肩袖损伤的影像学及关节镜诊疗价值

目的探讨肩袖损伤的影像学改变及关节镜检查在诊疗中的价值。方法18例肩袖损伤术前行造影和磁共振成像(MRI)。关节镜手术18例，其中关节镜下肩峰成形减压术16例，小切口肩峰成形2例。全层肩袖损伤10例行小切口肩袖缝合，肩袖部分磨损8例行关节镜下刨削清理术。结果肩关节造影13例，其中9例显示肩关节腔与肩峰下滑囊和三角肌下滑囊沟通，4例未见异常。MRI检查18例，其中10例显示肩袖全层损伤，8例冈上肌腱信号异常为部分损伤。根据关节镜检查结果判断其诊断准确率，MRI为100％，肩关节造影69％。术后随访时间3～22个月，平均7个月。根据美国加州洛杉矶大学(UCLA)肩关节评分标准，优9例，良6例，可3例，优良率达83％。结论肩关节造影有助于全层肩袖损伤的诊断；MRI对肩袖部分和全层损伤正确诊断率和敏感性最高；关节镜治疗肩袖损伤具有微创，有利于功能恢复。

Value of image analysis and arthroscopy in diagnosis and treatment of rotator cuff lesions

Objective To explore the value of magnetic resonance im aging (MRI), arthrogram and arthroscopy in diagnose and treatment of rotator cuf f lesions. Methods Arthrogram and MRI were made in 18 cases of rotator cuff lesions treated by arthroscopy. Subacromial decompression under the arthroscopy was performed in 16 cases, a small incision open procedure in tw o, full-thickness rotator cuff tear repair with a small incision open procedure in 10 and partial-thickness tear debridement under arthroscopy in eight. Results Of 13 cases with arthrogram, nine cases showed that the g lenohumeral joint communicated with the subacromial and subdeltoid burs and the other four remained normal. MRI demonstrated a full-thickness rotator cuff tear and defect in the distal aspect of the supraspinatus tendon in 10 cases and a p artial-thickness rotator cuff lesion in the articular surface and bursal sided in eight. According to arthroscopic findings, the diagnosis accuracy of MRI and arthrogram was estimated at 100% and 69% respectively. All cases were followed u p for 3-22 months (average seven months). Based on shoulder scale of the Univer sity of California Los Angeles (UCLA), nine were excellent,six good and three f air with an excellence ratio of 83%. Conclusions Arthrogram is helpful to diagnosis of full thickness tears and arthroscopy helpful to funct ional recovery with characteristics of slight trauma in treating rotator cuff le sions. MRI is the most accurate method with the highest sensitivity for the diag nosis of rotator cuff lesions.