超声检测肩袖间隙对冻结肩的诊断价值

Diagnostic value of ultrasonic detection of rotator interval in evaluating frozen shoulder

目的分析冻结肩患者肩袖间隙灰阶超声和多普勒超声表现,探讨应用超声检测肩袖间隙对冻结肩的诊断价值。方法回顾性分析于我院行肩关节超声检查并经临床确诊的冻结肩患者35例(冻结肩组)和肩关节不适的非冻结肩患者37例(非冻结肩组),冻结肩组根据病程进一步分为早期组(病程≤6个月)11例和中晚期组(病程>6个月)24例。分析各组肩袖间隙的超声表现,比较肩袖间隙厚度指数(RITI)、肩袖间隙血流、喙肱韧带厚度和形态的差异;以临床诊断结果为标准,绘制受试者工作特征曲线(ROC)评价各超声参数诊断冻结肩的诊断效能。结果冻结肩组RITI为(10.11±1.74)mm、喙肱韧带厚度为(3.30±0.54)mm,非冻结肩组RITI为7.30(6.55,8.40)mm,喙肱韧带厚度为2.40(2.15,2.80)mm,两组比较差异均有统计学意义(均P<0.05)。冻结肩组喙肱韧带迂曲12例(34.3%),肩袖间隙血流阳性11例(31.4%),非冻结肩组无喙肱韧带迂曲患者,肩袖间隙血流阳性2例,两组比较差异均有统计学意义(均P<0.05)。冻结肩患者早期组肩袖间隙血流阳性比例明显高于中晚期组(90.9%vs 4.2%),差异有统计学意义(P<0.05);RITI、喙肱韧带厚度、喙肱韧带迂曲比例比较差异均无统计学意义。ROC曲线分析显示,RITI、喙肱韧带厚度、肩袖间隙血流、喙肱韧带迂曲诊断冻结肩的曲线下面积分别为0.794、0.868、0.630、0.671,敏感性分别为0.829、0.800、0.314、0.343,特异性分别为0.838、0.811、0.946、1.000。结论应用灰阶超声和能量多普勒评价肩袖间隙有助于冻结肩的诊断,且肩袖间隙血流阳性有助于判断病程,有一定的临床应用价值。

Objective To explore the application value of ultrasonic detection of rotator interval(RI)in frozen shoulder by reviewing the gray-scale and Doppler ultrasound findings.Methods Thirty-five patients clinically diagnosed with frozen shoulder(frozen shoulder group)and 37 patients complaining discomfort in shoulders but without frozen shoulder(nonfrozen shoulder group)were selected.According to the course of the disease,frozen shoulder group were further divided into early group(≤6 months,11 cases),and relatively late group(>6 months,24 cases).Ultrasound findings between two groups,such as RI thickness index(RITI),RI blood flow,coracohumeral ligament(CHL)thickness and CHL tortuosity were analyzed and compared.Receiver operating characteristic(ROC)curve was drawn to assess the efficacy of ultrasonic indicators in diagnosing frozen shoulder.Results The RITI and CHL thickness in frozen shoulder group were(10.11±1.74)mm and(3.30±0.54)mm,and those in non-frozen shoulder group were 7.30(6.55,8.40)mm and 2.40(2.15,2.80)mm,respectively,there were significant differences(both P<0.05).Significant differences were found in CHL tortuosity(12 cases,34.3%)and RI blood flow(11 cases,31.4%)in frozen shoulder group accordingly compared with 0 and 2 cases in non-frozen shoulder group(both P<0.05).The positive rate of RI blood flow in early frozen shoulder group was significantly higher than that in middle and late frozen shoulder group(90.9%vs.4.2%),there was significant difference(P<0.05).There were no significant differences of proportion of RITI,CHL thickness and tortuosity.ROC analysis showed that the areas under the curve of RITI,CHL thickness,RI blood flow and CHL tortuosity in the diagnosis of frozen shoulder group were 0.794,0.868,0.630,0.671,respectively.Sensitivities were 0.829,0.800,0.314,0.343,respectively.Specificities were 0.838,0.811,0.946,1.000,respectively.Conclusion Grayscale ultrasound and power Doppler evaluation of rotator interval contribute to the diagnosis of frozen shoulder,and positive blood flow benefits for staging the disease.It has a definite applicable value.