MRI、MRAr及CT对外伤性肩关节盂唇损伤伴骨折的诊断效能比较

The diagnostic value of MRI,MRAr and CT in traumatic glenoid labrum injury patients with fracture

目的比较磁共振成像(MRI)、磁共振关节造影(MRAr)及CT对肩关节盂唇损伤伴/不伴骨折的诊断价值。方法回顾性分析2017-04至2018-04就诊于解放军总医院第三医学中心的肩关节盂唇损伤伴/不伴骨折患者34例,行常规MRI、MRAr和CT检查,经关节镜手术证实是否有Bankart损伤、肩关节上盂唇(SLAP)损伤及骨折。分析MRI、MRAr、CT征象应用对病变的诊断价值,评价三种影像手段对诊断不同类型盂唇损伤的灵敏度、特异度及准确度。结果34例(100%)有Bankart损伤,MRI诊断灵敏度94.12%,准确度94.12%;MRAr诊断灵敏度97.06%,准确度97.06%。30例(88.24%)合并SLAP损伤,MRI灵敏度53.33%,特异度22.22%,准确度58.82%;MRAr灵敏度93.33%,特异度66.67%,准确度94.12%。17例(50.00%)合并骨折,MRAr及MRI灵敏度均为52.94%;CT对诊断骨折灵敏度达94.12%,特异度94.44%。结论MRAr对SLAP损伤的诊断效能显著优于常规MRI;MRAr结合CT,可以提高肩关节盂唇损伤伴骨折的诊断完整性,可以减少漏诊。

Objective To analyze the diagnostic value of magnetic resonance imaging(MRI),magnetic resonance arthrography(MRAr)and CT in glenoid labral injuries with or without fractures.Methods Thirty-four cases of glenoid labrum injury with or without fracture were retrospectively analyzed,and MRI,MRAr and CT images were collected.Arthroscopic surgery was performed to confirm whether Bankart injury,superior labrum anterior and posterior(SLAP)injury and fracture were combined.The diagnostic value of MRI,MRAr and CT signs for different types of labral injury was analyzed,the sensitivity,specificity and accuracy of which were evaluated and compared with the surgical results.Results The results of all patients,34(100%)had Bankart lesions:conventional MRI had a diagnostic sensitivity of 94.12%and an accuracy of 94.12%.MRAr had a diagnostic sensitivity of 97.06%and an accuracy of 97.06%.Thirty patients(88.24%)had SLAP injury:conventional MRI had a sensitivity of 53.33%,a specificity of 66.67%,and an accuracy of 58.82%.MRAr had a sensitivity of 93.33%,specificity of 66.67%,and accuracy of 94.12%.Seventeen patients(50.00%)were complicated with fracture.The sensitivity of MRAr and MRI was 52.94%.The sensitivity and specificity of CT in the diagnosis of fracture were 94.12%and 94.44%,respectively.Conclusions MRAr is superior to conventional MRI in the diagnosis of SLAP injury,and MRAr combined with CT can improve the diagnostic integrity of shoulder labrum injury with fracture and reduce the incidence of missed diagnosis.