肩峰下撞击综合征的MRI诊断分析

目的探讨MRI诊断肩峰下撞击综合征(SIS)的临床价值。方法对46例SIS患者临床资料及MRI表现进行回顾性分析。结果 46例均出现冈上肌肌腱损伤。MRI表现:14例为肌腱信号增高;16例为肌腱局部撕裂,肌腱表面信号异常、混杂;12为冈上肌腱钙化性肌腱炎;4例为肌腱全层撕裂,斜冠状面T2WI示冈上肌肌腱正常条带状连续性低信号中断,中断处T1WI呈中等信号,T2WI呈高信号改变。肩峰形态呈平直形6例、弧形18例及钩形22例。4例肩峰-肱骨距<5mm,为钩型肩峰伴有肩锁关节增生、赘骨形成;23例肩峰-肱骨距为5~7mm,13例肩峰-肱骨距>7~10 mm,6例肩峰-肱骨距>10~15 mm。40例患者出现肩峰下滑囊增厚或积液改变。结论 MRI能准确显示SIS患者肩袖损伤征象,亦能显示肩峰形态及肩峰下滑囊等改变,对临床诊治有一定帮助。 更多还原     

肩袖损伤合并肩峰下撞击综合征的MRI表现

目的探讨肩袖损伤合并肩峰下撞击综合征的MRI影像表现。材料与方法对33例X线片无骨折但临床怀疑肩袖损伤或肩峰下撞击综合征的患者,用1.5 T MRI机检查,观察肩袖损伤及肩峰下撞击综合征在MR上的影像特征,分析两者的相关性,并与手术结果对比,计算准确率。结果 33例中肩袖损伤20例(合并肩峰下撞击综合征10例),肩峰下撞击综合征15例(合并肩袖损伤10例)。肩袖损伤和肩峰下撞击综合征术前MR诊断准确率分别约为95.0%、71.3%。结论肩关节MRI扫描对肩袖损伤及肩峰下撞击综合征的诊断有较高的临床应用价值,肩袖损伤者中至少半数合并肩峰下撞击综合征,临床和影像应予重视。     

肩撞击综合征MRI诊断20例分析

对我们收集的肩撞击综合征MRI诊断20例分析如下。 1临床资料 1．1一般资料男12例，女8例，年龄20～68（平均46）岁。其中5例有明显外伤史。     

3.0T MRI肩撞击综合征影像征象分析

目的 探讨3.0T MRI对肩关节撞击综合征的诊断价值,并分析其影像征象及损伤机制.方法 回顾性分析30例肩撞击综合征患者的MRI表现及临床症状.结果 ①直接征象:30例MRI均显示冈上肌肌腱信号和形态的改变,其中6例冈上肌肌腱完全撕裂;13例冈上肌肌腱的部分撕裂;11例表现冈上肌肌腱表面的信号异常、混杂;②间接征象:9例肩峰下滑囊增厚、肩峰下-三角肌下囊积液及15例关节囊积液;③继发征象:5例关节盂唇撕脱,于关节造影时显示较好,5例冈上肌萎缩、2例三角肌萎缩、4例Bankart病变;④病因征象:本组患者肩峰形态分别为平直型(4/30)、弧形(7/30)、钩型(19/30);肩峰下通道(AHI)7例<5 mm,23例为5～10 mm之间.结论 高场强3.0T MRI能够有效显示肩撞击综合征的影像特征,有助于临床诊治.     

比较X线造影与MRI诊断肩撞击综合征的临床价值

目的比较X线造影与磁共振成像(MRI)对肩撞击综合征患者的临床诊断价值。方法选取2013年1月至2015年1月收治的肩撞击综合征患者142例,随机分为观察组和对照组,每组71例,观察组采用MRI进行诊断,对照组采用X线造影进行诊断,比较两组患者的诊断效果。结果观察组直接征象诊断的特异度、敏感度及诊断符合率显著高于对照组,差异有统计学意义(P<0.05);观察组继发征象诊断符合率高于对照组,差异有统计学意义(P<0.05);两组间接征象诊断比较差异未见统计学意义(P>0.05)。结论采用MRI对患者进行诊断的正确率较高,有利于促进患者早日康复。     

肩峰下撞击综合征影像学诊断研究进展

肩峰下撞击综合征（SIS ）又称肩疼痛弧综合征,是肩关节外展活动到一定范围时,肩部和上臂出现的疼痛综合征。任何引起肱骨头与喙肩穹反复摩擦、撞击的疾病均可引起SIS［1］。SIS是中老年人肩关节疼痛最常见的原因之一［2］。SIS的病理变化包括从肩峰下滑囊炎到肩袖肌腱全层撕裂的一系列变化［3］。目前,SIS已独立于肩痛类疾病,但其临床症状与肩关节周围炎、肩关节不稳、骨性关节炎等引起的肩关节慢性疼痛难以鉴别,需影像学检查为临床诊断及治疗提供依据。现将S IS影像学诊断研究进展综述如下。     

肩峰下撞击综合征的经皮超声引导下肩峰下滑囊造影表现

目的 探讨肩峰下撞击综合征（SIS）的经皮超声引导下肩峰下滑囊造影（PUSB）表现。方法 对150例经临床诊断为SIS患者行PUSB检查,动态观察造影剂在滑囊内的弥散情况及是否进入肩袖、关节腔。结果 53例造影剂在滑囊内呈线状均匀分布,诊断为单纯性肩峰下滑囊炎。97例造影剂在滑囊内分布不均匀,诊断为粘连性肩峰下滑囊炎。40例可见造影剂由滑囊进入肩袖肌腱,但未达肱骨头表面;32例可见造影剂由滑囊进入肩袖肌腱,到达肱骨头表面;78例造影剂未进入肩袖肌腱。结论 PUSB可实时动态评估肩峰下滑囊炎、滑囊粘连、肩袖损伤等情况,对SIS的诊断具有较高的应用价值。     

肩峰下撞击综合征的病因

肩峰下撞击综合征是肩部病变中最常见的形式。Neer提出 10 0 %的撞击损伤和 95 %的肩袖病理改变是肩峰与肩峰下间隙中的周围组织摩擦所致。文献对这一提法提出质疑 ,指出肩峰下撞击损伤的病因是多因素的 ,这些病因包括解剖的和力学的因素、肩袖病变、盂肱关节不稳或限制性制动处理、控制肩胛骨的肌肉失衡以及姿势因素等。本文旨在探讨可能存在的病理影响因素。     

肩关节内在撞击综合征的MRI诊断

目的 评价常规MRI和MR关节造影在诊断肩关节内在撞击综合征中的价值. 方法 回顾性分析经关节镜证实的8例肩关节内在撞击综合征患者的常规MR影像、MR关节造影检查资料. 结果 8例中常规MRI表现冈下肌肌腱异常者4例,冈上肌肌腱异常者2例,盂唇异常者3例,关节囊异常者0例,骨异常者8例;MR关节造影表现冈下肌肌腱异常者7例,冈上肌肌腱异常者4例,盂唇异常者6例,关节囊异常者4例,骨异常者8例. 结论 常规MR检查及MR关节造影对诊断肩关节内在撞击综合征具有重要价值.     

肩峰下撞击综合征发病机制、诊断及治疗的研究进展

肩峰下撞击综合征(subacromial impingement syndrome,SAIS)是肩关节病变中较为常见的疾患,对其整体了解仍有所不足.多年来,多种假设提出来描述肩峰下撞击征的发病机制,但尚未找到明确的解释.近年来,否认撞击存在的内源性机制越来越受到大众的认可;多个不同的肩峰下撞击综合征的体格检查特异性较低...     

MRI测量对坐骨股骨撞击综合征的诊断价值

目的 探讨MRI对坐骨股骨撞击综合征（IFIS）患者的诊断价值。方法 回顾性分析70例IFIS患者（IFIS组）和40名健康志愿者（对照组）的MRI资料。于轴位脂肪抑制T2WI测量坐骨股骨间隙（IFS）宽度、股方肌间隙（QFS）宽度,于轴位T1WI测量坐骨角,于冠状位T2WI测量股骨颈干角,比较2组间的差异,分析IFS宽度与其他3个指标的相关性,绘制ROC曲线,评价其对IFIS的诊断效能。对IFIS组患者股方肌水肿和脂肪浸润程度进行分级,比较不同级别间IFS宽度的差异。结果 IFIS组患者IFS宽度、QFS宽度、坐骨角及股骨颈干角分别为（11.76±2.22）mm、（8.33±2.20）mm、（132.59±1.39）°和132.70（131.18,134.13）°,与对照组比较差异均有统计学意义（P均<0.001）。IFS宽度、QFS宽度、坐骨角度及股骨颈干角诊断IFIS的ROC曲线下面积分别为1.000、0.999、0.996和0.975（P均<0.001）。IFS宽度与QFS宽度呈正相关（r=0.743,P<0.001）,与坐骨角度及股骨颈干角呈负相关（r=-0.273,P=0.022;r=-0.332,P=0.005）。IFIS组患者不同股方肌水肿、脂肪浸润分级间IFS宽度总体差异均有统计学意义（P均<0.05）。结论 IFIS患者IFS、QFS均明显狭窄;股方肌水肿及脂肪浸润是IFIS常见MRI表现。     

Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review

Gebremariam L, Hay EM, Koes BW, Huisstede BM. Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review.

Objective

To provide an evidence-based overview of the effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome.

Data Sources

The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched.

Study Selection

Two reviewers independently selected relevant systematic reviews and randomized controlled trials (RCTs).

Data Extraction

Two reviewers independently extracted data and assessed the methodologic quality.

Data Synthesis

If pooling of data was not possible, a best-evidence synthesis was used to summarize the results.

Results

One review and 5 RCTs reporting on various surgical techniques, and postsurgical interventions were included. Moderate evidence was found in favor of adding platelet-leukocyte gel versus open subacromial decompression. No evidence was found for the superiority of subacromial decompression versus conservative treatment in the short, mid, and long term or in favor of 1 surgical technique when compared with another. Limited evidence was found in favor of early activation after arthroscopic decompression in the short and long term.

Conclusions

This review shows that there is no evidence that surgical treatment is superior to conservative treatment or that1 particular surgical technique is superior to another. Because of possibly lower risks for complications, conservative treatment may be preferred. When choosing for surgery, arthroscopic decompression may be preferred because of the less invasive character of the procedure.     

关节镜下肩峰成形术治疗肩峰下撞击综合征

目的探讨关节镜下肩峰成形术治疗肩峰下撞击综合征的方法和效果。方法分析应用关节镜行肩峰成形术治疗68例经保守治疗无效的2期肩峰下撞击综合征的情况。随访12个月以上纳入分析。采用洛杉矶加洲大学（UCLA）肩关节功能标准评价疗效。结果平均随访16．4个月，术后3-24个月有持续的症状和功能的改善，UCLA评分从术前18．3分改善到31．7分，优良率为89．7％。结论关节镜能明确诊断，镜下肩峰成形术治疗肩峰下撞击综合征能达到减压要求，效果良好。早期、持久地术后锻炼是康复的保证。     

MRI诊断Herlyn-Werner-Wunderlich综合征

目的 探讨MRI诊断Herlyn-Werner-Wunderlich综合征（HWWS）的价值。方法 回顾性分析10例经手术及病理证实为HWWS患者的MR平扫及增强扫描特征,并对其进行分型。结果 10例患者中,Ⅰ型4例,Ⅱ型3例,Ⅲ型3例。10例患者均合并斜隔侧肾脏缺如。8例为双子宫、双宫颈,2例为完全纵隔子宫。Ⅰ型阴道斜隔完整,隔后腔和同侧宫腔积血;Ⅱ型阴道斜隔瘘口形成,隔后腔与主阴道腔相通;Ⅲ型阴道斜隔完整,无斜隔侧宫颈壁瘘管形成,隔后腔与主阴道腔相通。10例患者中,8例患者术后预后良好;1例患者术后经期腹痛明显,复查MRI提示右侧卵巢子宫内膜异位囊肿;1例患者术后突发下腹痛,复查MRI提示盆腔炎症。结论 MRI可明确诊断HWWS并对其分型,为临床诊疗提供有价值的信息。     

Comparison of the effect of two different types of dry-needling techniques on subacromial impingement syndrome

IntroductionInfraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined.Designrandomized controlled clinical trial, single-blind study.MethodSixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups.InterventionsIn 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy.Main outcome measure(s)Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured.ResultsThe findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups.ConclusionPain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction.