超声及MRI检查诊断肩袖撕裂的临床研究

Clinical values of ultrasound and magnetic resonance imaging in diagnosis of rotator cuff tears

目的比较超声（US）和MRI成像（MRI）诊断肩袖撕裂的准确性,评估US与MRI检查在肩袖撕裂中的临床应用价值。方法收集以肩袖撕裂为诊断入院,并行肩关节镜检的患者210例,男84例,女126例,年龄22~78岁。210例患者中202例行MRI检查,130例接受US检查,以关节镜检结果为评价标准,分别计算US和MRI诊断肩袖撕裂的准确性、敏感性、特异性以及两种检查测量撕裂尺寸的准确性,比较两种检查方法的有效性。并对25例患者进行了术后1个月、3个月的US随访观察,对术前术后肩袖脂肪浸润的变化进行评估分析。结果与手术结果比较,US与MRI诊断肩袖撕裂的敏感性、特异性及准确性分别为91%、86%、91%和88%、85%、88%。US与MRI判断肌腱断端回缩度和撕裂宽度的准确性分别为73%、67.6%和74%、66%。US和MRI诊断肩袖撕裂和测量肩袖撕裂尺寸的准确性没有显著的统计学差异。US和MRI能准确有效地评估肩袖撕裂后脂肪浸润分级情况并进行随访观察,有利于预测患者的预后。结论 US与MRI均在诊断肩袖撕裂和测量肩袖撕裂尺寸上具有较高的准确性。对于有经验的骨科或影像科医生而言,US检查是一种省时、廉价、简单可靠并可重复的诊断方法,可作为肩袖撕裂诊断及随访的常规检查方法。

Objective To compare the accuracy of ultrasound（ US） and magnetic resonance imaging（ MRI） for the detection and measurement of the size of rotator cuff tears（ RCT） and to evaluate the clinical values of US and MRI. Methods A total of 210 patients（ 84 males and 126 females; age range,22 to 78 years） with suspected RCT underwent arthroscopy surgery. Among the patients,202 of them had MRI examination,and 130 of them had US examination preoperatively. The RCT existence status,RCT pattern,and sizes of RCT,were recorded. The preoperative results were compared with the findings during the arthroscopy to assess the effectiveness of the two methods. Twenty-five patients took US examination before the surgery,one month and three months after the surgery. The preoperative and postoperative assessments of fatty infiltration were performed. Results Compared with the arthroscopic results,the sensitivity,specificity,and accuracy of the diagnosis of RCT were 91%,86%,and 91% respectively in US,while 88%,85%,and 88% respectively in MRI. As for the assessment of the tendon retraction and the size of RCT,the accuracy was 73% and 67. 6% respectively in US,while 74% and 66% respectively in MRI. There was no statistic difference between the performance of US and MRI. US and MRI both could accurately and effectively evaluate the fatty infiltration after rotator cuff tears. Conclusions US and MRI both have comparably high accuracy for detecting and measuring the sizes of partial-thickness and fullthickness tears. The US examination of the shoulder performed by a sufficiently-trained orthopaedic surgeon or a radiologist is a reliable,time-saving,and cost-effective practice to identify rotator-cuff tears. US can be used as a routine method for the diagnosis and follow-up of RCT.