二维高频超声及能量多普勒评价2型糖尿病患者肩袖结构异常改变

Evaluation of abnormalities of the shoulder rotator cuff in patients with type 2 diabetes mellitus by two-dimensional high-frequency ultrasonography and power Doppler imaging

目的:探讨应用二维高频超声及能量多普勒技术评价2型糖尿病(T2DM)不同病程患者肩袖结构回声及血流改变的临床价值。方法:收集60例T2DM患者,分为2组:病程≤10年(B组)30例;病程>10年(C组)30例。另选取30名健康志愿者为正常对照(A组)。分别应用二维高频超声及能量多普勒观察3组肩袖结构各肌腱及肱二头肌长头腱的回声及血流情况,测量冈上肌腱(SUP)、肱二头肌长头肌腱(BT)、肩胛下肌腱(SUB)、冈下肌腱(INF)的厚度。结果:正常各肌腱长轴均显示为以纤细低回声区所间隔的多个互相平行的细线样强回声的索条样结构;B组中SUP、C组中SUP、BT、SUB、INF与A组相比,出现内部回声减低、不均匀、边缘不规则等内部回声异常的比率均增加(P<0.05);B组、C组各肌腱内发现钙化灶比率均大于A组(P<0.05);C组中BT出现腱旁组织异常的比率大于A组(P<0.05);B、C组各肌腱厚度与A组相比均增加(P<0.05);右侧C组中SUP、BT与B组相比厚度差异均有统计学意义(P<0.05);C组中BT双侧对比厚度差异有统计学意义(P<0.05);3组各肌腱内1级血流信号比率最高,各级血流信号差异无统计学意义。结论:二维高频超声以及能量多普勒可以客观评价T2DM不同病程患者肩袖结构的回声改变、厚度以及内部血流情况,具有重要的临床价值。

Objective： To evaluate the value of two-dimensional high-frequency uhrasonography and power Doppler imaging for judgement of the abnormalities of the shoulder rotator cuff in patients with type 2 diabetes mellitus （T2DM）. Methods： A total of 60 T2DM patients were enrolled and divided into two groups： group B（30 cases, the course≤10 years）, group C（30 cases, the course〉10 years）. 30 healthy subjects were enrolled in group A as normal control. The echotexture of the shoulder rotator cuff and blood flow were observed by two-dimensional high-frequency ultrasonography and power Doppler imaging. The thickness of the long head of the Biceps（BT）, Subscapularis tendon（SUB）, Supraspinatus tendon（SUP） and Infraspinatus tendon （INF） were measured. Results： The ultrasound imaging of each normal tendon was displayed as string like homogeneous hyperechogenicity interrupted by thin hypoechogenicity in longitudinal section. The abnormal ultrasound findings, such as hypoechoic areas, heterogenous echogenicity, or irregular edges, were more frequently detected in group B than group A of SUP, as well as in group C of BT, SUP, SUB and INF （P〈0.05）. The ratio of calcification of group B and group C was larger than that of group A （P〈0.05）. The ratios of abnormalities of the surrounding tissue in BT of group C was larger than that of group A （P〈 0.05）. In both sides, the thicknesses of each tendon in group B and group C were greater than those of group A（P〈0.05）, and the thicknesses of BT and SUP in the dominant side in group C were greater than those of group B（P〈0.05）. The thickness of BT in group C were greater in the dominant side than that in the other side （P〈0.05）. There were no significant difference a- mong the groups of A, B and C in gradings of blood flow. Conclusion： The abnormal echotextures, thickness and internal blood flow of the shoulder rotator cuff in the patients of T2DM can be evaluated by two-dimensional high-frequency ultra- sonography and power Doppler imaging objectively.