肌骨超声在肩峰下滑囊炎诊断及疗效评估中的应用观察

Application of musculoskeletal ultrasound in diagnosis and efficacy evaluation of subacromial bursitis

目的探究肌骨超声在肩峰下滑囊炎(subacromial bursitis,SAB)诊断及疗效评估中的应用价值,为临床提供更多参考。方法选取濮阳市油田总医院2018年7月到2023年7月收治的肩痛患者80例(92个肩关节),入院后均接受X线及肌骨超声检查,以临床诊断为“金标准”分析X线及肌骨超声对SAB的诊断价值,确诊SAB患者经超声引导下穿刺药物注射治疗4周,比较SAB患者治疗前后的肌骨超声定量参数[(肩峰-三角肌下滑囊(subacromial-subdeltoid bursa,SA-SD)壁厚度、积液最大深度)]、肩关节功能量表评分(CMS),分析肌骨超声定量参数与CMS评分的相关性。结果80例(92个肩关节)患者中,经临床诊断为SAB患者43例(47个肩关节);肌骨超声与X线诊断SAB的Kappa值分别为0.804和0.522;肌骨超声诊断SAB的敏感度、准确率及阴性预测值分别为93.62%、90.22%及92.86%,均高于X线的76.60%、76.09%及75.56%(P<0.05);SAB患者治疗4周后的SA-SD厚度薄于治疗前,积液最大深度小于治疗前(P<0.05);SAB患者治疗4周后的肩关节疼痛、日常活动能力、肩关节主动活动度、肌力及CMS总评分均高于治疗前(P<0.05);SAB患者治疗前后的SA-SD厚度及积液最大深度均与肩关节疼痛、日常活动能力、肩关节主动活动度、肌力及CMS总评分呈负相关(P<0.05)。结论肌骨超声在SAB诊断及疗效评分方面均有较好的价值,肌骨超声定量参数可以反映SAB患者肩关节功能及疼痛情况。

Objective To explore the application value of musculoskeletal ultrasound in the diagnosis and efficacy evaluation of subacromial bursitis(SAB)and provide more reference for clinical practice.Methods Totally 80 patients(92 shoulder joints)with shoulder pain in the Puyang Oilfield General Hospital from July 2018 to July 2023 were selected and received X-ray and musculoskeletal ultrasound examination after admission.The clinical diagnosis was taken as the"gold standard"to analyze the diagnostic value of X-ray and musculoskeletal ultrasound on SAB.The patients diagnosed with SAB were treated with ultrasound-guided puncture drug injection for 4 weeks.The quantitative parameters of musculoskeletal ultrasound[subacromial-subdeltoid bursa(SA-SD)wall thickness,maximum depth of effusion]and shoulder function scale score(constant-murley score,CMS)were compared among patients with SAB before and after treatment,and the correlation between quantitative parameters of musculoskeletal ultrasound and CMS scores was analyzed.Results Among 80 patients(92 shoulder joints),43 patients(47 shoulder joints)were clinically diagnosed as SAB.The Kappa values of musculoskeletal ultrasound and X-ray for the diagnosis of SAB were 0.804 and 0.522,respectively.The sensitivity,accuracy rate and negative predictive value of musculoskeletal ultrasound in the diagnosis of SAB were 93.62%,90.22%and 92.86%,which were higher than 76.60%,76.09%and 75.56%of X-ray(P<0.05).After 4 weeks of treatment,the SA-SD thickness of SAB patients was thinner than that before treatment,and the maximum depth of effusion was lower than that before treatment(P<0.05).The scores of shoulder pain,daily activity ability,active range of motion of shoulder joint and muscle strength and total score of CMS of SAB patients after 4 weeks of treatment were higher than those before treatment(P<0.05).The SA-SD thickness and maximum depth of effusion in SAB patients before and after treatment were negatively correlated with shoulder pain,daily activity ability,active range of motion of shoulder joint,muscle strength and total score of CMS(P<0.05).Conclusion Musculoskeletal ultrasound has a good value in the diagnosis and efficacy evaluation of SAB.The quantitative parameters of musculoskeletal ultrasound can reflect the shoulder function and pain in SAB patients.