CT双重对比关节造影术在诊断复发性肩关节前脱位中的作用

The diagnostic value of CT double-contrast arthrography in recurrent anterior glenohumeral dislocation

目的探讨CT双重对比关节造影术(CTdouble-contrastarthrography,CTA)在诊断复发性肩关节前脱位中的作用,评价其敏感性和准确性。方法自1990年3月～2003年5月共治疗31例复发性肩关节前脱位患者,男23例,女8例;年龄22～46岁,平均26.7岁。术前均行CTA检查,并将检查结果与关节镜或开放手术所见进行比较。结果盂唇和关节囊韧带复合体的损伤是复发性肩关节前脱位最常见的病理变化,手术发现31例中28例有关节盂唇病变,CTA发现26例(敏感度为92.8%,准确率为93.5%),表现为盂唇撕裂、分离和退变;术中发现20例有关节囊病变,CTA发现19例(敏感度为95%,准确率为87.1%),表现为关节囊肩盂起点的内移、剥脱,肩胛骨边缘的软组织撕裂或消失;7例(4例经手术证实)肩胛下肌及其肌腱的异常,表现为撕裂、变薄及不规则;15例Hill-Sachs缺损,全部与手术所见一致。CTA的总诊断准确率为83.8%。结论CTA可全面准确地显示出复发性肩关节前脱位的病理改变,从而指导治疗方案的选择。

Objective To determine the sensitivity and accuracy of CT do ub le-contrast arthrography (CTA) in detecting underlying soft-tissue and bony abno rmalities of recurrent anterior glenohumeral dislocations. Methods From March 19 90 to May 2003, 31 patients with the signs and symptoms of recurrent anterior in stability, which were 23 males and 8 females with an average age of 26.7 years ( ranging, 22 to 46 years), were recruited for the study. All patients suffered fr om more than three times of glenohumeral dislocations, underwent CT arthrography after intraarticular injection of air and radiographic contrast medium before o peration. The surgical procedures included open Bristow operation in 25, Bankart operation in 3, Putti-Platt operation in 2, and a combination of Bankart and ca psular tightness operation by arthroscopy in 1. Each patient also underwent arth roscopy or open surgery and the observations were compared with CTA. Results Les ions of labrum and capsulo-ligamentous complex were the two most common abnormal ities demonstrated by surgical findings, which were respectively found in 28 and 20 patients at surgery. Anterior glenoid labral abnormalities, including of tea r, detachment, degeneration, were detected on CTA in 26 of 28, 2 of glenoid labr al degeneration were undetected on CTA, and the accuracy rate diagnosis on CTA w as 93.5%, while the sensitivity of CTA was 92.8%. Capsular lesions, including of marked medial scapular insertion, glenoid marginal stripping, and loss of inter vening scapular marginal soft tissues, were detected on CTA in 19 of 20, 1 of ca psular glenoid marginal stripping was undetected on CTA, and the accuracy rate d iagnosis on CTA was 87.1%, while, the sensitivity of CTA was 95%. Subscapularis tendon abnormalities, including of tears and irregularities, were visualized in 7 cases on CTA, but only 4 of which were identified during surgery. Furthermore, all of 15 Hill-Sachs defects, 6 Bankart bony defects, and 1 rupture of supraspi natus tendon suggested by CTA, were identified during surgery. For 26 of the pat ients with above kinds of lesion resulting in recurrent anterior glenohumeral di slocation, the accuracy rate of diagnosis was 83.7%. Conclusion The utilization of CT double-contrast arthrography can improve the understanding of multiple les ions associated with recurrent shoulder dislocation, it is contributed to select proper operative procedure.