肩关节MR造影诊断肩袖关节侧大结节止点处外伤性撕脱的价值

Shoulder MR arthrography and injury mechanism of partial articular surface tendon avulsion

目的评估肩关节MR造影诊断肩袖关节侧大结节止点处外伤性撕脱（PASTA损伤）的能力。方法回顾性分析经关节镜证实的19例PASTA损伤的肩关节MR造影图像。19例PASTA损伤中，职业运动员15例，运动爱好者4例，年龄16～35岁。总结PASTA损伤的影像特点，并计算肩关节MR造影对PASTA损伤的诊断敏感度。结果12例PASTA损伤累及冈上肌腱，4例累及冈上肌腱与冈下肌腱交界部，3例累及冈下肌腱。中立位肩关节MR造影可确定15例为肩袖下表面的部分撕裂，诊断敏感度为78．9％（15／19），但只能确定13例为PASTA损伤，诊断敏感度为68．4％（13／19）。19例PASTA损伤中，18例合并有盂唇撕裂，肩关节MR造影诊断上方盂唇前后向撕裂的敏感度为100．0％（11／11），前下盂唇撕裂为92．3％（12／13），3例后方盂唇撕裂诊断2例。结论肩关节MR造影可以较全面的评价PASTA损伤。

Objective To evaluate the diagnostic value of shoulder MR arthrography for partial articular surface tendon avulsion （PASTA lesion）. Methods A retrospective study was undertaken in 19 patients of PASTA lesion of shoulder MR arthrography confirmed by subsequent shoulder arthroscopy. Nineteen PASTA lesions were detected （15 patients of athletes ,4 case of sports fans, aged 16 to 35 years old ）. Abnormalities of the rotator cuff and the labrum revealed on MR arthrography were recorded. The results of MR arthrography were compared with those of arthroseopy. Sensitivities were calculated. Results Twelve patients involved the supraspinatus tendon, 4 involved the supraspinatus/ infraspinatus tendon transition zone and 3 involved the infraspinatus tendon. MR arthrography in neutral position could determine 78.9% （15/19） of partial articular-sided tears, but could only be sure of 68.4% （13/19） of PASTA lesions. In all 18 patients of PASTA lesions with labral tears, MR arthrography could identify 100. 0% （ 11/11 ） of superior labral anterior posterior lesions, 92. 3% （ 12/13 ） of anteroinferior labral tears and 66.7% （2/3） of posterior labral tears. Conclusion Shoulder MR arthrography is a good and comprehensive evaluation method for PASTA lesions.