Wintzell G, Larsson H, Larsson S
Department of Orthopaedics, Uppsala University Hospital, Sweden.
Skeletal Radiol. 1998 Sep;27(9):488-94. doi: 10.1007/s002560050425.
The value of MRI for the evaluation of anterior shoulder instability can be enhanced by shoulder positions that stress the stabilising structures. The ABER position is one that has been described in combination with intra-articular gadopentetate dimeglumine arthrography. We believe that MRI in the Apprehension test position with 90 degrees abduction and maximal tolerable external rotation provides maximum tension on the anterior stabilising structures and with this technique it is sufficient to use indirect gadodiamide arthrography following intravenous injection of the contrast medium. The purpose of this study was to make a prospective comparative evaluation of the ABER and Apprehension test positions when using indirect arthrography with intravenous gadodiamide administration in shoulders with anterior instability.
Sixteen patients with persistent anterior instability after recurrent shoulder dislocations were examined in an open MRI unit (0.2 T) following 0.1 mmol/kg of intravenous gadodiamide. Oblique axial T1-weighted imaging was used for analysis. Operative findings were used for correlation.
Both the ABER and the Apprehension test position were useful techniques in detecting capsulolabral pathology and Hill-Sachs lesions. The Apprehension test position produced significantly better gadodiamide-enhanced joint fluid in the region of pathology in both the capsulolabral lesion and the Hill-Sachs lesion. It also visualised the size of the Hill-Sachs lesion significantly better than did the ABER position.
MRI examination of anterior shoulder instability in the Apprehension test position was more beneficial than examination in the ABER position in visualising capsulolabral and Hill-Sachs lesions when using indirect arthrography.
通过使肩部处于能对稳定结构施加压力的位置，可提高MRI对肩关节前向不稳的评估价值。ABER位是一种已被描述的与关节内钆喷酸葡胺关节造影相结合的体位。我们认为，在外展90度并最大程度外旋的恐惧试验体位下进行MRI检查，可使前稳定结构承受最大张力，采用该技术时，静脉注射造影剂后使用间接钆双胺关节造影就足够了。本研究的目的是对ABER位和恐惧试验体位进行前瞻性比较评估，这两种体位均用于前向不稳的肩部间接关节造影，造影剂为静脉注射钆双胺。
16例复发性肩关节脱位后存在持续性前向不稳的患者，在开放型MRI设备（0.2T）中静脉注射0.1mmol/kg钆双胺后接受检查。采用斜轴位T1加权成像进行分析。手术结果用于相关性分析。
ABER位和恐惧试验体位在检测盂唇病变和Hill-Sachs损伤方面均是有用的技术。恐惧试验体位在盂唇病变和Hill-Sachs损伤的病变区域产生的钆双胺增强关节液明显更好。它对Hill-Sachs损伤大小的显示也明显优于ABER位。
当使用间接关节造影时，在恐惧试验体位下对肩关节前向不稳进行MRI检查，在显示盂唇和Hill-Sachs损伤方面比在ABER位检查更具优势。
