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磁共振成像、关节造影和超声检查的结果能否反映特发性肩周炎患者的临床损伤情况?

Do the Findings of Magnetic Resonance Imaging, Arthrography, and Ultrasonography Reflect Clinical Impairment in Patients With Idiopathic Adhesive Capsulitis of the Shoulder?

作者信息

Park Gi-Young, Park Jung Hyun, Kwon Dong Rak, Kwon Dae Gil, Park Jinyoung

机构信息

Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Arch Phys Med Rehabil. 2017 Oct;98(10):1995-2001. doi: 10.1016/j.apmr.2017.06.006. Epub 2017 Jul 4.

Abstract

OBJECTIVE

To investigate the correlation between arthrography, magnetic resonance imaging (MRI), and ultrasonography (US) findings in patients with idiopathic adhesive capsulitis (IAC) of the shoulder and their clinical presentation as well as functional impairment.

DESIGN

Cross-sectional observational study.

SETTING

Institutional practice.

PARTICIPANTS

Patients (N=75) with a clinical diagnosis of unilateral IAC.

INTERVENTIONS

Contrast-enhanced MRI, single-contrast arthrography, and US were performed in all patients.

MAIN OUTCOME MEASURES

The thickness of the axillary recess, coracohumeral ligament (CHL), and enhanced portion in the rotator cuff interval was measured using MRI. Arthrography was used to calculate the total score of shoulder arthrographic criteria. US was used to measure the thickness of the inferior glenohumeral ligament (IGHL) and CHL, and the IGHL ratio and CHL ratio were calculated by comparing those of the unaffected side.

RESULTS

None of the MRI parameters was correlated with clinical assessment scores. The total score of shoulder arthrographic criteria was negatively correlated with passive range of motion of the total shoulder motion (P<.05), shoulder forward flexion (P<.05), and abduction (P<.05). The total Constant-Murley score was well correlated with the total score of shoulder arthrographic criteria (P<.05). The total shoulder joint space capacity was positively correlated with passive range of motion of the total shoulder motion (P<.05) and shoulder forward flexion (P<.05). The IGHL thickness, IGHL ratio, CHL thickness, and CHL ratio were negatively correlated with shoulder external rotation (P<.05).

CONCLUSIONS

The findings of arthrography and US in patients with IAC of the shoulder were correlated with clinical assessment scores, whereas all measuring parameters on MRI were not. US is recommended as the preferred option for diagnosing IAC of the shoulder because it is noninvasive, reflects the clinical features of IAC, and provides anatomical accuracy.

摘要

目的

探讨肩关节特发性粘连性关节囊炎(IAC)患者的关节造影、磁共振成像(MRI)及超声检查(US)结果与临床表现及功能障碍之间的相关性。

设计

横断面观察性研究。

地点

机构性医疗实践。

参与者

临床诊断为单侧IAC的患者(N = 75)。

干预措施

所有患者均接受了对比增强MRI、单对比关节造影及超声检查。

主要观察指标

使用MRI测量腋窝隐窝、喙肱韧带(CHL)及肩袖间隙强化部分的厚度。关节造影用于计算肩关节造影标准的总分。超声用于测量下盂肱韧带(IGHL)及CHL的厚度,并通过与未受影响侧比较计算IGHL比率和CHL比率。

结果

MRI参数均与临床评估评分无相关性。肩关节造影标准总分与全肩关节活动度的被动活动范围(P <.05)、肩关节前屈(P <.05)及外展(P <.05)呈负相关。Constant-Murley总分与肩关节造影标准总分相关性良好(P <.05)。全肩关节间隙容量与全肩关节活动度的被动活动范围(P <.05)及肩关节前屈(P <.05)呈正相关。IGHL厚度、IGHL比率、CHL厚度及CHL比率与肩关节外旋呈负相关(P <.05)。

结论

肩关节IAC患者的关节造影及超声检查结果与临床评估评分相关,而MRI的所有测量参数均不相关。由于超声无创、反映IAC临床特征且提供解剖学准确性,推荐将其作为诊断肩关节IAC的首选方法。

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