闭合性跟腱损伤的超声动态声像表现

目的:探讨闭合性跟腱损伤的超声动态声像图特征,为跟腱病变的超声鉴别诊断提供依据。方法:对35例临床疑诊为闭合性跟腱损伤患者行超声动态检查,观察足在背屈和伸运动时,跟腱有无部分损伤的声像图表现,与手术结果对照。结果:根据跟腱损伤不同的动态声像图表现,超声提示完全性跟腱撕裂9例,不完全性跟腱撕裂19例,慢性跟腱增生3例,陈旧性跟腱损伤伴粘连2例,跟腱局部肿胀2例。33例得手术病理证实,2例超声随访得到验证。结论:高频超声动态观察闭合性跟腱损伤具有一定特异性,可为跟腱病变的诊断及鉴别诊断提供依据。     

踝关节侧副韧带损伤超声检查

目的　探讨超声诊断踝关节侧副韧带损伤的应用价值。方法　与临床及手术结果比较 ,分析 42例踝关节侧副韧带不同类型损伤的声像图表现。结果　 18例完全撕裂超声诊断与手术结果符合 ,12例挫伤、10例部分撕裂及 2例完全撕裂经临床保守治疗前后超声对比观察证实超声检查结果与临床诊断符合。结论　超声是诊断踝关节侧副韧带损伤的一种可靠方法。     

高频超声在距腓前韧带损伤诊断中应用价值

目的探讨高频超声在距腓前韧带损伤诊断中的应用价值。方法 50例单侧距腓前韧带损伤患者均行高频超声检查,观察距腓前韧带的厚度、内部回声、连续性、张力和活动度、韧带附着处骨质、周边软组织及踝关节腔有无积液等,并与健侧进行比较。结果 50例患者中4例高频超声声像图未见明显异常,46例可见异常,其中挫伤19例,声像图表现为韧带厚度较健侧增粗,内部回声减低或不均匀;部分撕裂11例,声像图表现为部分韧带纹理连续性中断或变薄;完全撕裂16例,声像图表现为韧带连续性完全中断,断端回缩;14例患者行手术治疗,其中12例术中证实为完全撕裂患者术前超声诊断为完全撕裂,2例术中证实为部分撕裂患者术前超声1例诊断为挫伤,1例诊断为部分撕裂;46例异常声像图中9例患者距腓前韧带附着处合并撕脱骨折碎片,6例合并血肿,14例合并踝关节腔积液。结论高频超声检查操作简便,可动态观察距腓前韧带损伤情况和严重程度,可作为距腓前韧带损伤诊断的一种辅助检查方法。     

高频超声在膝关节外侧副韧带损伤中的价值

目的 总结膝关节外侧副韧带损伤的声像图表现,探讨超声在膝关节外侧副韧带损伤中的价值。方法　选择42例经临床、MRI或手术证实为膝关节外侧副韧带损伤患者,回顾性分析膝关节外侧副韧带损伤的声像图表现。通过患侧与健侧对比,观察膝关节外侧副韧带的厚度、内部回声、连续性、韧带附着处骨质情况、韧带周边软组织有无血肿、关节腔有无积液及膝关节其他结构有无伴发损伤,并行侧方应力试验动态观察韧带张力和关节间隙的变化。韧带损伤程度以MRI或手术结果为金标准。结果　42例膝外侧副韧带损伤患者中,超声和MRI均诊断为韧带损伤。超声诊断挫伤20例,部分撕裂7例,完全撕裂15例。MRI诊断挫伤19例,部分撕裂6例,完全撕裂17例。超声和MRI均诊断为完全撕裂的15例患者进行手术治疗,超声诊断结果与MRI及手术结果一致。结论 超声检查能显示膝关节外侧副韧带损伤的各种表现,判断损伤程度,可作为膝关节外侧副韧带损伤的一种重要辅助检查手段。     

股直肌的超声解剖学特点与撕裂的声像图关系

目的探讨股商肌的超声解剖结构及其与不同部位股直肌外伤撕裂问的关系。方法应用高频超声对10例健康志愿者的股直肌（20条）进行超声扫查,采用系列长轴和短轴切面依次获得股直肌的纵断面与横断面声像图,并将声像图与解剖描述及图谱相对照分析,识别股直肌的超声解剖结构。回顾性分析2006年4月至2009年1月14例超声诊断股直肌撕裂患者的声像图资料,结合声像图解剖进行分型诊断,并经随访和临床证实。结果正常股直肌近端由直头肌腱和反折头肌腱起源。连续超声扫查显示直头肌腱参与形成浅层腱膜,反折头肌腱在近端肌腹内形成中央腱膜,中央腱膜于横断面显示清晰,呈“逗号样”高回声结构位于肌肉中央。股直肌远端肌腱参与形成股四头肌腱浅层。以此为基础,14例股直肌撕裂可分为3类,发生在远端肌肉肌腱连接处1例,肌纤维与外周腱膜连接处5例,肌纤维与中央腱膜连接处8例。结论超声检查能够显示股直肌存在特殊的解剖结构,识别其声像斟特点有助于对外伤撕裂的准确定位诊断。     

高频超声诊断冈上肌腱撕裂

目的观察冈上肌腱撕裂超声声像图特征,评估高频超声诊断冈上肌腱撕裂的效能。方法纳入65例(65肩)超声诊断为冈上肌腱撕裂患者,以同期10名健康志愿者(20肩)为对照,对比超声与关节镜术中诊断结果,采用Cohen's Kappa系数分析二者诊断的一致性,评价超声诊断效能。结果冈上肌腱撕裂超声多表现为无回声、肌腱滑囊面凹陷及连续性不佳,据以诊断撕裂的敏感度分别为85.42%、89.58%及93.75%,特异度分别为76.47%、100.00%及76.47%;超声根据肌腱滑囊面凹陷诊断冈上肌腱撕裂与关节镜术中诊断的一致性最佳(Kappa=0.818),其次为肌腱连续性不佳(Kappa=0.716)及无回声区(Kappa=0.586)。超声根据上述特征诊断与关节镜术中诊断差异均无统计学意义(P均>0.05)。结论高频超声可较准确地诊断冈上肌腱撕裂;根据滑囊面凹陷诊断与关节镜诊断冈上肌腱撕裂的一致性最佳;回声特点结合动态观察肌腱连续性有助于减少漏、误诊。     

肩胛下肌腱断裂的超声特征分析

正肩胛下肌腱作为肩袖的一部分,具有使肩关节内旋的作用,肩关节过度外展、外旋等外伤时其易发生撕裂。冈上肌腱或肩袖巨大撕裂常伴随肩胛下肌腱的撕裂,而孤立性的肩胛下肌腱撕裂临床少见,其发生率占所有肩袖撕裂的4%[1]。本组回顾性分析我院经手术证实的7例肩胛下肌腱断裂患者的超声表现,旨在总结其声像图特征,探讨超声诊断肩胛下肌腱断裂的价值。     

高频超声诊断腓骨长肌腱滑脱症

目的：探讨高频超声诊断腓骨长肌腱滑脱症。方法：回顾2005年1月~2010年4月7例经手术证实腓骨长肌腱滑脱症的病例资料,分析X线检查结果和超声声像图表现。结果：X线检查不能直接诊断腓骨长肌腱滑脱症。腓骨长肌腱滑脱症超声表现为长肌腱和短肌腱分别位于外踝前、后两侧,2例病例跖屈踝关节时,长肌腱可复位至外踝后部,5例病例不能复位。结论：高频超声能直接、动态观察腓骨长、短肌腱的位置,能为临床诊断腓骨长肌腱滑脱症提供可靠的诊断依据,具有重要的临床价值。     

高频超声在指伸肌腱止点损伤中的诊断价值

目的探讨高频超声在指伸肌腱止点损伤中的诊断价值。 方法选取2015年7月至2019年6月在东部战区总医院镇江医疗区经手术证实为手指伸肌腱止点损伤患者58例,年龄5~71岁,其中男性40例,女性18例,分析手指伸肌腱止点损伤患者的超声声像图特点、超声诊断分型及不同超声扫查方法的差异,并与X线检查结果进行对比分析。超声诊断与X线诊断评估手指伸肌腱止点骨性损伤的敏感度、特异度、PPV、NPV、准确性之间差异采用χ²检验。 结果手指伸肌腱止点损伤的超声声像图表现为骨性损伤和腱性损伤2种类型,图像特征表现为82%出现断端回缩增厚、86%出现连续性中断、77%出现回声降低、36%提示撕脱性骨折或基底部骨折、70%动态观察出现断端间距增大;与手术结果相比,高频超声在诊断指伸肌腱止点骨性损伤敏感度为84%、特异度为75.7%、阳性预测值（PPV）为72.4%、阴性预测值（NPV）为86.2%、准确性为79.3%,诊断腱性损伤的敏感度为90.9%、特异度为72%、PPV为81.1%、NPV为85.7%、准确性为82.7%,差异均无统计学意义（P均>0.05）,X线检查不能诊断手指伸肌腱止点的腱性损伤;未使用超声耦合垫直接超声扫查与使用超声耦合垫超声扫查诊断指伸肌腱止点损伤,两种扫查方法诊断符合率比较,差异有统计学意义（χ²=12.645,P=0.001）。 结论高频超声能够对指伸肌腱止点损伤的诊断分型,是指伸肌腱止点损伤可靠的影像学检查方法,为临床选择合适的治疗方法提供依据。     

MR平扫与MR关节造影在肩袖损伤及其分型的诊断价值

目的:探讨研究磁共振(MR)平扫与MR关节造影在肩袖损伤及其分型的诊断价值。方法:回顾性分析92例肩袖损伤患者的MR平扫与MR关节造影结果,并与其手术或者临床症状进行对比。结果:92例患者中包含有冈上肌肌腱完全撕裂7例;冈上肌肌腱不完全撕裂61例(包括:部分全层撕裂21例,肌腱内撕裂11例,关节面撕裂15例,滑囊面撕裂14例);肩袖间隙撕裂12例;肌腱变性、水肿12例。两种检查在对于冈上肌肌腱和肩胛下肌肌腱完全撕裂的诊断没有明显差异(P0.05);MR平扫在肌腱内撕裂、滑囊面撕裂、肌腱变性水肿方面的诊断准确性结果明显优于关节造影(P0.05);而MR关节造影在部分全层撕裂、关节面撕裂及肩袖间隙撕裂的诊断准确性高于MR平扫(P0.05)。结论:MR平扫联合MR关节造影能准确的对肩袖损伤进行诊断,且能更好的明确分型,为肩袖损伤的临床治疗能有效的提供影像学依据。     

Sonography of partial-thickness quadriceps tendon tears with surgical correlation.

OBJECTIVE: With the use of surgical findings as the reference standard, the purpose of this study was to describe the sonographic findings of partial-thickness and complete tears of the quadriceps tendon and to determine whether sonography can potentially aid diagnosis. METHODS: Three hundred eighty-nine consecutive sonographic reports (January 1996 to April 2001) of the knee/quadriceps tendon were reviewed retrospectively and assessed for subsequent surgery on the quadriceps tendon. Seven cases were thus identified. Findings at surgery (complete versus partial tears) were compared with the original sonography reports. RESULTS: All 4 partial tears and 1 of 2 complete tears were diagnosed correctly on the basis of sonography. One complete tear was described as a partial tear on the basis of sonography. In a seventh case, complete disruption of the extensor mechanism with osseous avulsion of the superior pole of the patella was identified correctly. Dynamic scanning was essential in diagnosing a partial quadriceps tendon tear in 1 case. CONCLUSIONS: Sonography, including the use of dynamic evaluation, was helpful in the diagnosis of partial-thickness tears of the quadriceps tendon and may aid in differentiation of such cases from complete quadriceps tendon tears, particularly in the acute setting. The presence of scar tissue in the setting of chronic injury may represent a potential pit-fall in the assessment of partial versus complete quadriceps tears. Further study is needed to define the accuracy of sonography for detecting quadriceps tendon tears.     

实时超声检查与磁共振成像诊断冈上肌腱撕裂的对比研究

目的评价实时超声检查与磁共振成像(MRI)对冈上肌腱撕裂病变的诊断价值。方法回顾性分析2003年1月至2008年1月间经手术证实冈上肌腱撕裂且临床资料完整的70例患者的实时超声检查及MRI检查资料,以开放手术或肩关节镜术中结果作为金标准,比较两种检查方法的有效性。结果 70例冈上肌腱撕裂,术前实时超声检查诊断65例,MRI诊断67例。实时超声检查诊断冈上肌腱撕裂的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为92.8%、82.1%、92.8%、82.1%及89.8%。MRI诊断冈上肌腱撕裂的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为95.7%、85.7%、94.4%、88.9%及92.9%。经χ2检验,冈上肌腱撕裂实时超声检查的有效性与MRI检查的有效性无统计学差异(χ2=0.09,P0.05)。结论实时超声检查与MRI同样能够准确地诊断冈上肌腱撕裂,可作为冈上肌腱检查的首选影像学方法 。     

产前超声诊断胎儿神经系统畸形的价值

目的探讨产前超声在诊断胎儿神经系统畸形的价值。方法回顾性分析121例产前超声诊断为胎儿神经系统畸形的声像图特点,并与引产或产后结果进行对照分析。结果超声检出的544例胎儿畸形中,发生中枢神经系统畸形121例,约占22％,其中脑积水最为常见,其他依次为脊柱裂、无脑畸形、全前脑、露脑畸形,以及其他少见畸形。结论超声可检出大多数的胎儿神经系统畸形,是诊断胎儿中枢神经系统畸形的主要手段。     

超声诊断类风湿性肩关节炎肩袖损伤：与关节镜手术对照

目的 探讨超声检查对类风湿性肩关节炎肩袖损伤的诊断价值。方法 应用超声对47例临床拟诊肩袖损伤的类风湿性肩关节炎患者的47侧肩袖进行扫查,依次观察肩胛下肌腱、冈上肌腱、冈下肌腱、小圆肌腱在静止状态和运动状态下有无损伤及撕裂。 在超声检查1周内对所有患者行肩关节镜手术治疗,将超声结果与手术结果进行对照。结果 超声可清晰显示类风湿性肩关节炎肩袖病变的形态学特征,包括有无撕裂和厚度改变;共检出31侧肩袖损伤,其中不完全撕裂18侧,完全撕裂7侧,肩袖肌腱厚度变薄6侧。与关节镜手术结果比较,超声诊断肩袖损伤的总体敏感度为90.62%(29/32),特异度为86.67%(13/15),准确率为89.36%(42/47)。超声对肩袖完全撕裂的诊断准确率为100%(7/7)。结论 超声对检出和判断类风湿性肩关节炎肩袖损伤程度有较高价值,尤其对显示完全撕裂和肩袖肌腱厚度变薄意义更显著。     

子宫内妊娠物残留的超声影像特征和诊断分析

目的 探讨超声诊断子宫内妊娠物残留(RPOC)及其对临床的指导意义.方法 157例中、晚期妊娠后临床怀疑RPOC的病例进行盆腔超声检查.超声阳性结果与清宫术后病理检查结果对照,超声阴性结果给予临床保守治疗,后随访3～6个月(平均约4.5个月).结果 157例病例中,二维超声检查阳性98例,手术后病理阳性73例,超声诊断准确率、敏感性、特异性较高,为84%、100%、70%.其二维声像图特征以显示子宫腔内团块的准确率较高(89%);子宫内膜异常和子宫腔内复合性积液的准确率较低,为42%和60%,误诊率较高,为44%和32%.超声检查阴性的59例,经临床治疗随访,证实均为阴性.另外,二维超声检查98例阳性中随机有47例应用了CDFI,其中30例病理阳性中,21例显示异常血流(70%);17例病理阴性中,11例显示异常血流(66%).结论 二维超声显示子宫腔内团块时,其诊断RPOC的意义较大;二维超声显示无子宫内团块、内膜异常和宫腔内复合性积液时,基本可排除RPOC;CDFI对诊断RPOCs无确切意义.     

Sonographic features of dialysis-related amyloidosis of the shoulder.

This study evaluated the diagnostic role of ultrasonography in dialysis-related amyloidosis in shoulders of chronically hemodialyzed patients. Fourteen shoulders of 12 long-term hemodialysis patients were examined. All patients had been on dialysis for at least 10 years. All patients had varying degrees of pain and limitations of movement in the studied shoulders. Dialysis-related amyloidosis was the presumed diagnosis in all patients. Any patient with a history of any disease, other than dialysis-related amyloidosis, capable of producing a pathologic shoulder condition was excluded. The following parameters were studied: supraspinatus and biceps tendon thickness, tendon tears, synovial thickening, and the presence of hypoechoic material around tendons and within bursae. All shoulders had a nonhomogeneous thickening, greater than 7 mm, of the supraspinatus tendon. Seven shoulders (50%) had abnormal thickening of the biceps tendon (4 mm or greater), and two shoulders had abnormal thickening of the subscapularis tendon. Hypoechoic deposits were seen in the subdeltoid bursae and biceps sheaths in five and six shoulders, respectively. Three shoulders showed partial tears of the supraspinatus tendon, one shoulder showed a tear in the biceps tendon, and one shoulder had a tear in the subscapularis tendon. Ultrasonography is an excellent imaging modality in diagnosing the presence of dialysis-related amyloidosis in symptomatic shoulders of long-term hemodialysis patients, without having to resort to invasive procedures. The results of previous studies have been confirmed and new ultrasonographic findings described. Of particular interest is the involvement of the subscapularis tendon in dialysis-related amyloidosis. Repeat ultrasonography can become an important way to follow-up progression of shoulder dialysis-related amyloidosis in hemodialyzed patients.     

Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

OBJECTIVE: To determine the benefit of screening ultrasonography for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma. METHODS: A total of 2693 patients with blunt trauma who were triaged to a level 1 trauma center underwent screening abdominal ultrasonography in the resuscitation suite. Examinations were performed by experienced sonographers and included a screen for free intraperitoneal fluid and evaluation of the abdominal organ parenchyma and heart for traumatic injury. Screening ultrasonographic findings were reviewed and compared with findings from autopsy, laparotomy, diagnostic peritoneal lavage, computed tomography, repeated ultrasonography, cystography, and clinical outcome. Imaging studies of all patients with confirmed or suspected injuries were reviewed to identify those in whom parenchymal findings aided diagnosis. RESULTS: One hundred seventy-two patients were found to have evidence of abdominal injury due to blunt trauma on the basis of clinical data, imaging, laparotomy, or autopsy. Forty-four of these patients had no sonographic evidence of hemoperitoneum at the time of initial ultrasonography. Screening ultrasonographic findings were positive for injury in 19 of 44 patients on the basis of parenchymal findings or small retroperitoneal collections of fluid thought to be indicative of trauma. In the remaining 25 patients, screening ultrasonography showed no abnormalities, and injuries were detected by repeated ultrasonography, subsequent computed tomography, or diagnostic peritoneal lavage performed for suspected occult injury on the basis of clinical parameters. In addition, 47 of 126 injured patients with sonographically detected free fluid had parenchymal findings that helped localize injury. Sixteen of those patients were taken to the operating room on the basis of clinical and sonographic findings without undergoing computed tomography. CONCLUSIONS: The inability to show injuries with no hemoperitoneum or with delayed hemoperitoneum has been shown to be a limitation of ultrasonography in patients with blunt trauma. In our series, 26% of all patients with documented injuries had no free fluid visible on screening ultrasonography Attention to findings other than free fluid allowed detection in 43% of injured patients without sonographic evidence of hemoperitoneum.     

Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography

We studied the value of dynamic sonography in adhesive capsulitis of the shoulder joint in patients with clinically suspected frozen shoulder. The sonographic criterion of adhesive capsulitis was continuous limitation of the sliding movement of the supraspinatus tendon against the acromion of the scapula. Arthrography was regarded as a gold standard in the diagnosis of adhesive capsulitis against which the sonographic results were compared. Among 23 patients with arthrographically documented adhesive capsulitis, sonographic examination showed limitation of movement of the supraspinatus tendon in 21. This sonographic sign therefore has a sensitivity of 91%, a specificity of 100%, and an accuracy of 92% for detecting adhesive capsulitis, making dynamic sonography a reliable technique for the diagnosis of this condition.     

Ultrasonographic-surgical correlation of ankle tendon tears.

This study evaluates the accuracy of ultrasonography in detecting ankle tendon tears of the peroneal, posterior tibial, and flexor digitorum longus tendons based on operative findings and clinical follow-up. A prospective study was performed in 33 patients with clinically suspected tendon injury. Sixty-eight tendons were evaluated sonographically. The diagnosis of an intrasubstance tear was made when disruption of uniform tendon architecture by hypoechoic linear or globular clefts was observed. Criteria used to diagnose complete tendon rupture included discontinuity or gap within the tendon or complete nonvisualization of the tendon. Treatment decisions were based on a combination of clinical parameters and imaging studies. Twenty-six patients had the presence or absence of tear confirmed at surgery. Five patients had a final diagnosis based on clinical findings, and two were lost to follow-up. Of the 68 tendons evaluated sonographically, 54 were directly inspected at surgery; 20 were found to be torn and 34 were intact. Ultrasonography was able to identify all tears correctly with an accuracy of 93%, a sensitivity of 100%, and a specificity of 88%. The positive and negative predictive values were 83% and 100%, respectively. The combined accuracy, sensitivity, and specificity of ultrasonography in detecting tendon tears in all patients evaluated both surgically and by clinical follow-up were 94%, 100%, and 90%, respectively.