放射学方法诊断肩峰下撞击综合征的信息价值

E. A. Andronnikov, V. Diomidova, Nikolai S. Nikolaev, R. N. Drandrov, N. V. Gogulina
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The authors analyzed Russian and foreign publications on anatomical, etiological, pathogenetic, clinical, diagnostic features of subacromial conflict syndrome from databases: e-library (https://www.elibrary.ru), Oxford Medicine Online (https://academic.oup.com /), PubMed (https://pubmed.ncbi.nlm.nih.gov/) and others. The applied research methods were analysis and synthesis, axiomatic method and abstraction. Results. The development of subacromial impingement syndrome was revealed to be due to the structural features of the shoulder joint, which differs from other joints in anatomical and functional complexity. 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引用次数: 0

摘要

高达30%的成年人患有严重疼痛的撞击综合征。在早期阶段很难发现这种疾病。早期诊断肩峰下间隙退行性改变的初始体征可使患者免于手术,并避免术后并发症的额外风险。本研究的目的是在分析国内外作者发表的论文的基础上,根据发病因素和肩关节的解剖结构,评价放射方法诊断肩峰下撞击综合征的信息价值。材料和方法。作者从电子图书馆(https://www.elibrary.ru)、牛津医学在线(https://academic.oup.com /)、PubMed (https://pubmed.ncbi.nlm.nih.gov/)等数据库中分析了俄罗斯和国外关于肩峰下冲突综合征的解剖学、病因学、发病机理、临床、诊断特征的出版物。应用的研究方法有分析综合法、公理法和抽象法。结果。肩峰下撞击综合征的发展是由于肩关节的结构特征,不同于其他关节的解剖和功能复杂性。此时,肩关节肩袖的变化是在多种致病因素的影响下发生的,这些致病因素可以是外部的(肩峰下间隙减小、喙峰弓体积增大、不稳定、肩关节负荷过大),也可以是内部的(血管化改变、胶原纤维微结构病变、肩袖肌腱退行性变)。等)目前对于撞击综合征早期征象和肩关节肩袖损伤的放射诊断算法尚无统一的方法。虽然x线摄影是评估肩关节状况的一种简单且信息丰富的方法,但其在撞击综合征早期的敏感性不足。磁共振成像对肩关节肩袖损伤的诊断具有很高的信息和敏感性,但也存在一些局限性,如存在一些禁忌症、费用高、检查时间长等。超声检查因其信息价值高、执行速度快、可重复性好,目前被认为是诊断撞击综合征的首选方法。结论。放射诊断方法的信息价值分析表明,在识别肩峰下撞击综合征的早期征象时,考虑到发病因素和肩关节的解剖结构,超声方法是最优和优选的;对于更复杂和有争议的病例,根据一定的适应症,它们是x射线计算机和磁共振成像的方法。在没有可能使用高科技诊断方法的情况下,进行肩关节的经典x线摄影。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
INFORMATIVE VALUE OF RADIOLOGICAL METHODS FOR DIAGNOSING SUBACROMIAL IMPINGEMENT SYNDROME
Up to 30% of the adult population suffers from impingement syndrome with severe pain. Detection of the disease in the early stages is difficult. Early diagnosis of the initial signs of degenerative changes in the subacromial space saves the patient from surgery and additional risk of postoperative complications. The aim of the study is to evaluate the informative value of radiation methods for diagnosing subacromial impingement syndrome based on the analysis of papers published by domestic and foreign authors, depending on etiopathogenetic factors and anatomical structure of the shoulder joint. Materials and methods. The authors analyzed Russian and foreign publications on anatomical, etiological, pathogenetic, clinical, diagnostic features of subacromial conflict syndrome from databases: e-library (https://www.elibrary.ru), Oxford Medicine Online (https://academic.oup.com /), PubMed (https://pubmed.ncbi.nlm.nih.gov/) and others. The applied research methods were analysis and synthesis, axiomatic method and abstraction. Results. The development of subacromial impingement syndrome was revealed to be due to the structural features of the shoulder joint, which differs from other joints in anatomical and functional complexity. At this, changes in the rotator cuff of the shoulder joint develop under the influence of various etiopathogenetic factors, which can be both external (a decrease in subacromial space, an increase in the volume of the coracoacromial arch, instability, overload of the shoulder joint) and internal (changes in vascularization, pathology of collagen fibers' microstructure, degeneration of the tendons in the rotator cuff, etc.) Currently there is no unified approach to the algorithm of radiation diagnosing the early signs of impingement syndrome and injuries to the rotator cuff of the shoulder joint. Although radiography is a simple and informative method to assess the condition of the shoulder joint, its sensitivity at an early stage of impingement syndrome is insufficient. Magnetic resonance imaging is highly informative and sensitive in the diagnosis of injuries to the rotator cuff of the shoulder joint, however, it has a number of limitations, such as the presence of some contraindications, its high cost, protracted examination time, etc. Ultrasound examination is currently considered the preferred method in the diagnosis of impingement syndrome due to its high informative value, speed of execution and the possibility of its repeatability. Conclusions. The analysis of the informative value of radiation diagnostics methods showed that in identifying the early signs of subacromial impingement syndrome, taking into account etiopathogenetic factors and the anatomical structure of the shoulder joint, the ultrasound method is optimal and preferable; for more complex and controversial cases, according to certain indications, they are the methods of X-ray computer and magnetic resonance imaging. In the absence of the possibility of using high-tech diagnostic methods, classical radiography of the shoulder joint is performed.
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