厚的诊断价值。方法：回顾性分析52例肩关节黏连性关节囊炎患者的MRI图像,比较斜冠状面3D-FIESTA序列与FSE T1WI不抑脂序列显示喙肱韧带的差异,并比较3D-FIESTA序列斜矢状面与斜冠状面显示喙肱韧带的差异。结果：斜冠状面3D-FIESTA序列对喙肱韧带的显示率为75.00%,高于斜冠状面FSE T1WI不抑脂序列57.69%的显示率, 差异有统计学意义（χ2值=17.754,P=0.000）。斜矢状面3D-FIESTA序列对喙肱韧带的显示率为90.38%,高于斜冠状面3D-FIESTA序列75.00%的显示率,差异有统计学意义（χ2值=5.974,P=0.015）。结论：斜矢状面3D-FIESTA序列是显示肩关节黏连性关节囊炎患者喙肱韧带的理想序列,当临床怀疑患者有肩关节黏连性关节囊炎时,加扫斜矢状面3D-FIESTA序列很有必要。     

重建肩锁韧带及喙锁韧带治疗陈旧性肩锁关节脱位

目的探讨治疗陈旧性肩锁关节脱位的新方法：方法采用喙肩韧带加强重建肩锁韧带、喙突部肱二头肌短头与喙肱肌联合腱肌筋膜加强重建喙锁韧带治疗陈旧性肩锁关节脱位29例，获得随访25例，按A11man等分型：Ⅱ度10例，Ⅲ度15例。随访观察3～36个月。结果依照Lazzcano评定标准，优16例、良9例，无其他并发症，肩锁关节无再脱位。结论喙肩韧带加强重建肩锁韧带、喙突部肱二头肌短头与喙肱肌联合腱肌筋膜加强重建喙锁韧带治疗陈旧性肩锁关节脱位既有良好固定脱位的作用，又符合肩锁关节的微动生理，是一种较为理想的治疗方法：     

喙锁韧带的影像学分析

目的 研究喙锁韧带的影像学表现.方法 选取正常胸部正位CR片400例,其中男、女各200例,观察喙锁关节和喙锁韧带附着处锁骨粗隆显示率,测量喙锁韧带部喙突和锁骨间距.选取正常肩关节MRI 30例,观察喙锁韧带显示率和测量喙锁韧带长度和宽度;选取临床已证实的肩锁关节Ⅱ、Ⅲ级损伤MRI检查8例.结果 400例800侧中见1例(0.25%)存在喙锁关节.198 侧(198/800;24.8%)显示喙锁韧带锁骨附着处粗隆存在.正常喙突锁骨间距为(6.92±3.16) mm.30例正常人MRI斜冠状扫描均可显示喙锁韧带,其锥状韧带长度(11.48±1.43) mm,宽度为(4.82±1.21) mm,梯状韧带长度(9.09±0.84) mm,宽度为(5.10±0.87) mm.肩锁关节损伤8例,MR检查发现:肩锁关节Ⅱ级损伤肩锁韧带撕裂,Ⅲ级损伤并喙锁韧带撕裂.结论 本文建立了正常喙锁韧带的X线和MRI测量标准,为诊断喙锁韧带等疾病提供了依据,肩锁关节Ⅲ级损伤有喙锁韧带撕裂.     

MRI检查肩袖损伤的临床分析

目的分析肩袖损伤在MR检查时的不同扫描定位及在不同序列上的显示效果。方法对40例肩袖损伤患者行横断位T2WI,斜矢状位T1WI,斜冠状位脂肪抑制(STIR)及双斜冠状位T1WI、T2WI、脂肪抑制(STIR)扫描,分析斜冠状位与双斜冠状位图像对冈上肌、冈上肌肌腱以及肱骨干长轴的显示能力和对肩袖损伤的显示效果;以及在双斜冠状位各个序列(T1WI、T2WI、脂肪抑制STIR)中对肩袖损伤的图像显示效果按评价标准进行评价和对显示结果比较。结果 40例肩关节的斜冠状位和双斜冠状位都能全部显示冈上肌长轴,且双斜冠状位能把冈上肌、冈上肌肌腱全长及肱骨干长轴显示于一幅图像中,而斜冠状位不能;斜冠状位(STIR)显示肩袖部分撕裂和完全撕裂的分别为13例和14例,双斜冠状位(STIR)分别为22例和14例;双斜冠状位T1WI、T2WI、STIR三个序列显示肩袖结构好、较好、差的例数分别为(10、26、32;14、11、7;3、2、1)双斜冠状位T1WI、T2WI、STIR三个序列发现冈上肌肌腱、肩胛下肌肌腱、冈下肌肌腱、小圆肌肌腱、肱二头肌长头肌腱异常的例数分别为(4、21、28;2、9、15;1、6、10;0、2、4;0、1、2)。结论双斜冠状位对冈上肌、冈上肌肌腱全长及肱骨干长轴的显示能力和对肩袖损伤的显示结果均优于斜冠状位;双斜冠状位的脂肪抑制(STIR)序列对肩袖损伤的显示效果和结果均优于T2WI和T1WI。     

盂肱下韧带MR影像对冻结肩的诊断价值

目的探讨盂肱下韧带MR表现对冻结肩的诊断价值。方法分析我院间141例肩关节MR影像,将临床诊断为冻结肩48例患者作为冻结肩组、经关节镜证实的肩袖部分撕裂37例患者作为肩袖撕裂组、正常对照组56例。在斜冠状位T_2WI脂肪饱和序列上评估盂肱下韧带T_2信号强度、有无关节囊外高信号层并测量盂肱下韧带厚度。结果盂肱下韧带T_2WI脂肪饱和序列上呈高信号:冻结肩组41例、肩袖撕裂组5例、对照组5例,其诊断冻结肩的准确性88%、敏感性85%、特异性89%、阳性预测值80%、阴性预测值92%;斜冠状位T_2WI脂肪饱和序列上盂肱下韧带厚度:冻结肩组(n=48)(5.22±1.03)mm、肩袖撕裂组(n=37)(3.95±0.69)mm、对照组(n=56)(3.96±0.72)mm,冻结肩组厚度明显大于肩袖撕裂组、对照组,差异比较具有统计学意义(P0.001),肩袖撕裂组与对照组差异比较无统计学意义(P0.05)。结论盂肱下韧带T_2WI脂肪饱和序列上信号增高、增厚表现有助于冻结肩诊断。     

不同MR扫描序列在SPIO增强大鼠肝癌模型的对比研究

目的：比较多种扫描序列超顺磁氧化铁（SPIO）增强扫描对显示大鼠肝癌病灶的能力，找出最佳扫描方案。TSE T2WI、SE双回波的T2WI＋PDWI、GRE T1WI、T2^＊WI，分析增强前后大鼠肝癌病灶的强化特征，并进行病理学检查对照分析。结果：注射SPIO对比剂后，所有扫描序列均显示肝脏的信号强度较增强前有不同程度的下降，肝癌病灶CNR均分别高于平扫。增强后GRE T2^＊WI中病灶的CNR明显高于其它序列，但增强后TSE T2WI和常规SE T2WI在显示病变的SNR、CNR方面没有显著性差异。结论：SPIO增强后检测肝癌病灶的各种序列中，以GRE T2^*WI最为敏感，其次是双回波的T2WI＋PDWI序列。     

髌支持带的MRI检查

目的 研究正常人髌支持带的MRI检查方法,以便提高髌支持带损伤的MRI诊断.方法 收集37例正常健康者膝关节MRI检查资料,其中男24例,女13例,平均年龄34.16岁.使用Philips 1.5T Intera Achiera 双梯度磁共振系统,采用膝关节相控阵线圈,分别做膝关节矢状T1WI和PDWI SPAIR,冠状T2WI和PDWI SPAIR,横切T1WI、T2WI、3D-WATS.分析比较各方位、各序列髌支持带的显示情况.结果 (1)支持带在T1WI、T2WI、PDWI SPAIR呈均匀低信号强度,在3D-WATS呈中等均匀信号强度.(2)横切位支持带显示优于矢状、冠状位显示.(3)横切位3D-WATS序列优于横切T1WI、T2WI序列.结论 横切位3D-WATS序列是显示髌支持带的最佳成像方法.     

肩关节MRI

对91例患者和15例无症状的志愿者用MR诊断肩关节袖、盂肱关节囊和肩关节盂缘疾病,并评价其敏感性、特异性和预测值。在T_1加权象上,关节囊周围脂肪平面的高信号强度区可以伸到肩峰、三角肌并接近肩袖腱。信号和形状正常,肩峰～三角肌下脂肪平面完整为正常肩袖(0级)。在短TR和短TE质子密度加权序列(PDWS),虽然肌腱形状正常,但信号强度增加为肌腱炎(1级)。肩峰～三角肌下脂肪平面完整,但形状有改变且呈高信号强度是肌腱退变(2级)。肩峰～三角肌下脂肪平面破裂为肩袖部分撕裂。肩袖肌腱2级或3级还在T_1加权象或PDWS上显示肩峰～三角肌下脂肪平面过高信号强度的丧失,T_2加权象看到肩峰～三角肌下囊液体诊断肩袖完全撕裂。肩袖腱疾病分级:0级肌腱的形状和信号正常;1级形状正常,信号强度增加;2级形状和信号都异常(按     

MR三维成像技术在大学生足球运动员前交叉韧带损伤诊断中的应用

目的 探讨MR三维成像技术(M3D/cube T2WI)对大学生足球运动员前交叉韧带(anterior cruciate ligament,ACL)正常显示和损伤诊断的价值.方法 对确诊为前交叉韧带损伤的22名足球运动员及8名健康运动员志愿者的MR资料进行回顾性分析,在GE 1.5T磁共振分别行MR常规膝关节矢状面T1WI、FSE压脂T2WI(fs-T2WI)、冠状位压脂PDWI和M3D/cube T2WI序列扫描,运用ADW4.4工作站行ACL重建.采用双盲法判断MRI常规图像和M3D/cube T2WI图像ACL正常和异常显示情况.结果 40例膝关节常规MR扫描显示ACL结果分别为:Ⅰ级15例,Ⅱ级20例,Ⅲ级5例;FSE-cube T2WI三维后重建矢状位对ACL显示结果分别为:Ⅰ级35例,Ⅲ级5例.2种方法显示ACL损伤的灵敏度及特异度分别为82.8%/76.2%,92.3%/88.9%.结论 M3D/cube T2WI技术可以提高ACL的显示率,对大学生足球运动员ACL损伤有较大诊断价值.     

MRI不同的扫描序列对肩袖撕裂的诊断价值

目的 探讨MRI在肩袖撕裂的诊断中最佳序列的选择.方法 对22例24肩关节疼痛患者,使用1.5T MR扫描仪进行肩关节磁共振检查,所有患者均采用SE/T1WI、FSE/T2WI、GRE/T2*、STIR及PDWI扫描,比较SE/T1WI、FSE/T2WI、GRE/T2*、STIR及PDWI序列在诊断肩袖撕裂诊断中的敏感性.结果 22例患者24肩关节经手术及临床治疗证实肩袖完全撕裂5例、肩袖部分撕裂15例、肩袖结构完整者4例,在SE/T1WI、FSE/T2WI序列分别为1例、16例、7例;PDWI组为6例、14例、4例;STIR序列为8例、12例、4例.结论 PDWI在提高肩袖撕裂诊断敏感性上是最好的成像序列.     

Arthroscopic reconstruction of the anterior cruciate ligament with Leeds-Keio ligament in non-professional athletes

We report our experience using the Leeds-Keio artificial ligament for anterior cruciate ligament (ACL) reconstruction. The study relates the results of the first 40 patients subjected to arthroscopic reconstruction of the ACL with a Leeds-Keio ligament, with a mean follow-up of 73 months. No associated peripheral procedures were carried out on any patient. The average age of the patients at the time of the operation was 31 years (range 26–35 years). The rehabilitation protocol followed by all patients aimed at resumption of sport 4 months after the operation. Clinical assessment included IKDC and the Lysholm scoring scale. The KT-2000 system was used for instrumented evaluation of joint laxity. All patients underwent a radiographic check-up. Clinically there were 55% excellent or good results when using the IKDC scale, while with the Lysholm score, satisfactory results were obtained in 80%. Complete post-traumatic rupture of the ligament was observed in three patients. No patient suffered an episode of either hydrarthrosis or reactive synovitis, which indicates good tolerance to the ligament. The radiographic evaluation of the operated knees showed a close correlation between the appearance of degenerative phenomena and performance of arthroscopic meniscectomy. The results achieved with the Leeds-Keio artificial ligament 5 years after application, although not completely satisfactory and inferior to those obtained with autologous biological ligaments, should be considered an encouragement to promote new efforts in this interesting research field.     

同种异体组织重建关节韧带临床疗效的初步观察

目的评价同种异体组织重建膝关节前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带(MCL)、外侧副韧带(LCL)和肩关节喙锁韧带(CCL)的疗效. 方法回顾调查43例患者,将其分为3组,A组ACL或ACL/MCL损伤34例;B组PCL或PCL/LCL 损伤6例;C组完全肩锁关节损伤3例.分别应用同种异体骨-髌腱-骨(B-PT-B) 、半腱肌腱与股薄肌腱、胫后肌腱、跟腱-骨重建. 结果平均随访19个月, A、B两组术前Lysholm评分63.0±5.6,术后89.0±5.9,手术前后差异有非常显著性意义(P<0.01); 术后国际膝关节文献委员会(IKDC)评分A级3例(8%),B级23例(58%),C级12例(30%),D级2例(5%).KT2000测定A组手术前后胫骨前移分别为(13.10±0.29)mm和(4.70±1.37)mm;B组胫骨后移则分别为(10.53±2.50)mm和(5.74±1.33)mm,手术前后差异有非常显著性意义 ( P<0.01).术后健患侧比较A、B两组健患差异<3 mm 33例(83%);>5 mm 4例(10%);前后抽屉试验36例(90%)由术前3度恢复至术后平均1.3度.合并MCL/LCL损伤患者的侧方应力试验由术前3度恢复至术后平均1.2度,并呈现明显的硬终点;单纯与复合性ACL或PCL损伤,伸屈正常分别占91%和88%.喙锁韧带重建后X线片显示肩锁关节间隙基本正常,肩锁与肩肱关节活动良好. 结论同种异体移植物重建膝关节ACL、PCL、MCL、LCL与肩关节喙锁韧带疗效满意,是自体组织重建的良好替代物.     

关节镜下应用LARS人工韧带同时重建前、后交叉韧带

目的 探讨关节镜下应用LARS人工韧带重建前交叉韧带(ACL)、后交叉韧带(PCL)同时损伤的方法及疗效. 方法 关节镜下同时重建13例ACL、PCL损伤的患者,重建材料采用LARS人工韧带.术后随访12～36个月,采用国际膝关节文件编制委员会(IKDC)韧带标准评价表和Lysholm膝关节功能评分表评估患膝功能,通过KT-1000检查膝关节前后松弛度.结果 术后无膝关节感染发生;均无伸膝受限,屈膝活动度105°～125°,平均117°.术后随访时IKDC评分:A类10例(77%),B类3例(23%).屈膝25°位KT-1000检查:双侧膝关节前向松弛度差异＜2 mm 12例,3～5 mm 1例;屈膝70°位检查:＜2 mm 12例,2～4 mm 1例.术前Lysholm膝关节功能评分为(63.8 ±2.9)分(49～69分),终末随访时为(91.1±2.7)分(88～95分),差异有统计学意义(P＜0.01). 结论 关节镜下同时重建膝关节ACL、PCL是目前治疗ACL、PCL同时损伤的一种微创、安全、有效的手术方法,近期疗效佳.     

Injuries to the posterior cruciate ligament and posterolateral structures of the knee

Although the incidence of injuries to the posterior cruciate ligament (PCL) is much lower than with the anterior cruciate, recent evidence suggests that deficiency of the PCL may be a much larger problem than originally thought, in the isolated case or in combination with posterolateral structures. Although advances have been made in understanding PCL injuries, the diagnosis and treatment of PCL insufficiency remain unclear. The natural history of a PCL-deficient knee is just beginning to be understood. Numerous methods have been reported for the surgical repair and reconstruction of the PCL, yielding less than optimal results in many cases. Controversy exists regarding the choice between conservative and surgical treatment in the isolated PCL injury. This article reviews the literature and summarizes the state of the art regarding the PCL and related posterolateral injuries, with an emphasis on anatomy, biomechanics, mechanism of injury, diagnosis and treatment Future directions in PCL research are proposed.     

The Effect of Track-and-Field Training on Cardiovascular Fitness

In brief: Distance runners, sprinters, jumpers, and weightmen in track and field offer advantages for studying the effects of physical exertion on selected cardiovascular parameters because they undertake a variety of training programs. Fifty-six athletes and 40 controls were tested for percent body fat, maximal oxygen consumption, and plasma lipids before and after a seven-month training season. Sprinters had lower percent body fat and distance runners had higher vo₂ max values than the other groups, but all groups had low plasma lipids. However, a season of training did not beneficially change these variables-probably because the athletes were already fit.     

Surgical treatment of ACL/PCL/ lateral-side knee injuries

Injury to the lateral knee structures is often accompanied by disruption of the posterolateral corner and cruciate ligaments. Failure to recognize and treat posterolateral pathologic laxity can result in persistent symptoms and failure of cruciate-ligament reconstruction efforts. Surgeons should proceed with early repair of the involved lateral and posterolateral structures when possible. Augmentation or reconstruction of the fibular collateral and popliteofibular ligaments is necessary if the existing tissues are inadequate. Late reconstruction is more challenging and requires careful attention to limb alignment. A proximal tibial osteotomy may be essential before ligament reconstruction surgery. Anatomic placement of high-strength grafts affords the best results. Improved surgical techniques, the use of allogeneic graft sources, and controlled postoperative knee range of motion reduce the risk of pathologic laxity and arthrofibrosis. Early surgical repair, augmentation, or reconstruction of the lateral structures combined with reconstruction of the cruciate ligaments provides the highest level of function.     

Meniscotibial (Coronary) ligamant tears

Preservation of the meniscus whenever possible is essential in maintaining knee stability and preventing premature osteoarthritis. Peripheral meniscal tears are the most amenable to surgical repair. This study evaluates the peripheral attachments of the medial meniscus and focuses on a specific tear limited to the meniscotibial ligament (coronary ligament). The diagnosis is made arthrographically when the medial meniscus floats above the tibial plateau without separating completely from the capsule. The lateral meniscus is rarely involved in this type of injury.     

Experience with the Leeds-Keio artificial ligament for anterior cruciate ligament reconstruction

Artificial anterior ligament reconstruction was very popular between 1975 and 1990. Recently, disappointing results have been published. We reviewed 68 patients who had received an artificial anterior cruciate ligament reconstruction 1 year and 5 years after their operation. The Leeds-Keio device was used as a scaffold. The ligament failed in 32 knees. This was arthroscopically confirmed in 20 cases. The other 12 knees were grossly unstable, with a reappearance of pivot shift, anterior drawer sign and high KT 1000. Generally, we found a marked increase in laxity over the period of investigation. Several biopsies were taken during arthroscopic examination of suspected ruptures. They showed lack of collagenisation and ingrowth.