盂肱关节前方不稳MR表现与关节镜手术所见比较

Comparative study of MR findings and arthroscopy for common diseases of anterior glenohumeral instability

目的探讨盂肱关节前方不稳的关节镜检查和3.0T MRI表现。方法收集45例盂肱关节前方不稳患者的MRI检查及关节镜检查资料,回顾性对照分析MRI与多角度镜头关节镜手术结果,总结损伤类型、程度,采用Kappa检验分析MRI与关节镜诊断结果的一致性,观察MRI对各种损伤诊断结果及敏感度。结果盂唇损伤在盂肱关节前方不稳病变中占84.4%(38/45),其中前下盂唇损伤占51.1%(23/45),盂唇损伤合并Hill-sachs损伤、关节囊损伤占44.2%(20/45),盂唇损伤合并骨性Bankart损伤占17.7%(8/45)。MRI诊断前下盂唇损伤、HAGL病变、Hill-sachs病变的敏感度分别为78.2%、71.0%、90.0%。MRI与关节镜诊断结果具有一致性,其中诊断肩胛下肌及肌腱损伤及骨性Bankart损伤的结果完全一致,诊断前下盂唇损伤、HAGL病变及Hill-sachs病变的一致性较好,诊断SLAP损伤一致性一般。结论3.0T MRI能够较准确地显示盂肱关节前方不稳常见病变及MRI征象,为临床早期诊断和治疗提供依据。

Objective To investigate the applicability of arthroscopic and 3.0 T MRI findings of anterior glenohumeral instability.Methods The MRI and arthroscopic data of 45 patients with anterior instability of glenohumeral joints was collected.MRI findings and outcomes of multi-angle lens arthroscopic surgery were retrospectively analyzed and compared.The types and degrees of injuries were summarized.Kappa test was used to analyze the consistency between MRI and arthroscopy.The diagnostic results and sensitivity of MRI were observed.Results Glenoid labrum injury accounted for 84.4%(38/45)of cases of anterior glenohumeral instability,of which the anterior lower glenoid labrum injury accounted for 51.1%(23/45).Glenoid labrum injury combined with Hill-sachs injury and joint capsule injury accounted for about 44.2%(20/45),while glenoid labrum injury combined with bony Bankart injury made up about 17.7%(8/45).According to 3.0 T MRI diagnosis,the sensitivities of anterior lower glenoid labrum injury,HAGL lesion,and Hill-sachs lesion were 78.2%,71.0%,and 90.0%,respectively.According to MRI and arthroscopy diagnosis,the consistency between glenoid labrum injury,HAGL lesion and Hill-sachs lesion was good.The results of diagnosis of musculus subscapularis and tendon injury and bony Bankart injury were completely consistent,but the consistency of diagnosis of SLAP injury was not so good.Conclusions 3.0 T MRI can accurately display the common lesions and MRI signs of anterior glenohumeral instability,and provide reliable data for early clinical diagnosis and treatment.