肩袖钙化性肌腱炎的影像学表现及与VAS评分的相关性研究

The Imaging Findingsof Rotator Cuff Calcified Tendinitis and its Correlation with VAS Score.

目的探讨肩袖钙化性肌腱炎的影像学表现及与VAS评分的相关性。方法回顾性收集39例经临床及影像学检查诊断为肩袖钙化性肌腱炎的患者,分析其X线及MRI表现,并分析钙化灶大小、位置及影像学分型与VAS评分的相关性。结果39例钙化灶均为单发,长径0.3~3.1 cm,平均长径(1.42±0.10)cm。84.6%钙化灶位于冈上肌肌腱,7.7%位于冈下肌肌腱,5.1%位于小圆肌肌腱,2.6%位于肩胛下肌肌腱;所有钙化灶均位于肌腱止点区内;79.5%钙化灶位于肌腱滑囊面,20.5%位于肌腱内。符合I型影像学类型的有19例,Ⅱ型8例,Ⅲ型12例。MRI图像各序列均显示钙化灶为低信号。39例患者均有肩关节退变、滑囊积液,其中3例合伴粘连性关节囊炎,6例合伴肩袖撕裂。钙化灶长径与VAS评分无明显相关性(r=-0.20,P=0.22)。滑囊组与肌腱组的VAS评分差异无统计学意义(Z=-1.66,P=0.09)。不同影像学分型钙化灶的VAS评分分布不全相同(H=18.97,P<0.05),其中Ⅰ型与Ⅲ型、Ⅱ型与Ⅲ型的VAS评分差异均有统计学意义(Z=-4.09、Z=-3.29,P均<0.05),Ⅰ型与Ⅱ型的VAS评分差异无统计学意义(Z=-0.44,P=0.66),钙化灶的影像学分型与VAS评分呈中度正相关(r=0.64,P=0.00)。结论Ⅲ型钙化性肌腱炎的临床疼痛程度较Ⅰ型与Ⅱ型重,影像学分型与VAS评分具有相关性,通过钙化灶的形态学特点可以预测患者的病程发展过程。

Objective To explore the imaging manifestation of calcified tendinitis of the rotator cuff and its correlation with VAS score.Methods 39 patients with calcified tendinitis of rotator cuff diagnosed by clinical and imaging examinations were retrospectively collected,and their X-ray and MRI manifestations were analyzed,and the correlation between the size,location and image classification of calcified lesions and the VAS score was analyzed.Results All 39 cases of calcification were single,with a length of 0.3 cm to 3.1 cm and an average length of(1.42±0.10)cm.84.6%of the calcifications located in the supraspinatus tendon,7.7%in the subspinatus tendon,5.1%in the teres minor tendon,and 2.6%in the subscapularis tendon.All calcification located in the tendon insertion area.79.5%of calcification was on the surface of the tendon bursa,and 20.5%in the deep layer of the tendon.There were 19 cases of type I imaging,8 cases of type II,and 12 cases of type III.All sequences of MRI images showed low signal of calcification.All 39 patients had shoulder joint degeneration and synovial effusion,including 3 cases with adhesive capsulitis and 6 cases with rotator cuff tear.There was no significant correlation between the length of the calcification and VAS score(r=-0.20,P=0.22).There was also no significant difference in VAS score between the bursa group and the tendon group(Z=-1.66,P=0.09).The distribution of VAS scores of calcification lesions of different imaging types was not the same(H=18.97,P<0.05),among which,the VAS scores of type I and type III,type II and type III had statistical significance(Z=-4.09,Z=-3.29,P<0.05),and the VAS scores of type I and type II showed no statistical significance(Z=-0.44,P=0.66).The imaging classification of calcification was positively correlated with VAS score(r=0.64,P=0.00).Conclusions The degree of clinical pain in type III calcified tendinitis is more severe than that in type I and type II.Imaging scores are correlated with VAS scores,and morphological characteristics of calcification foci can predict the course of the disease.