摘要
目的探讨高频超声多个指标在肩关节僵硬诊断中的应用价值,为肩关节僵硬的诊断和治疗提供数据支持和理论基础。方法回顾性分析2023年1月至12月河北医科大学第三医院肩肘专科收治的单侧肩痛伴活动受限患者261例的临床资料,以肩关节镜检查结果为金标准,将患者分为肩关节僵硬患者(观察组)127例,非肩关节僵硬肩痛者(对照组)134例。观察并测量两组肱二头肌长头腱(LHBT)腱鞘积液、肩袖间隙(RI)回声及血流信号、喙肱韧带(CHL)厚度、肩峰下-三角肌下滑囊(SASD)增厚、积液及血流信号、盂肱关节(PJ)积液、盂肱关节下方关节囊(ICT)厚度、盂肱下韧带(IGHL)厚度,并计算患侧与对侧CHL差值、ICT差值及IGHL差值,对两组超声指标进行差异性比较及多因素logistic逐步回归分析,绘制ROC曲线评估各指标对肩关节僵硬的诊断价值。结果观察组RI低回声并血流信号增多、SASD增厚、SASD积液、SASD血流信号检出率及IGHL厚度、IGHL差值、ICT差值显著高于对照组(均P<0.05)。多因素logistic逐步回归分析显示SASD增厚、SASD积液、IGHL差值为肩关节僵硬的独立预测因子(均P<0.05)。SASD增厚、SASD积液、IGHL差值单独诊断肩关节僵硬的曲线下面积分别为0.550、0.540、0.636,诊断灵敏度分别为89.8%、10.2%、60.6%,特异度分别为20.1%、97.8%、67.2%;3项指标联合应用的曲线下面积为0.676,诊断灵敏度为59.8%,特异度为75.4%。结论高频超声是辅助临床诊断肩关节僵硬的有效影像学方法,SASD增厚、SASD积液、IGHL差值可能是肩关节僵硬的独立预测因子,3项指标联合应用具有更高的临床应用价值,为临床鉴别诊断肩关节僵硬提供了有利的超声指标。
Objective To explore the application value of multiple indexes of high-frequency ultrasound in the diagnosis of shoulder stiffness,and to provide data support and theoretical basis for the diagnosis and treatment of shoulder stffness.Methods Clinical data of 261 patients with unilateral shoulder pain with limited mobility admitted to the Orthopedic Trauma,Hebei Medical University Third Hospital from January to December 2023 were retrospectively analyzed.With the results of shoulder arthroscopy as the gold standard,the patients were divided into 127 patients with shoulder stiffness(observation group)and 134 patients with non-shoulder stffness and shoulder pain(control group).The fluid accumulation of long head of the biceps tendon(LHBT),echo of rotator interval(RI)and blood flow signal,thickness of coracohumeral ligament(CHL),thickness of subacromial-subdeltoid bursa(SASD),fluid accumulation and blood flow signal,fluid accumulation of posterior glenohumeral joint capsule(PJ),the inferior capsule thickness(ICT)and the thickness of inferior glenohumeral ligament(ICHL)were observed and measured in the two groups in addition,the CHL difference,ICT difference and ICHL difference between the affected side and the contralateral side were calculated,and the difference between the two groups of ultrasound indicators was compared and the multivariate logistic stepwise regression analysis was performed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of each indicator for shoulder stiffness.Results RI hypoecho with increased blood flow signal,SASD thickening,SASD effusion,SASD blood flow significantly higher than those in the control group(all P<0.05).Multivariate logistic stepwise regression analysis showed that SASD thickening,SASD effusion and IGHL difference were independent predictors of shoulder stiffness(all P<0.05).The area under the curve of SASD thickening,SASD effusion and IGHL difference in the diagnosis of shoulder stiffness were 0.550,0.540 and 0.636,respectively.Th
作者
朱雅茹
陆博
叶辉
米亚儒
宋天格
邓荷萍
Zhu Yaru;Lu Bo;Ye Hui;Mi Yaru;Song Tiange;Deng Heping(Department of Ultrasonography,Hebei Medical University Third Hospital,Shijiazhuang 050051,China;Department of Orthopedic Trauma,Hebei Medical University Third Hospital,Shijiazhuang 050051,China)
出处
《中国医师杂志》
CAS
2024年第10期1464-1469,共6页
Journal of Chinese Physician
关键词
超声检查
肩关节僵硬
关节囊
盂肱下韧带
Ultrasonography
Shoulder stiffness
Joint capsule
Inferior glenohumeral ligament
