肌骨超声诊断指南肩部.ppt
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1、肌骨超声技术指南-肩部(欧洲肌骨放射学)n nAlthough patients positioning for shoulder US varies Although patients positioning for shoulder US varies widely across different Countries and Institutions widely across different Countries and Institutions reflecting multifaceted opinions and experiences of reflecting multif
2、aceted opinions and experiences of different examiners,we strongly recommend to examine different examiners,we strongly recommend to examine the patient while seated on a revolving stool.This the patient while seated on a revolving stool.This position allows the examiner to reach the anterior,latera
3、l position allows the examiner to reach the anterior,lateral and posterior aspects of the shoulder with the probe by and posterior aspects of the shoulder with the probe by simply asking the patient to rotate on the chair.simply asking the patient to rotate on the chair.n n不同的国家和机构给病人进行肩部超声检查时所采取的体不
4、同的国家和机构给病人进行肩部超声检查时所采取的体位各不相同,体现了不同诊查者不同的观点和经验,但是,位各不相同,体现了不同诊查者不同的观点和经验,但是,我们强烈推荐让病人坐在转凳上进行检查。这个体位能够我们强烈推荐让病人坐在转凳上进行检查。这个体位能够让诊查者只要让病人转动一下凳子就能够使用探头扫查到让诊查者只要让病人转动一下凳子就能够使用探头扫查到肩的前面、侧面和后面。肩的前面、侧面和后面。n nlong head of the biceps tendonlong head of the biceps tendon二头肌腱长头二头肌腱长头Place the arm in slight int
5、ernal rotation(directed Place the arm in slight internal rotation(directed towards the towards the contralateralcontralateral knee)with the elbow knee)with the elbow flexed 90,palm up.Start by finding the long flexed 90,palm up.Start by finding the long biceps tendon in between the greater and lesse
6、r biceps tendon in between the greater and lesser tuberositiestuberosities Use short and long(more limited Use short and long(more limited utility)axis planes to examine the biceps.utility)axis planes to examine the biceps.肘部屈曲肘部屈曲9090,手臂轻度内旋(指向对侧膝部),手臂轻度内旋(指向对侧膝部),掌心向上。先在大、小结节之间找到肱二头肌长掌心向上。先在大、小结节之
7、间找到肱二头肌长头腱,采用短轴和长轴(作用有限)切面检查二头腱,采用短轴和长轴(作用有限)切面检查二头肌。头肌。Shift the probe up to examine the biceps Shift the probe up to examine the biceps in its in its intraarticularintraarticular course and down to reach the course and down to reach the myotendinousmyotendinous junction(level of the junction(level
8、 of the pectoralispectoralis major tendon).major tendon).n n向上移动探头检查二头肌关节内的走行,向下移向上移动探头检查二头肌关节内的走行,向下移动探头探测肌动探头探测肌-腱连接部(胸大肌肌腱水平)。腱连接部(胸大肌肌腱水平)。n nLegend:SubS,subscapularis tendon;SupraS,supraspinatus tendon;Arrow,long head of the biceps tendon;LT,lesser tuberosity;GT,greater tuberosity;SH,short head
9、 of the biceps;LH,long head of the biceps;H,humeral shaft;Arrowheads,pectoralis major tendonn n图例:SubS 肩胛下肌肌腱;SupraS 冈上肌肌腱;箭号,肱二头肌长头;LT 小结节;GT 大结节;SH 二头肌短头;LH 二头肌长头;H 肱骨干;箭头,胸大肌肌腱n n3 3 subscapularissubscapularis tendon tendonRotate the arm externally fixing the elbow on Rotate the arm externally fi
10、xing the elbow on the iliac crest to show the the iliac crest to show the subscapularissubscapularis tendon tendonand its insertion on the lesser and its insertion on the lesser tuberositytuberosity(slight (slight supinationsupination of the hand may be helpful of the hand may be helpfulto neutraliz
11、e the tendency to lift and abduct the to neutralize the tendency to lift and abduct the elbow from the lateral chest wall).elbow from the lateral chest wall).3 3 肩胛下肌肌腱肩胛下肌肌腱将肘部固定于髂嵴处,上肢外旋可显示肩胛下肌将肘部固定于髂嵴处,上肢外旋可显示肩胛下肌肌腱及其小结节附着部。(手掌轻度后旋可有助肌腱及其小结节附着部。(手掌轻度后旋可有助于抵抗肘部上抬和外展离开侧胸壁的力量)于抵抗肘部上抬和外展离开侧胸壁的力量)n nT
12、his tendon should be evaluated along its long-This tendon should be evaluated along its long-(transverse planes)and short-(transverse planes)and short-(sagittalsagittal planes)planes)axis during passive external and internal rotation axis during passive external and internal rotation with hanging ar
13、m.Sweep the transducer up and with hanging arm.Sweep the transducer up and down over the down over the subscapularissubscapularis until its full width is until its full width is demonstrated.demonstrated.评价该肌腱应该在手臂上举状态下被动外旋和内评价该肌腱应该在手臂上举状态下被动外旋和内旋时沿其长轴切面(横切面)和短轴切面(矢状旋时沿其长轴切面(横切面)和短轴切面(矢状切面)进行扫查。在肩胛下
14、肌表面上下扫查,直切面)进行扫查。在肩胛下肌表面上下扫查,直至整块肌肉都能全部显示。至整块肌肉都能全部显示。n nLegend:Arrow,long head of the biceps tendon;dashed Legend:Arrow,long head of the biceps tendon;dashed line,insertion of the line,insertion of the subscapularissubscapularis tendon;Co,tendon;Co,coracoidcoracoid;Del,deltoid muscle;LT,lesser Del,
15、deltoid muscle;LT,lesser tuberositytuberosity;SubSSubS,subscapularissubscapularis tendon;void arrowheads,tendon fascicles tendon;void arrowheads,tendon fascicles of the of the subscapularissubscapularis;white arrowheads,muscle tissue;white arrowheads,muscle tissue interposed between tendon fascicles
16、interposed between tendon fasciclesn n图例:图例:箭号,肱二头肌长头腱;虚线,肩胛下肌肌腱附箭号,肱二头肌长头腱;虚线,肩胛下肌肌腱附着处;着处;CoCo喙突;喙突;Del,Del,三角肌;三角肌;LT,LT,小结节;小结节;SubSSubS,肩胛下肩胛下肌肌腱;空心箭头,肩胛下肌肌腱束;白色箭头,插入肌肌肌腱;空心箭头,肩胛下肌肌腱束;白色箭头,插入肌腱束之间的肌肉组织;腱束之间的肌肉组织;n n4 4 anteromedialanteromedial structures and structures and coracoacromialcoracoa
17、cromial ligament ligamentMoving the probe toward medial on transverse planes,Moving the probe toward medial on transverse planes,look at the look at the coracoidcoracoid process,the process,the coracoacromialcoracoacromial ligament(the medial margin of the transducer is on the ligament(the medial ma
18、rgin of the transducer is on the coracoidcoracoid process and the lateral edge is shifted upward process and the lateral edge is shifted upward and laterally towards the and laterally towards the acromionacromion),the conjoined),the conjoined tendon and the anterior aspect of the tendon and the ante
19、rior aspect of the subacromialsubacromial subdeltoidsubdeltoid bursa.Then,check the bursa.Then,check the subscapularissubscapularis recess recess and the and the subcoracoidsubcoracoid bursa for effusion.External and bursa for effusion.External and internal rotation may also used to demonstrate inte
20、rnal rotation may also used to demonstrate anteromedialanteromedial impingement(distance between impingement(distance between coracoidcoracoid processprocessand lesser and lesser tuberositytuberosity measured in internal rotation).measured in internal rotation).4.4.肩部前内侧结构和喙肩韧带在横切面上,将探头向内侧肩部前内侧结构和喙肩
21、韧带在横切面上,将探头向内侧移动,查看肩胛骨喙突、喙肩韧带(探头的内侧固定在肩移动,查看肩胛骨喙突、喙肩韧带(探头的内侧固定在肩胛骨喙突,探头外侧缘向外上方转动指向肩峰)、联合腱胛骨喙突,探头外侧缘向外上方转动指向肩峰)、联合腱和肩峰下的三角肌下滑囊前部。然后,探测肩胛下肌隐窝和肩峰下的三角肌下滑囊前部。然后,探测肩胛下肌隐窝和喙突下囊有无积液。内旋和外旋也可用以探测前内侧的和喙突下囊有无积液。内旋和外旋也可用以探测前内侧的创伤部位(内旋可用以测量肩胛骨喙突和肱骨小结节之间创伤部位(内旋可用以测量肩胛骨喙突和肱骨小结节之间的距离)的距离)n nLegendLegend:AcrAcr,acrom
22、ionacromion;Arrows,short head of;Arrows,short head of the biceps;Arrowheads,the biceps;Arrowheads,coracoacromialcoracoacromial ligament;Co,ligament;Co,coracoidcoracoid;CoBrCoBr,coraco-brachialiscoraco-brachialis;HH,humeral head;HH,humeral head;SubSSubS,subscapularissubscapularis tendon;tendon;SupraS
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