超声诊断肩袖撕裂

目的 探讨直接及间接超声征象对肩袖撕裂分型的诊断价值。方法 收集52例于我院行肩关节镜手术的患者,所有患者均接受超声检查,计算直接、间接超声征象诊断肩袖撕裂的效能,并比较直接超声征象诊断肩袖撕裂亚型与关节镜结果的一致性。结果 直接征象诊断肩袖有无撕裂、全层撕裂、部分撕裂的准确率分别为90.38%（47/52）、96.15%（50/52）和86.54%（45/52）,且直接征象诊断肩袖撕裂亚型与关节镜结果的一致性较好。在间接征象中,3部位同时出现积液（肩峰下-三角肌下滑囊积液、肩关节腔积液及肱二头肌长头腱腱鞘积液）、三角肌滑囊疝及软骨分界征诊断肩袖撕裂的特异度分别为80.95%（17/21）、90.48%（19/21）及95.24%（20/21）。结论 直接联合间接超声征象诊断肩袖撕裂的分型具有较高的临床应用价值。     

正常肩袖及肩袖撕裂的超声检查

肩痛是临床常见病症，病因很多，如肌腱炎、过度牵拉以及部分或完全撕裂等，而肩袖(旋转袖)肌腱损伤在40岁以上的患者中是最常见原因。因此，治疗前正确鉴别病因十分重要。     

超声检测肩袖间隙对冻结肩的诊断价值

目的 分析冻结肩患者肩袖间隙灰阶超声和多普勒超声表现,探讨应用超声检测肩袖间隙对冻结肩的诊断价值.方法 回顾性分析于我院行肩关节超声检查并经临床确诊的冻结肩患者35例(冻结肩组)和肩关节不适的非冻结肩患者37例(非冻结肩组),冻结肩组根据病程进一步分为早期组(病程≤6个月)11例和中晚期组(病程>6个月)24例.分析各...     

不同超声征象在肩袖撕裂诊断中的效能研究

目的 探讨不同超声征象诊断肩袖撕裂的效能,筛选出诊断肩袖撕裂的特异性超声征象。方法 对133例肩关节超声征象进行分析,运用Logistic回归及诊断试验评估不同超声特征对肩袖撕裂的诊断效能。结果 单因素分析显示腱内异常回声、肩袖缺损、肌腱变薄、肩峰撞击综合征、肩峰下滑膜囊增厚、肱骨头骨质不整与肩袖撕裂显著相关。多因素分析显示腱内异常回声是肩袖撕裂的独立风险因素(P＜0.05,OR=2.85)。将腱内异常回声和肩袖缺损作为诊断肩袖撕裂的主要超声表现,与其他超声征象联合可以明显提高灵敏度和特异度。结论 腱内异常回声和肩袖缺损在RCT的超声诊断中,具有较高的灵敏度和特异度,与其他超声特征联合,可提高肩袖撕裂的诊断准确性。     

肩袖损伤康复治疗疗效超声评价

目的:应用高频超声监测各级别肩袖损伤康复治疗前及治疗过程中的声像图改变,评价康复治疗效果。材料与方法:收集68例肩袖损伤的患者。按肩袖损伤程度进行超声分级为轻度32例、中度21例、重度15例。结果:三级损伤程度不同的患者,最终的康复疗效明显不同。轻度损伤组的患者明显收到良好的效果。中度损伤患者疗效尚可。重度肩袖损伤患者症状及超声表现都未明显改善。结论:超声可进行肩袖损伤无创诊断,同时能够实时动态的监测肩袖损伤康复治疗效果,为临床医师及康复治疗师提供可靠的客观依据。     

肩袖损伤的超声诊断

肩袖损伤的超声诊断孙常太①黄公怡①郭发金②本文对２４例临床上拟诊肩袖损伤的病例超声诊断后进行肩关节造影，以造影结果为标准对超声诊断的价值作出评估。１资料和方法２４例临床诊断肩袖撕裂的患者，男１３例，女１１例，年龄２８～６７岁，右肩１６例，左肩９例，有...     

超声引导经肩袖间隙注射治疗冻结肩的临床研究

目的探讨超声引导经肩袖间隙肩关节腔和三角肌下滑囊注药治疗冻结肩的可行性与临床疗效。 方法选取2020年3月至2021年3月于解放军总医院第一医学中心确诊的65例冻结肩患者进行超声引导经肩袖间隙肩关节腔和三角肌下滑囊注药治疗。治疗前超声检查测量肩袖间隙处肱二头肌长头肌腱至皮肤的最短距离和喙肱韧带的厚度,分别于治疗前和治疗后1周、1个月及3个月行视觉模拟量表（VAS）疼痛评分以及Constant量表和美国加利福尼亚大学（UCLA）量表肩关节功能评分。 结果治疗前测量肱二头肌长头肌腱至皮肤最短距离为（11.81±2.52）mm,喙肱韧带厚度平均为（2.69±0.42）mm。所有患者均成功进行超声引导经肩袖间隙肩关节腔和三角肌下滑囊注药治疗。与治疗前评分比较,治疗后1周、1个月和3个月的VAS疼痛评分随时间延长而降低,两两比较差异均有统计学意义（P均＜0.008）。与治疗前比较,治疗后1个月、3个月Constant量表和UCLA量表的肩关节功能评分得到改善,评分比较差异均有统计学意义（P均＜0.016）;与治疗后1个月比较,治疗后3个月Constant量表和UCLA量表的肩关节功能评分改善不明显,评分比较差异无统计学意义（P＞0.016）。与治疗前相比,治疗后1个月、3个月Constant量表中的疼痛程度、日常生活能力、肩关节活动程度和肌力均得到改善,评分比较差异均有统计学意义（P均＜0.016）;与治疗后1个月相比,治疗后3个月的疼痛程度、日常生活能力、肩关节活动度和肌力均未见进一步改善,评分差异均无统计学意义（P均＞0.016）。 结论超声引导经肩袖间隙注射可一次进针实现肩关节腔和三角肌下滑囊2个部位的注射,临床短期疗效满意,可作为冻结肩超声引导微创治疗的方案之一。     

超声在肩袖撕裂诊疗中的研究进展

肩袖撕裂是一种临床常见疾病,部分患者可无症状。超声诊断肩袖肌腱撕裂的准确率较高,在术前进行定位和定性诊断、评估撕裂大小、预后,术后评估肌腱修复的完整性等方面具有独特的优势。本文就超声在肩袖撕裂的诊断及撕裂修复手术前后应用中的研究进展进行综述。     

超声对肩袖部分撕裂的诊断价值

目的 探讨超声在肩袖部分撕裂诊断中的价值,分析不同超声征象对肩袖部分撕裂的意义.方法 选取我院行肩关节镜手术患者81例,术前均同时行超声和MRI检查,以关节镜检查结果为金标准,比较超声与MRI对肩袖部分撕裂的诊断效能;分析不同超声征象与肩袖部分撕裂的相关性;Logistic回归分析肩袖部分撕裂的影响因素.结果 超声与M...     

超声在肩袖撕裂诊断中的应用价值

目的探讨超声在肩袖撕裂诊断中的应用价值,分析各型肩袖撕裂解剖结构的声像图特征。方法选取临床疑诊为肩袖撕裂患者91例(共100只肩),均行高频超声和关节镜检查并比较检查结果。结果超声诊断肩袖撕裂88只肩,正常肩袖12只肩;关节镜诊断肩袖撕裂91只肩,正常肩袖9只肩。超声诊断肩袖撕裂的敏感性为94.5%,特异性为77.8%,诊断准确率为93.0%。结论超声在肩袖撕裂的诊断中有较高的应用价值,可作为诊断肩袖撕裂的首选检查方法。     

肩袖损伤与关节镜手术后康复

肩袖损伤是肩关节的多发病。关节镜下肩袖缝合术因具有创伤小、恢复快的优点而成为目前治疗肩袖损伤的主要方法之一。术后肩关节康复亦是手术成功的关键。     

Comparison Between Exclusively Long‐Axis and Multiple‐Axis Sonographic Protocols for Screening of Rotator Cuff Lesions in Symptomatic Shoulders

Objective. The purpose of this study was to determine whether exclusively long‐axis sonography differs from a multiple‐axis scanning protocol as a screening tool for rotator cuff lesions in symptomatic shoulders when compared with magnetic resonance imaging (MRI). Methods. A total of 509 consecutive patients (mean age, 52.8 years) referred for MRI were also routinely evaluated by sonography. We initially performed exclusively long‐axis sonography and graded the rotator cuff as normal or abnormal. Patients subsequently underwent a full sonographic protocol using multiple‐axis views. Magnetic resonance imaging findings were compared with sonographic findings for both techniques. Results. The overall accuracy of sonography was greater than 90%. We found divergent results from different sonographic techniques in 34 patients. Of these, 8 were multiple‐axis false‐negative; 14 were exclusively long‐axis false‐negative; 6 were exclusively long‐axis false‐positive; and 6 were multiple‐axis false‐positive. All cases with divergent false‐negative findings on multiple‐axis sonography showed tendinosis on MRI. Causes for false‐negative findings on exclusively long‐axis sonography included tendinosis and partial‐thickness tears of the supraspinatus. No statistically significant difference was seen between both sonographic techniques compared with MRI in terms of accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (P > .05). Conclusions. Sonography is reliable for detecting rotator cuff abnormalities. Exclusively long‐axis sonography seems appropriate as a screening tool for rotator cuff lesions in symptomatic shoulders.     

Treatment Options for Massive Irreparable Rotator Cuff Tears

Purpose of ReviewMassive irreparable rotator cuff tears present a significant challenge to the orthopedic surgeon. No single treatment, particularly among joint-preserving options, has been shown to be superior. The purpose of this review is to discuss recent advances in the treatment of massive irreparable rotator cuff tears, including partial repair with and without graft augmentation, interposition grafts, superior capsule reconstruction, subacromial balloon spacers, tendon transfer, and reverse total shoulder arthroplasty. We will also offer guidance on surgical indications based on our clinical experience.Recent FindingsPartial repair may offer reasonable clinical improvement for patients with lower preoperative function despite high re-tear rates. Additionally, several types of interposition grafts have shown promising short-term results and may outperform repair alone. Subacromial balloon spacers may lead to clinical improvement, especially in patients without glenohumeral osteoarthritis or pseudoparalysis, and recently received FDA approval for use in the USA. Superior capsule reconstruction is a technically demanding procedure that appears to produce excellent short-term results particularly when performed at high volume, but long-term studies in heterogeneous study groups are needed. Tendon transfers improve function by restoring force coupling in the shoulder, offering a promising option for younger patients. Reverse total shoulder arthroplasty (RTSA) is a reliable option for treatment of irreparable cuff tears in elderly patients with lower functional demands.SummaryIrreparable cuff tears remain a difficult condition to treat. Recommended treatment for younger patients without glenohumeral osteoarthritis is particularly controversial. For older patients with low-demand lifestyles and glenohumeral osteoarthritis, RTSA is an effective treatment option. For all discussed procedures, patient selection appears to play a critical role in clinical outcomes.     

关节镜下肩袖修补术患者的护理

目的探讨关节镜下肩袖修补术患者肩关节康复与护理方法。方法回顾性分析2008年11月至2010年8月在上海市第六人民医院骨科行关节镜下缝合锚肩袖修补术的110例患者的临床资料。所有患者术前均制定系统的康复护理计划,术后尽早进行循序渐进的主被动功能锻炼,分别在术前和最终随访时采用美国加州大学肩关节功能评分系统(University ofCalifornia at Los Angeles shoulder scores,UCLA)对其进行评价。结果患者随访时间为6～19个月,术前、术后UCLA评分分别为(14.3±3.6)和(33.4±1.4)分,差异有统计学意义(P<0.01)。术后患者肩关节功能优65例、良25例、可20例。结论关节镜下行肩袖修复术具有创伤小、恢复快等优点,及时进行个性化康复护理是恢复肩关节功能的有效方法,对功能康复具有重要作用。     

A Systematic Comparison on Postoperative Analgesia Effect Between Subacromial and Intravenous Analgesia Pumps for Arthroscopic Rotator Cuff Repair

PurposeArthroscopic rotator cuff repair is often associated with severe postoperative pain. Various agents, routes, and modes are used for the treatment of postoperative pain with a minimum of side effects. This systematic work was conducted to compare the postoperative effect of subacromial patient-controlled analgesia with intravenous patient-controlled analgesia after an arthroscopic rotator cuff repair surgery.DesignA systematic review of relevant studies were retrieved from electronic databases and included based on criteria and eligibility.MethodsThe articles were retrieved from 1997 to 2018 by computerized searches of Scopus, PubMed, and EMBASE using different combinations of search terms, such as shoulder, rotator cuff, analgesic, analgesia, arthroscopic, pain, cuff repair, rotator cuff repair, acromion, and intravenous.FindingsA total of 10 articles were included in this study from the initial search of 778 records. Compared with subacromial procedure, the intravenous procedure helps in reducing the postoperative pain but with more side effects.ConclusionsThis study described that the direct continuous infusion of anesthetic under subacromial analgesic pump showed a greater pain relief with less side effects compared with intravenous infusion for arthroscopic rotator cuff repair.