CT引导下肩关节腔穿刺行气,碘双重造影22例

近年来,随着对肩关节疾患的研究取得进展,提出了“肩关节不稳定”学说〔1～3〕。我院采用CT引导下肩关节穿刺行气、碘双重造影22例,不仅显示关节囊、盂唇、盂缘损伤,且提示关节囊松弛程度,对肩关节不稳定的诊断及指导治疗提供了重要依据。1　临床资料1.1　一般情况　本组男12例,女10例;年龄20～62岁,平均45岁。手术证实有盂唇撕脱及(或)关节囊松弛、破裂。1.2　方法　将损伤侧肩关节前侧常规消毒,铺单。从肩胛喙突外侧1cm处进针,行关节腔穿刺。首先向关节腔内注入76%泛影葡胺4ml,再注入10ml无菌过滤空气,然后拔出穿刺针,病人适度活动肩关节…     

CT引导下肩关节造影诊断肩关节前不稳症的价值

目的 :探讨CT引导下穿刺、空气 -碘水双对比造影CT诊断肩关节前不稳症的意义。材料和方法 :经临床和手术证实 5 6例为肩关节前不稳症患者 ,在CT引导下 ,行肩关节囊穿刺 ,并注入 30 %～ 35 %泛影葡胺 6～ 10ml和过滤空气10～ 2 0ml后 ,分别行仰卧位和俯卧位CT扫描 ,必要时 ,行螺旋CT扫描和 3维重建。结果 :5 6例肩关节前不稳症患者中除1例因耐药性差未检查成功外 ,其余 5 5例造影均获成功 ,16例手术患者气 碘双对比造影CT表现均与手术中所见一致。结论 :CT引导下肩关节造影可以准确诊断肩关节前不稳症并为外科手术治疗肩关节不稳症提供可靠的影像学信息。     

前关节囊修复成形术治疗创伤性肩关节前不稳定

创伤性肩关节前不稳定易误诊为“肩周炎”、“肱二头肌腱鞘炎”而对症治疗，结果病情迁延，长期不愈。我院采用气、碘双重造影ＣＴ检查，显示肩关节盂唇、关节囊损伤部位及其损伤程度［１］。据此，采用前关节囊修复成形术治疗，病人肩关节功能明显改善，取得满意效果。资...     

普通X线监视引导与CT介入引导穿刺肩关节行气、碘双重造影CT效果比较

作者通过20例肩关节气、碘双重造影CT的分析,阐述CT介入引导肩关节囊穿刺并行气、碘双重造影在成功率、受辐射剂量以及病人所受痛苦3方面较普通X线监视引导穿刺肩关节囊造影的优劣.     

创伤性肩关节前不稳定康复治疗与手术治疗效果分析

目的 :分析影响创伤性肩关节前不稳定患者的康复治疗与修复重建手术治疗的效果。方法 :5 8例患者根据临床症状、体征 ,盂唇损伤的范围 ,关节囊撕裂、松弛的范围和关节不稳定的程度 ,分别选择康复治疗(3 9例 )、康复治疗无效改成手术治疗 (5例 )与手术治疗 (1 4例 )。结果 :本组病例平均随访 2 4个月 ,康复治疗组 4例剧烈活动后肩部不适 ,3例后伸受限 1 0°,1例前屈受限 2 0°。康复治疗无效改成手术治疗组 5例 ,手术治疗组 1 4例 ,其中后伸活动受限 2例(1 0°) ,剧烈活动后肩前部不适 1例 ,其余病例症状消失 ,关节活动度正常。结论 :创伤性肩关节前不稳定的康复治疗可避免手术创伤 ,疗效满意 ,但治疗周期较长 ,治疗效果受病程长短、患者配合治疗的情况以及肩关节盂唇、前关节囊损伤程度的影响。康复治疗后症状无改善、甚至加重 ,或者前关节囊明显撕裂、盂唇撕脱、肩关节明显不稳定者需采用手术治疗。肩关节盂唇、前关节囊修复成形术不破坏正常关节稳定结构 ,关节功能恢复良好。肩关节稳定结构的损伤程度 ,如前关节囊严重损伤、盂唇广泛撕脱以及病程过长等会影响治疗效果     

X线气钡双对比造影、MSCT检查对胃癌TNM分期的评估

目的：探讨X线气钡双对比造影、MSCT检查对胃癌术前TNM分期的评估。方法：经病理证实的160例胃癌患者，分析其X线气钡双对比造影、MSCT表现，并和手术、病理做对照分析。结果：X线气钡双对比造影、MSCT显示早期胃癌5例，进展期胃癌155例。浸润型（BorrmannⅢ、Ⅳ）淋巴结转移率（76．5％）明显高于局限型（BorrmannⅠ、Ⅱ）转移率（43．2％）。肿瘤直径〈4cm、4～8cm和〉8cm的淋巴结转移率依次增加，其差异有高度显著性（P〈0．01）。T分期诊断正确率83．0％，N分期诊断正确率68．1％，M分期诊断正确率79．0％。结论：X线气钡双对比造影、MSCT检查对进展期胃癌诊断价值较大，可指导临床手术和治疗方案的制定。     

高压氧辅助治疗二例头皮回植术后的疗效

1991～1995年间我科共收治大面积头皮撕脱伤5例，有2例术后即给予高压氧（HBO）治疗，效果较满意，现报告如下。一、临床资料1．一般资料：5例患者均为女性，术前情况详见表1。撕脱范围：3例为全头皮，2例为4／5头皮，尚留枕部1／5头皮末撕脱；5例均伴有程度不等的额、眉间、双颈部位面部皮肤撕脱。2治疗方法：患者就诊后即行头皮回植术，彻底行创面及撕脱头皮清创，将撕脱头皮取韧厚皮片，原位回植于创面。HBO组（例4、5）术后开始HBO治疗，采用多人氧舱，压力0．2MPa，面罩吸纳氧60分钟，中间吸舱内空气10分钟，每日1次，每10次为1个…     

电子束CT与常规心血管造影计算左心室容积准确性的比较

目的评价电子束ＣＴ（ＥＢＣＴ）及常规心血管造影计算左心室容积的相对准确性。材料与方法对１４只人的左心室铸型进行了ＥＢＣＴ扫描，并与常规双平面Ｘ线电影结果进行比较。左心室铸型的实际容积由铸型排除的水的容积来测定。结果左心室铸型的实际容积为５５．５７±２８．９１ｍｌ，ＥＢＣＴ长轴扫描的计算容积为６６．５０±３３．０４ｍｌ，ＥＢＣＴ短轴扫描的计算容积为６０．３６±２９．９０ｍｌ；常规双平面Ｘ线电影的计算容积为８２．０９±４０．４０ｍｌ。Ｘ线电影计算的左心室容积明显大于ＥＢＣＴ的左心室容积值及左心室铸型的实际容积值（Ｐ＜０．００１）。相关分析表明，ＥＢＣＴ及双平面Ｘ线造影的左心室计算容积值均与左心室铸型的实际容积高度相关（ｒ均高于０．９８）；但双平面Ｘ线电影对左心室容积值的高估程度较ＥＢＣＴ更高（Ｘ线电影为２６．５２±１６．１１ｍｌ，ＥＢＣＴ短轴扫描为４．７９±６．５９ｍｌ，ＥＢＣＴ长轴扫描为１０．９３±８．１４ｍｌ，Ｐ＜０．０１）。结论在左心室容积计算方面，ＥＢＣＴ较常规心血管造影更精确，其同样可以作为左心室容积计算的金标准。     

脑池气造影高分辨率CT诊断小听神经瘤

目的：评价脑池气造影高分辨率ＣＴ检查（Ｇａｓ－ＨＲＣＴＣ）对微小听神经瘤的诊断价值。方法：对临床及ＣＴ疑诊听神经瘤患者１０例１２个内耳道行Ｇａｓ－ＨＲＣＴＣ。结果：检出听神经瘤５例，其中３例为内耳道内微小听神经瘤；另７个内耳道检查阴性，诊断准确率为１００％。结论：Ｇａｓ－ＨＲＣＴＣ是诊断和排除小听神经瘤非常敏感、安全和可靠的方法     

小肝癌影像学诊断的对照研究

笔者对３２例４１个直径≤５ｃｍ的小肝癌进行血管造影（ＩＡＤＳＡ）、Ｂ超、ＣＴ和碘油ＣＴ等方法的对照研究。结果四种影像学方法对本组小肝癌诊断的敏感性分别是血管造影８７．８％（３６／４１）、Ｂ超６５．９％（２７／４１）、ＣＴ５７．７％（１５／２６）、碘油ＣＴ１００％（１４／１４），血管造影的诊断敏感性与Ｂ超、ＣＴ比较有显著性差异（Ｐ＜０．０５）。作者认为血管造影和碘油ＣＴ是诊断小肝癌准确而有效的方法。     

A prospective comparison study of double contrast computed tomography (CT) arthrography and arthroscopy of the shoulder

Thirty consecutive patients who underwent double contrast CT arthrography prior to shoulder arthroscopy were prospectively studied. Results from both studies were recorded with the radiologist blinded to the arthroscopic findings when making the final CT reading. The sensitivity, specificity, and accuracy, respectively, of CT arthrography findings compared to arthroscopy were 50%, 100%, 96% for rotator cuff; 66%, 100% 96% for bicipital labral complex; 100%, 100%, 100% for loose bodies; 50%, 100% 93% for Hill-Sachs lesions; 90%, 73%, 83% for anterior labral defects; and 100%, 100%, 100% for posterior labral defects. We conclude that shoulder arthroscopy accurately delineates abnormalities of the anterior and posterior labrum, bicipital labral complex, rotator cuff, joint synovium, and humeral head. CT arthrography accurately delineates capsular redundancy, loose bodies, hardware around joints, and bony glenoid rim abnormalities.     

Computed tomography (CT) arthrography of shoulder instabilities in athletes

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of suspected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical manifestations and CT arthrographic findings, were considered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaffiliated with shoulder instability, were identified. These included total or partial detachment of superior segments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 patients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.     

Direct MR arthrography of the shoulder: is exercise prior to imaging beneficial or detrimental?

PURPOSE: To define the beneficial and detrimental effects of adding exercise to direct magnetic resonance (MR) shoulder arthrography. MATERIALS AND METHODS: Direct, intraarticular, gadolinium arthrography of the shoulder was performed in 41 patients, who underwent 1.5-T MR imaging before and after 1 minute of arm swinging. Fourteen milliliters of dilute gadolinium solution was injected. Two readers blinded to exercise independently graded the randomly distributed images with a five-point scale for capsular contrast material resorption; extraarticular contrast material leakage; rotator cuff, glenoid labrum, and anterior capsule conspicuity; and partial-thickness or full-thickness rotator cuff tear and labral tear detectability. The sign test was performed to evaluate the significance of differences between preexercise and postexercise grading for each reader. A second review was performed, with direct side-by-side comparison of preexercise and postexercise images. RESULTS: There was evidence of increased capsular resorption after exercise but no alteration in the depiction of the rotator cuff tendons or glenoid labrum. There was no significant extraarticular contrast material leakage after exercise and no alteration in depiction of the anterior capsule. There was no difference in the detectability of rotator cuff or labral tears. CONCLUSION: Exercise with direct shoulder MR arthrography has no beneficial or detrimental effect on image quality or on the depiction of rotator cuff or labral tears.     

Athlete shoulder injuries: CT arthrographic findings

Forty-three professional and amateur athletes with persistent shoulder pain that interfered with their sports activities were evaluated by computed tomographic (CT) arthrography. In 19 patients, glenohumeral instability (14 anterior, two posterior, three multidirectional) was diagnosed with CT arthrography based on the simultaneous presence of labral and capsular lesions. The findings were crucial in establishing the diagnosis of instability in six patients in whom the condition was not suggested or could not be confirmed clinically. Another significant injury consisted of labral lesions not associated with glenohumeral instability. These tears often involved the anterior and parasuperior segments of this structure. Other, less frequently detected lesions included segmental labral enlargement and several labra with abnormal orientation (everted labrum). Early onset of degenerative disease was present in many athletes, especially those with a long history of sports activity. CT arthrographic findings were correlated with arthroscopic or surgical results in 19 patients.     

Capsulo-labro-ligamentous lesions of the shoulder: evaluation with MR arthrography

PURPOSE: The aim of the study was to analyse the accuracy of MR arthrography in the evaluation of capsulo-labro-ligamentous lesions of the shoulder in patients with glenohumeral joint instability. MATERIALS AND METHODS: From 1999 to 2001 fifty-eight patients with glenohumeral joint instability were studied by MR arthrography. Twenty-seven patients underwent surgical repair: 11 by arthroscopic and 16 by arthrotomic approach. All shoulder evaluations were performed with T1 and T2 weighted axial, coronal and sagittal oblique images, before and after intra-articular injection of gadolinium contrast. RESULTS: Forty capsulo-ligamentous lesions (including 14 capsular ruptures with extravasation of the contrast medium) were detected by MR arthrography. Fifty-two labral tears (36 of the anterior, 13 of the superior and 3 of the posterior glenoid labrum) were identified: 11 out of 52 were not recognized before gadolinium contrast injection. Five rotator cuff tears were identified, one of which was not shown in the pre-injection examination. Surgical results confirmed the MR arthrographic findings in 25/27 patients. In one case MR arthrography did not recognize a SLAP lesion; in another case it identified a tear of the capsule but not of the glenoid labrum. CONCLUSIONS: In many cases of subacute glenohumeral joint lesions with intracapsular fluid, MR may accurately evaluate capsulo-labral-ligamentous lesions. Indeed, the examination of lesions is limited by the absence of the natural contrast determined by fluid; in such cases, intra-articular injection of gadolinium contrast is necessary. MR arthrography evaluates the degree of capsulo-labro-ligamentous tears and may guide the surgical approach.     

X-ray computed tomography in the study of anterior instability of the shoulder. Study of a series of 23 cases

The place of standard CT scan imaging more particularly when combined with double contrast arthrography, is defined in the preoperative screening of patients with anterior instability of the shoulder. The joint scan provides complete data on the anatomic elements of the shoulder lesion, particularly with reference to the glenoidal labrum and the anterior capsular structure. It is also of major diagnostic value in painful subluxations.     

CT arthrography of capsular structures of the shoulder

The capsular mechanism of the shoulder joint consists of the joint capsule, which is strengthened by the glenohumeral ligaments and the rotator cuff, the glenoid labrum, and a variable number of synovial recesses. Although the fibrous capsule is a lax structure, the normal function of the capsular mechanism makes it an effective barrier against anterior dislocation, particularly in external rotation. There has been a tendency in the past to overestimate the role of the glenoid labrum in stability of the shoulder joint. In patients with instability, the significance of the capsular attachment or its anomalous insertions to the glenoid has not been adequately recognized. Labral tears may develop as secondary lesions due to repeated dislocations and subluxations rather than representing the primary lesion responsible for instability. Operative visualization of capsular defects or detachments is often difficult. Prior knowledge of these lesions can effectively help the choice of an appropriate surgical procedure and reduce operating time. The results of computed tomographic (CT) arthrography of the shoulder joint in 45 patients are reported and the normal and pathologic variations of the joint capsule and particularly the capsular insertions are described. Configuration of the joint recesses and the glenoid labrum are also evaluated. These CT findings were correlated and verified by surgery or arthroscopy in 26 cases.     

肩盂肱关节不稳的CT关节造影表现

目的　总结分析盂肱关节不稳在CT关节造影上的表现。方法　 16例经关节镜手术检查证实病例 ,对盂唇撕裂 ,关节囊撕脱 ,关节盂骨折等在CT关节造影上表现特点进行总结分析。结果　关节内损伤包括盂唇撕裂 ,见盂唇内有造影剂充盈 ;关节盂唇软骨剥脱 ,正常关节软骨三角形结构消失 ,骨性关节盂裸露于关节囊内 ;关节囊撕脱 ,表现有关节囊腔扩大 ,关节囊附着点位置改变等 ;以及骨性关节盂缘骨折 ,肱骨外上方压缩骨折等。结论　肩盂肱关节CT造影对比性好 ,断层图像无重叠 ,可清晰显示出关节内损伤 ,是肩盂肱关节不稳的一种有效准确的检查方法     

Arthroscopic treatment of posterior and multidirectional instability

The author can answer the three fundamental questions which were posed in the beginning of this chapter as follows: Atraumatic posterior and multidirectional laxity is attributable to capsular ligamentous laxity and can be asymptomatic initially. Over the time, repetitive subluxation of the humeral head exerts excessive rim-loading on the posteroinferior glenoid labrum which can develop into retroversion of the glenoid labrum and eventually leading to labral tears. In this stage, a patient develops shoulder pain during daily and sports activities. Besides increased translation, the diagnosis should be based on the symptoms reproduced by the jerk and Kim tests. The jerk test is a hallmark for predicting the prognosis of nonoperative treatment in posteroinferior instability. Shoulders with a painful jerk test have posteroinferior labral lesion and are unresponsive to nonoperative treatment. In these patients, early surgery may be indicated. Any successful surgical procedure should correct both the capsular laxity and the retroversion of the posteroinferior glenoid labrum. Simple capsular plication or an inferior capsular shift is insufficient for correcting the two major pathologies. Arthroscopic capsulolabroplasty restores capsular tension as well as labral height.     

Comparison between Conventional MR Arthrograhphy and Abduction and External Rotation MR Arthrography in Revealing Tears of the Antero-Inferior Glenoid Labrum

Objective

To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient''s shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient''s arm in the neutral position.

Materials and Methods

MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student''s t test was performed.

Results

In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05).

Conclusion

MR arthrography with the patient''s shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior glenoid labrum. When equivocal features are seen at conventional axial MR arthrography, oblique axial imaging in the ABER position is helpful.