肩关节肱二头肌肌腱损伤的MRI表现

Tears of the long bicipital tendon of the shoulder MR imaging findings

目的:探讨MRI对肩关节肱二头肌长头肌腱损伤的诊断价值。方法:收集2006年1月～2010年8月共12例肩关节肱二头肌长头肌腱损伤的病例资料,回顾性分析患者的肩关节MR扫描图像,所有病例均经肩关节手术证实。结果:①12例肱二头肌长头肌腱断裂,其中部分撕裂4例,表现为肱二头肌长头腱增粗,T2W上可见局部高信号影,肌腱连续性存在;完全撕裂8例,表现为横断面上,结节间沟内未见肱二头肌长头腱显示,斜冠状面可见撕裂肌腱近端或远端呈波浪状。肱二头肌长头肌腱半脱位1例,表现为横断面上,肱二头肌长头肌腱向内侧移位,位于肱骨小结节前方;脱位2例,表现为横断面示空置的结节间沟,肱二头肌长头腱向内侧移位、位于肩胛下肌腱前方;②肱二头肌长头腱损伤伴随腱鞘积液2例,表现为横断面上肌腱被液性高信号影所环绕;伴随肩关节腔内积液12例;③12例肱骨结节间沟宽度≥8mm;深度<3mm、结节间沟变浅3例;3例内壁角<30°;④合并肩袖损伤7例,其中冈上肌腱撕裂5例,冈下肌腱撕裂1例,肩胛下肌肌腱撕裂1例;合并喙肱韧带损伤11例。出现肩峰撞击综合征10例。结论:MRI能够准确的诊断肩关节肱二头肌长头肌腱损伤,从而有助于临床手术方案的制定。

Objective：To assess the usefulness of MR imaging in the diagnosis of long bicipital tendon ruptures.Methods：12 cases（collected from Jan 2006 to Aug 2010） with MRI of the shoulder were retrospectively reviewed and proved by results of surgery.Results：① Of the 12 cases,4 partial tears show tendon thickening,and partially high signal intensity within it on T2WI,and the tendon continuity exists;8 complete tears were displayed as absence of long bicipital tendon between the trench tubercle on a axial MR image,and on the oblique coronal MR image,the proximal or distal portion of ruptured tendon were shown as wave-like.1 subluxation shows medially dislocated long bicipital tendon,which is anterior to lesser tuberosity on the axial image.2 dislocation show the empty bicipital groove and the long bicipital tendon located anterior to subscapularis tendon;② cases of the injured long bicipital tendon along with fluid in the biceps tendon sheath were displayed as tendon surrounded by high signal intensity fluid.12 cases show fluid within glenohumeral joint;③ The width of intertubercular sulcus ≥8 mm in 12 cases,the depth 〈3 mm and the sulcus become flat in 3 cases,the medial wall angle 〈30°in 3 cases;④ Combined with rotator cuff injury in 7 cases,of which 5 cases supraspinatus tendon tear,and 1 case subspinatus tendon tear,and 1 case subscapularis tendon tear.11 cases have the associated disruption of coracohumeral ligament,and 10 cases along with subacromial impingement syndrome.Conclusion：MR imaging can help confirm the long bicipital tendon ruptures of the shoulder,thus contributing to the development of clinical operation program.