肩关节常见疾病诊断演示文稿

肩关节常见疾病诊断演示文稿本文档共26页；当前第1页；编辑于星期六\15点38分（优选）肩关节常见疾病诊断本文档共26页；当前第2页；编辑于星期六\15点38分常见疾病名称Rotatorcuff

tendonsdisease肩袖肌腱病Rotatorcuff

tear肩袖撕裂Subscapularisrupture肩胛下肌断裂Acromioclavicularjointdisease肩锁关节病Thesub-acromialshoulderimpingementsyndrome肩峰下撞击综合征SLAP病变（上盂唇前后向撕裂）Bankart病变HAGL病变（盂肱下韧带肱骨部撕脱）Labrumcyst盂唇囊肿Adhesivecapsulitisjoints粘连性关节囊炎Shoulderjointosteoarthrosis肩关节骨关节病本文档共26页；当前第3页；编辑于星期六\15点38分一、Rotatorcuff

tendonsdisease肩袖肌腱病Etiologypathology病因病理：Excessiveuse,leadtodegenerationandtearofrotatorcuff过度使用导致肩袖的退行性变和撕裂Mostofteninimpingement最常继发于撞击综合征Canoccurin

patientswithcollagenvasculardisease可发生于胶原血管病患者Canbeacute,butmoreoftenrepeatedattacksonthebasisofthealreadysufferfromtendondisease可急性发生，但更常在已患有肌腱病的基础上反复发作Tendonthickening,hardening;Partialortotaldisruption;Sometearonslipperybursa,articularsurfaceorinthestroma肌腱增厚、硬化；部分或完全中断；部分撕裂可在滑囊面、关节面或间质中Collagendegeneration,butthereisnoinflammatorycells,chronictendoncanappearinfattyinfiltration胶原变性，但没有炎性细胞，慢性肌腱撕裂中可出现脂肪浸润本文档共26页；当前第4页；编辑于星期六\15点38分NEERininstallmentofrotatorcufftendonlesions肩袖肌腱病变的NEER分期Ⅰ

period:rotatorcuff,especiallyhillstendonedemaandhemorrhage肩袖特别是岗上肌腱水肿和出血Tendonitisorinflammatorylesions,itisbettertosendinlessthan25yearsoldyoungman.reversible肌腱炎或炎性病变，最好发于小于25岁的青年人,可逆.Ⅱ

period:inflammationfurtherprogressandmorefibroustissueformation炎症进一步进展及更多的纤维组织形成Happensat25～45yearsold.好发于25-45岁。Ⅲ

period:rotatorcufftear.肩袖撕裂。Oftenoccurinmorethan45yearsold.常发于45岁以上。☆Bestlocation:beingis1cm,fromthehillsmuscletothegreatertuberosityattachmentpoints(novasculardistribution).最好发部位：岗上肌距大结节附着点1cm处（无血管分布）。本文档共26页；当前第5页；编辑于星期六\15点38分MRImanifestationsofrotatorcufftendonsdisease肩袖肌腱病的MRI表现Onallpulse

sequence,signalsareincreased在所有脉冲序列上，信号均增高Tendonthickening,signalnotusuallyhomogeneous肌腱常常增厚、信号不均匀Partialtear,visiblewatersignalinthetendons,butonlypartialtendoninvolvement部分撕裂，在肌腱中可见水样信号，但只是部分肌腱受累Tendonfull-thicknesstear,liquidintotendonfractures,withvaryingdegreesoftendonretraction肌腱全层撕裂，液体进入肌腱裂隙中，伴不同程度的肌腱回缩Tendonfull-thicknesstearofthechronicpatientstomergemusclefatatrophy肌腱全层撕裂的慢性患者可合并肌肉脂性萎缩本文档共26页；当前第6页；编辑于星期六\15点38分ObliquecoronaryanormalMRIimaging

斜冠状位正常MRI造影

Thincontrastsketchbelowoutlineoftherotatorcuff(whitearrow)薄的造影剂勾画出肩袖的下面轮廓（白长箭头），Normaljointcapsule(blackarrow),正常关节囊（黑箭头），axillaryfossae(whitetrianglearrows).腋隐窝（白三角箭头）。本文档共26页；当前第7页；编辑于星期六\15点38分Fig1Subdeltoid–subacromialbursitis.肩峰下滑囊炎。CoronalobliqueMRimagesoftheshouldershowfluidinthedilatedsubdeltoid–subacromialbursa(arrowhead).常规MRI斜冠状位示肩峰下滑囊积液(箭头)；1A:SET1W;1B:TSET2W.

Fig2Acromialmorphology.肩峰形态。A.ShapeoftheAcromion.TypeI,flatⅠ型，肩峰下表面为一平面；TypeII,curvedⅡ型，肩峰下表面为弧形凹面；TypeIII,hookedⅢ型，肩峰下表面前部呈钩状突；

B.SagittalobliqueimageshowsaTypeIIacromionandadegenerativespurattheanteroinferioredgeoftheacromion(arrow).

MRI造影斜矢状位示肩峰前下缘的骨刺(箭)，Ⅱ型肩峰

本文档共26页；当前第8页；编辑于星期六\15点38分Fig3Tendinitis.肩袖变性。

CoronalobliqueMRimagesoftheshouldershowthesupraspinatustendonisdiffusethickening,withintrasubstanceintermediatesignalonT1-weightedandT2-weightedMRimages(arrow).常规MRI斜冠状位示冈上肌腱增粗，连续性好，T1W和T2W信号均增高(箭)本文档共26页；当前第9页；编辑于星期六\15点38分4AFig4:Bursal-sidedpartialthicknesstearofthesubscapularis.冈上肌腱上表面部分撕裂.4A:ObliquecoronalT2-weightedimageshowspartialdisruptureofthebursal-sidedtendonfibers(arrow).Thearticular-sidedfibersareintact.

常规MRI斜冠状位FST2W示冈上肌腱止点处上表面部分撕裂，局部见液性高信号(箭)，伴肩峰下滑囊积液，下表面完整.4B:partialthicknesstearofthesubscapularis.ObliquecoronalT2-weightedMRimageshowspartialdiscontinuityofthearticular-sidedtendonfibers(arrow).Thebursal-sidedfibersareintact.冈上肌腱下表面部分撕裂。常规MRI斜冠状位FST2W示冈上肌腱止点处下表面撕裂(箭)，信号增高，但上表面完整4B本文档共26页；当前第10页；编辑于星期六\15点38分4C4DFig4C:Intratendinouspartialthicknesstearofthesubscapularis.

冈上肌腱腱内部分撕裂。ObliquecoronalT2-weightedMRimageshowsabnormalintratendinousfluidaccumulation(arrows).Thebursal-sidedandarticular-sidedfibersareintact常规MRI斜冠状位FST2W示冈上肌腱止点处腱内限局液性高信号影(箭)，肌腱上下表面均完整.Fig4D:Articular-sidedpartialthicknesstearofthesubscapularis.冈上肌腱下表面部分撕裂。ObliquecoronalT1-weightedMRarthrographicimageshowspartialdiscontinuityofthearticular-sidedfibers(arrows),withcontrastmaterialleakingintothesubstanceofthetendon,andintactbursal-sidedfibers.MRI造影斜冠状位示高信号对比剂进入冈上肌腱下表面(箭)，但未进入肩峰下滑囊本文档共26页；当前第11页；编辑于星期六\15点38分Fig5:DifferentMRItechniquesforlabraltear.盂唇撕裂对比。

Fig5A:AnaxialroutineMRimageshowsintactanteroinferiorlabrum.常规MRI轴位示盂唇未见撕裂征象；Fig5B:AnaxialMRarthrographicimagedemonstratestearoftheanteroinferiorlabrum(arrow).MRI造影轴位示前方盂唇撕裂(箭)5A5B本文档共26页；当前第12页；编辑于星期六\15点38分54,M,Therightobliquecoronary:partofthejointsurfaceandtheslipperybursasurfaceoftheRotatorcuffistorn右侧斜冠状位示肩袖的关节面和滑囊面部分撕裂PDWIT2WIMRarthrogramPDWI（质子加权像）：supraspinatustendonobviouslyobviouslyirregular(longarrow);岗上肌肌腱明显不规则（长箭头所示）；T2WI：foundsimilarsignal,inlinewiththetearoftheparts(longarrow);发现相似信号符合部分撕裂（长箭头所示）；MRarthrogram（关节造影）：contrastagentintotheshouldersleevematerial,butnotfallingdowntotheshoulderpeakcapsule(arrow),inaddition,asmallpartofcontrastagents,insertedneartheshouldersleeve(longarrow).造影剂进入肩袖实质内，但未沿伸到肩峰下滑囊（三角箭头所示），另外一小部分相连的造影剂插入邻近肩袖（长箭头所示）。本文档共26页；当前第13页；编辑于星期六\15点38分58Y，M，Theleftobliquecoronaryinrotatorcufffull-thicknesstear

左侧斜冠状位示肩袖全层撕裂PDWIT2WIMRarthrogramPDWI：

rotatorcuffessence,lackoflimitations(longarrow);肩袖实质局限性缺失（长箭头所示）；T2WI：tearmouthincreasedsignal(longarrow);撕裂口信号增高（长箭头所示）；MRarthrogram：contrastfillinggapsofrotatorcuff(longarrow),undertheshoulderpeak-deltoidincapsule(arrow).造影剂充填肩袖缺口（长箭头所示）、肩峰下-三角肌下滑囊（三角箭头所示）。本文档共26页；当前第14页；编辑于星期六\15点38分Thedifferentialdiagnosisoftendondisease肌腱病的鉴别诊断Calcificationfeaturestendonitis钙化性肌腱炎：tendonthickening,andoftenaccompaniedbysignaldecreases肌腱可增厚，并常伴有信号减低Withinthetendoncyst肌腱内囊肿：tendonthickening,andonT2WItumorcystwithpartialrotatorcufftear肌腱增厚，且在T2WI上见囊肿合并部分肩袖撕裂本文档共26页；当前第15页；编辑于星期六\15点38分二、Rotatorcuff

tear肩袖撕裂Intendonfissure,visibleinjointfluid,slipperybursaliquidfillingorgranulationtissue,ontheFSET2WIorSPAIRsequencesismostclear在肌腱裂隙中可见充以关节液、滑囊液或肉芽组织，在FSET2WISPAIR序列中最清晰Tendonedgesappeardifferentdegreeofcontractionanddegeneration肌腱边缘出现不同程度的收缩和退行性变Inpatientswithchronictendonfull-thicknesstearcanincorporatethefatofmuscleatrophy慢性患者的肌腱全层撕裂可合并肌肉的脂性萎缩Mergerofsynovialsaceffusionundertheshoulderpeak合并肩峰下滑囊积液Occurbetweenthefrontofthehillsmuscletearorrotatorcufftear,easytomergesynovialsaceffusionunderbeak有岗上肌前方撕裂和肩袖间撕裂时易合并喙下滑囊积液本文档共26页；当前第16页；编辑于星期六\15点38分

Suspiciouspatientswithrotatorcufftear,imagingexamination,shouldbeacomprehensiveobservationofrotatorcuffandthesurroundingstructure可疑肩袖撕裂的病人行影像学检查时需对肩袖及其周围结构作全面观察:Notethattearmouthsize,affectedthescope,edgecases,muscleatrophyandbonechangeandsoon.注意撕裂口大小、肌腱受累范围、肌腱边缘情况、肌肉萎缩及骨骼改变等。Partialtendonaccordingtotearthicknessordepthintothreedegrees.部分性肌腱撕裂可按撕裂厚度或深度分三度。Ⅰ度：﹤3mm；Ⅱ度：3-6mm；Ⅲ度：﹥6mm。Completeatendon,accordingtothegapsizeisdividedintofourcategories完全性肌腱撕裂据裂口大小分四类。﹤2mmMildtear轻度撕裂；2-4Moderatetear中度撕裂；

4-5mmSeveretear重度撕裂；﹥5mmGianttear巨型撕裂。本文档共26页；当前第17页；编辑于星期六\15点38分TheMRIclassificationofRotatorcufftear(Neer)肩袖撕裂的MRI分级（Neer）0：Normally,auniformlowsignal正常，呈均匀一致的低信号1：Rotatorcuffnormalform,onT1WIorPDWIsequencesshoweddiffuseorlinearhighsignal肩袖形态正常，T1WI或PDWI上呈弥漫性或线状高信号2：Shouldersleeve,isthinningorirregular,andhashighsignalonT1WIorPDWIsequences肩袖变薄或不规则，T1WI或PDWI上呈高信号3：Rotatorcuff

signalonT2WIsequenceincreasedandaffectedtendonlayerT2WI上肩袖信号增高且累及肌腱全层本文档共26页；当前第18页；编辑于星期六\15点38分Carrino,thinkrotatorcufftearisdividedintosevendegrees肩袖撕裂分7级:0级：Tendonisnormal肌腱正常；1级：Tendon(T1WIsignalorPDWI)increased,theattachmentpointsabout1cm距附着点1cm肌腱信号（T1WI或PDWI）增高；2级：Tendonitis,increasedsignalonT2WI,butnotinvolvingthetopoftheshoulderjoint(withNeer2degree)肌腱炎，T2WI上信号增高，但未累及肩关节上面（同Neer2级）；3级：Degeneration,oneormorehighsignalonT2WI,andthereisnoenoughtothetornpartofdiagnosticcriteria退行性变，T2WI上一个或多个高信号区，未达部分撕裂诊断标准；4级：Partoftear,onT2WIsequence,tendonsignalincreasedobviously,andaffectedtendonaboveorbelow部分撕裂，T2WI上肌腱信号明星增高，且累及肌腱上下面；5级：Tendonnearfull-thicknessrupture,butwithalittlemusclefibercomplete肌腱近乎全层断裂，但有少许肌纤维完整；6级：Tendonfull-thicknessrupture,withouttendoncontracture肌腱全层断裂，无肌腱挛缩；7级：Tendonfull-thicknessrupturewithtendoncontracture.肌腱全层断裂伴肌腱挛缩。本文档共26页；当前第19页；编辑于星期六\15点38分Obliquecoronary

斜冠状位Tendonitis肌腱炎（1级）TIWITIWIT2WIRotatorcuff

tear肩袖撕裂（2级）本文档共26页；当前第20页；编辑于星期六\15点38分Fig3Fullthicknesstearofthesupraspinatus.肩袖全层撕裂。CoronalobliqueT2-weightedMRimageshowsthesupraspinatustendonbecomesthicker,withabnormalhighsignalasintenseasfluidextendingfromthearticularsurfacetothesubacromialbursasurface(arrow)常规MRI斜冠状位FST2W示冈上肌腱连续、增厚，其内部可见关节液样的高信号，累及肌腱全层(箭)Fig4Fullthicknesstearofthesupraspinatus.肩袖全层撕裂。CoronalobliqueT2-weightedMRimageshowsthecompletediscontinuityandretractionofthetendon(arrow).MRI造影斜冠状位FST2W示冈上肌腱连续性中断，断端回缩(箭)本文档共26页；当前第21页；编辑于星期六\15点38分5A5BFig5:Fullthicknesstearofthesupraspinatus.肩袖全层撕裂。A：Fig6A:CoronalobliqueT1-weightedMRarthrographicimageshowsthecompletediscontinuityandretractionofthesupraspinatustendon(arrow),atrophyofthesupraspinatus,andupwarddisplacementofthehumeralhead.MRI造影斜冠状位，示冈腱连续性中断，断端(箭)回缩，同时伴有肌腱萎缩、肱骨头上移；B:SagittalobliqueT1-weightedMRarthrographicimageshowsthediscontinuityoftherotatorcuffandthepresenceofhighsignalcontrastmaterialwithinthesubacromialbursa(arrow).MRI造影斜矢状位，示肩袖不完整，撕裂累及冈上肌腱和冈下肌腱，肩峰下滑囊内(箭)可见高信号对比剂本文档共26页；当前第22页；编辑于星期六\15点38分三、Subscapularisrupture肩胛下肌断裂Patientswithsecondarytoanteriordislocationofshoulderjoint,typicallymorethan40years继发于肩关节前脱位，患者一般大于40岁Secondarytotherearoftheshoulderjointdislocation,visibleatanyage继发于肩关节后脱位，可见于任何年龄Tendonsignaluneven;Tendoninseewatersignal;Differentdegreeoftendonretraction.肌腱信号不均匀；肌腱中见水样信号；不同程度肌腱回缩。Plainradiographs,showsthehumerussmalltuberclefracture平片可见肱骨小结节骨折