MRI 评估不同时段创伤性肩关节前脱位患者 关节内结构异常的价值

Value of MRI in evaluating intra-articular structural abnormalities in patients with traumatic anterior dislocation of shoulder at different time points

摘要:

目的 对MRI 检查创伤性肩关节前脱位患者不同时段的关节内结构异常进行比较。方法 回顾 性分析2014 年6 月—2018 年12 月在沧州市人民医院医专院区经临床和放射学证实为原发性肩关节前脱位的 89 例患者的临床资料，从最初脱位事件至行MRI 检查分为<6 个月组44 例和≥ 6 个月组45 例。MRI 评估 软组织损伤，包括上唇、囊膜、肩袖和软组织损伤严重程度，以及骨缺失。结果 ≥ 6 个月组关节内异常程 度较<6个月组更严重（P <0.05）；≥6个月组肩胛盂缘上唇自前向后撕脱（57.8% VS 34.1%）和软组织损伤（73.3% VS 27.3%）较<6 个月组比例更大（P <0.05）。<6 个月组软组织损伤轻、中及重度分别为18.2%、6.8% 及 2.3% ；而≥ 6 个月组软骨损伤轻、中及重度分别为37.8%、31.1% 及4.4%。此外，≥ 6 个月组较<6 个月组出 现更多的肩关节脱位复发（P <0.05）；<6 个月组肩袖撕裂（50.0% VS 24.4%）和关节囊撕裂（25.0% VS 8.8%） 比例高于≥ 6 个月组（P <0.05）。结论 从初次肩关节前脱位事件开始≥ 6 个月进行MRI 检查的患者，其肩 关节脱位事件复发率增加，关节内异常发生率和严重程度也更高。

Abstract:

Objective To compare intra-articular structural abnormalities in patients with traumatic anterior dislocation of shoulder by MRI at different time intervals. Methods We performed a retrospective review of 89 patients from our hospital with clinically and radiographically confirmed primary traumatic anterior shoulder dislocations. Patients were divided into 2 groups: those undergoing MRI less than 6 months (n = 44) or more than 6 months (n = 45) from the initial dislocation event. The MRI assessment evaluated soft tissue injuries, including the labrum, capsule, rotator cuff, cartilage damage severity and bone loss. Results The >6 months group demonstrated a greater degree of intra-articular abnormalities compared to the <6 months group (P < 0.05). A greater percentage of superior labral anterior-posterior (SLAP) tears (57.8% VS 34.1%, respectively) and cartilage damage (73.3% VS 27.3%, respectively) was present in the >6 months group compared to the <6 months group (P < 0.05). Mild, moderate and severe cartilage damage was 18.2% , 6.8% and 2.3% in the <6 months group as compared to 37.8%, 31.1%, and 4.4% in the >6 months group, respectively. Additionally, more recurrent shoulder dislocations were seen in the >6 months group compared to the<6 months group (P < 0.05). In the <6 months group, there were more rotator cuff tears (50.0% VS 24.4%, respectively) and capsular tears (25.0% VS 8.8%, respectively) than those in the>6 months group (P < 0.05). Conclusions Patients who undergo MRI more than 6 months from the time of primary or initial shoulder dislocation have more recurrent shoulder instability events and demonstrate greater incidence and severity of intra-articular abnormalities.