CT气-碘双对比造影诊断创伤性肩关节前不稳定的临床研究

目的 总结临床经验，提出CT气-碘双对比造影诊断创伤性肩关节前不稳定的临床价值。方法48例患者行CT气-碘双对比造影检查。在CT介入引导下行肩前侧穿刺，注入76％泛影葡胺4ml，再注入无菌过滤空气10ml。在西门子SOMATOM CR全身CT机下扫描。CT显示结果并参照病史、临床症状、体征及手术所见，分为Ⅰ、Ⅱ和Ⅲ度损伤。结果检查后3例肩部胀痛，2d后消失，余患者未述不适。CT气-碘双对比造影结果，Ⅰ度损伤9例，Ⅱ度损伤22例，Ⅲ度损伤17例。Ⅰ度损伤者采用康复治疗。Ⅱ度损伤者多采用康复治疗，但治疗时间较长。Ⅲ度损伤以手术治疗为主。结论CT气碘双对比造影显示结果分为Ⅰ、Ⅱ和Ⅲ度损伤，不仅可反映病损及临床症状的严重性，而且能为临床治疗提供重要的影像学信息。

CLINICAL STUDY ON DOUBLE CONTRAST CT DIAGNOSIS OF TRAUMATIC ANTERIOR SHOULDER INSTABILITY

OBJECTIVE: To evaluate the clinical importance of double contrast CT diagnosis of traumatic anterior shoulder instability. METHODS: Forty-eight patients underwent double contrast CT scan. With the guide of CT scan, anterior arthrocentesis of the shoulder was performed and 4 ml of 76% urografin was injected into the joint and then 10 ml of filtrated air was injected. The patients were examined by SOMATOM CR Systematic CT. The results of double contrast CT of the 48 patients were divided into I, II and III degree according to the CT results related to their injury history, clinical symptoms, signs and operation findings. RESULTS: The patients had no complaint after the CT examination except for 3 patients, who had slight pain within 2 days after CT examination. The results of double contrast CT were as follow: I degree: 9 patients, II degree: 22 patients, and III degree: 17 patients. All patients with I degree injuries were treated with rehabilitation program. The patients with II degree injuries were mainly treated with rehabilitation program, but took much longer time. The patients with III degree injuries were suggested to be treated with surgery. CONCLUSION: To divide the results of double contrast CT into I, II and III degree not only reflects the severity of traumatic anterior shoulder instability but provides information for the treatment of the instability.