肩峰下撞击综合征的MR定量诊断指标探讨

摘要

Objective To investigate the relationships of MR indexes such as acromio humeral intervals (AHI),lateral extension of the acromion (LEA) and inclination angle of the acromion with the subacromial impingement syndrome (SIS).Methods 151 patients underwent MRI examination of shoulder joints,they were grouped according to age,gender and location of acromion.The differences in age,gender and MR indexes were compared between SIS group and non SIS group.The distribution statuses of SIS in different groups were compared at the same time,the relationships of various MR indexes with SIS were investigated and analyzed.Results There were no statistical differences in age,location distribution,the average shortest AHI value and the thickness of the subacromial bursal effusion between SIS group and non SIS group (P ＞ 0.05).There showed statistical difference in gender between the two groups (P =0.000),and there were more males than females in both groups.The acromion exactly covered the supraspinatus tendon in 79 patients,the average value of LEA in the SIS group was greater than that in the non SIS group,and there showed statistically significant difference between the two groups (P =0.002),the Youden index of LEA was 0.40,the sensitivity was 61％ and the specificity was 79％.The inclination angle of the acromion in the SIS group was smaller than that in the non SIS group,and there was a statistically significant difference between the two groups (P =0.019),the Youden index of the inclination angle of the acromion was 0.18,the sensitivity was 62％ and the specificity was 56％.47 patients in the SIS group had subacromial bursal effusion,51 patients in the non SIS group had subacromial bursal effusion.The thickness of the subacromial bursal effusion in the SIS group was greater than the non SIS group,and there showed statistically significant difference between the two groups (P =0.002),the Youden index of the thickness of the subacromial bursal effusion was 0.34,the sensitivity was 78 ％ and the specificity was 56 ％.Conclusion LEA,the inclination angle of the acromion and the thickness of the subacromial bursal effusion can be used as quantitative MR diagnostic criteria of SIS.The LEA measured by cardiothoracic ratio is simple and easy to use.%目的 探讨最短肩肱距离(AHI)、肩峰横向延展度(LEA)、肩峰倾斜度等MR指标与肩峰下撞击综合征(SIS)之间的关系.方法 对151例患者行肩关节MRI检查,按年龄、性别以及肩峰位置进行分组,利用统计学方法比较SIS组与非SIS组年龄、性别及相关MR指标之间的差异,同时比较SIS在不同组的分布情况,处理并分析各个MR指标与SIS之间的关系.结果 年龄、位置分布、最短AHI均值以及三角肌下滑囊积液厚度在SIS组和非SIS组均无统计学差异(P＞0.05).性别在SIS组和非SIS组有统计学差异(P=0.000),2组病例均男多于女.肩峰刚好完全覆盖冈上肌腱共79例,LEA在SIS组平均值较非SIS组大,2组有统计学差异(P=0.002),LEA的约登指数为0.40,敏感度61％,特异度79％.肩峰倾斜度在SIS组较非SIS组小,2组有统计学差异(P=0.019),肩峰倾斜度的约登指数为0.18,敏感度62％,特异度56％.肩峰下滑囊积液在SIS组共47例,非SIS组共51例.肩峰下滑囊积液厚度在SIS组较非SIS组大,2组有统计学差异(P =0.002),肩峰下滑囊积液厚度约登指数为0.34,敏感度78％,特异度56％.结论 LEA、肩峰倾斜度以及肩峰下滑囊厚度可作为MR定量诊断SIS的指标,其中利用心胸比例测量工具测得LEA,简单易行.