MR肩关节造影对肩袖损伤手术治疗的指导作用

Guiding Roles of MR Shoulder Arthrography in Rotator Cuff Injury Surgery

目的探究MR肩关节造影对肩袖损伤手术治疗的指导作用。方法回顾性分析我院2014年8月-2018年8月期间收治66例疑似肩袖损伤患者资料,依据患者检查方式不同将使用MRI和MR肩关节造影检查患者纳入MRI组(n=32)和MR造影组(n=34),随后所有患者使用肩关节镜进一步确认并进行手术。分析MRI与MR肩关节造影影像学表现,比较两种方式检出肩袖损伤类型,两种方式诊断肩袖损伤诊断价值,两种方式手术前后患者关节功能评分。结果MRI组诊断肩袖损伤Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型和Ⅵ型分别为4例(12.50%)、6例(18.75%)、8例(25.00%)、9例(28.13%)、3例(9.38%)和2例(6.25%),MR造影组诊断肩袖损伤Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型和Ⅵ型分别为5例(15.63%)、6例(18.75%)、8例(25.00%)、11例(34.38%)、3例(9.38%)、1例(3.13%);以关节镜检查结果作为金标准,MRI和MR造影诊断肩袖损伤灵敏度、特异度、准确度分别为92.86%、50.00%、87.50%和96.88%、50.00%、94.12%,两组间仅准确性之间比较差异具有统计学意义(P<0.05);两组患者术后ASES和Constant-Murley功能评分较术前显著改善(P<0.05),术后MR造影组患者ASES和Constant-Murley功能评分改善明显优于MRI组患者(P<0.05)。结论MR肩关节造影用于诊断肩袖损伤诊断价值优于MRI,依据MR肩关节造影结果制定手术方案术后患者肩关节功能损伤改善较显著,应用价值较好。

Objective To explore the guiding role of MR shoulder arthrography in rotator cuff injury surgery.Methods A retrospective analysis was performed on the data of 66 patients with suspected rotator cuff injury in the hospital from August 2014 to August 2018.Patients treated with MRI or MR shoulder arthrography were included in MRI group(n=32)and MR arthrography group(n=34)according to different examination methods.The arthroscopy was performed on all patients for further confirming and they underwent operation.The imaging findings of MRI and MR shoulder arthrography were analyzed.The rotator cuff injury types,diagnostic value for rotator cuff injury,joint function scores before and after operation detected by two methods were compared.Results In the MRI group,there were 4 cases(12.50%),6 cases(18.75%),8 cases(25.00%),9 cases(28.13%),3 cases(9.38%)and 2 cases(6.25%)diagnosed with rotator cuff injuries of type Ⅰ,type Ⅱ,type Ⅲ,type Ⅳ,type Ⅴ and type Ⅵ.In MR arthrography group,there were 5 cases(15.63%),6 cases(18.75%),8 cases(25.00%),11 cases(34.38%),3 cases(9.38%)and 1 case(3.13%)diagnosed with rotator cuff injuries of type Ⅰ,type Ⅱ,type Ⅲ,type Ⅳ,type Ⅴ and type Ⅵ.Taking arthroscopy results as golden standard,the sensitivity,specificity and accuracy of MRI and MR angiography for diagnosis of rotator cuff injury were(92.86%,50.00%,87.50%)and(96.88%,50.00%,94.12%),respectively.There was only significant difference in accuracy between the two groups(P<0.05).The ASES and Constant-Murley functional scores in both groups were significantly improved after surgery(P<0.05).After surgery,the improvement of the above 2 indexes in MR angiography group was significantly better than that in MRI group(P<0.05).Conclusion The diagnostic value of MR shoulder arthrography is better than that of MRI in diagnosis of rotator cuff injury.The surgical plans are made according to MR shoulder angiography results,the improvement of shoulder joint function injury is relatively more significant after surgery and the application value is better.