肌骨超声诊断指南肩部.ppt

肌骨超声技术指南-肩部(欧洲肌骨放射学)nAlthough patients positioning for shoulder US varies widely across different Countries and Institutions reflecting multifaceted opinions and experiences of different examiners,we strongly recommend to examine the patient while seated on a revolving stool.This position allows the examiner to reach the anterior,lateral and posterior aspects of the shoulder with the probe by simply asking the patient to rotate on the chair.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。nlong head of the biceps tendon二头肌腱长头Place the arm in slight internal rotation(directed towards the contralateral knee)with the elbow flexed 90,palm up.Start by finding the long biceps tendon in between the greater and lesser tuberosities Use short and long(more limited utility)axis planes to examine the biceps.肘部屈曲90，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头腱，采用短轴和长轴（作用有限）切面检查二头肌。Shift the probe up to examine the biceps in its intraarticular course and down to reach the myotendinous junction(level of the pectoralis major tendon).n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-腱连接部（胸大肌肌腱水平）。:SubS,subscapularis tendon;SupraS,supraspinatus tendon;Arrow,long head of the biceps tendon;LT,lesser tuberosity;GT,greater tuberosity;SH,short head of the biceps;LH,long head of the biceps;H,humeral shaft;Arrowheads,pectoralis major tendon 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n3 subscapularis tendonRotate the arm externally fixing the elbow on the iliac crest to show the subscapularis tendonand its insertion on the lesser tuberosity(slight supination of the hand may be helpfulto neutralize the tendency to lift and abduct the elbow from the lateral chest wall).3 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）nThis tendon should be evaluated along its long-(transverse planes)and short-(sagittal planes)axis during passive external and internal rotation with hanging arm.Sweep the transducer up and down over the subscapularis until its full width is demonstrated.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。nLegend:Arrow,long head of the biceps tendon;dashed line,insertion of the subscapularis tendon;Co,coracoid;Del,deltoid muscle;LT,lesser tuberosity;SubS,subscapularis tendon;void arrowheads,tendon fascicles of the subscapularis;white arrowheads,muscle tissue interposed between tendon fasciclesn 箭号，肱二头肌长头腱；虚线，肩胛下肌肌腱附着处；Co喙突；Del,三角肌；LT,小结节；SubS,肩胛下肌肌腱；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；n4 anteromedial structures and coracoacromial ligamentMoving the probe toward medial on transverse planes,look at the coracoid process,the coracoacromial ligament(the medial margin of the transducer is on the coracoid process and the lateral edge is shifted upward and laterally towards the acromion),the conjoined tendon and the anterior aspect of the subacromial subdeltoid bursa.Then,check the subscapularis recess and the subcoracoid bursa for effusion.External and internal rotation may also used to demonstrate anteromedial impingement(distance between coracoid processand lesser tuberosity measured in internal rotation).4.肩部前内侧结构和喙肩韧带在横切面上，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的距离）:Acr,acromion;Arrows,short head of the biceps;Arrowheads,coracoacromial ligament;Co,coracoid;CoBr,coraco-brachialis;HH,humeral head;SubS,subscapularis tendon;SupraS,supraspinatusn图示：Acr,肩峰；箭，二头肌短头；箭头，喙肩韧带；Co,喙突；CoBr,喙肱肌；HH,肱骨头；SubS,肩胛下肌肌腱；SupraS,冈上肌nsupraspinatus tendon:positioning(1)n冈上肌肌腱：定位（1）nPlace the patients arm posteriorly,placing the palmar side of the hand on the superior aspect of the iliac wing with the elbow flexed and directed posteriorly.The supraspinatus tendon should be evaluated along its long-and short-axis.n患者上肢后置，肘部向后屈曲，手掌面置于髂骨翼上部。应沿长轴和短轴观测冈上肌肌腱。nsupraspinatus tendon冈上肌肌腱nRefer to the intraarticular portion of the biceps as a landmark to obtain proper transducer orientation for imaging the supraspinatus.In fact,these tendons run parallel one to the other and the intraarticular portion of the biceps is easy to be recognized due to a more clearly defined fibrillar pattern.One should rotate the transducer until the biceps is depicted as more elongated as possible in the US image.Then,the probe is shifted upward and posteriorly over the supraspinatus without changing its orientation.The resulting image is in axis with the supraspinatus.Between the supraspinatus and the deltoid,the normal subacromial-subdeltoid bursa appears as a thin hypoechoic band.n肱二头肌的关节内部分是确定合适的探头方向以显示冈上肌的定位标志。事实上，这些肌腱是相互平行的，而二头肌关节内的部分由于其边界清晰的细纤维结构而易于辨认。操作者应该转动探头使二头肌的超声图像显示得尽可能长。然后，保持探头方向不变，在冈上肌表面向后上方移动探头，最终图像就是冈上肌的长轴。在冈上肌和三角肌之间，正常的肩峰-三角肌下滑囊呈一条薄薄的低回声带。nTilt the transducer gently in the area overlying the tendon insertion to avoid anisotropy.Remember to scan the lateral pouch of the subacromial subdeltoid bursa along the lateral edge of the greater tuberosity.When looking for