髂腰肌滑囊扩张的超声影像学特征分析
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摘要
目的分析髂腰肌滑囊扩张的临床和超声影像学特征,探讨高频超声诊断髂腰肌滑囊扩张的临床价值。方法回顾性分析解放军第一八四医院45例经关节镜、穿刺活检以及临床证实的髂腰肌滑囊扩张患者(扩张组),随机抽取62例髋部不适未合并髂腰肌滑囊扩张的患者作为对照组,分析2组患者临床资料并行统计学分析,总结髂腰肌滑囊的临床和超声影像学特征。结果扩张组累及单、双侧分别为41例、4例,合并髋关节病变35例;对照组累及单、双侧分别为47例、15例,合并髋关节病变33例;组间比较的差异有统计学意义(P<0. 05)。扩张组超声确诊38例,误诊4例,漏诊3例,诊断符合率约84.4%。髂腰肌滑囊扩张的主要超声影像学特征为髋关节囊前方和髂腰肌腱(腹)间大小不等、形态各异的单房或多房囊性包块,向上可达髂腰肌腹,向下可达小转子,包块增大时可压迫股静脉。结论髂腰肌滑囊扩张大多单侧发病,常合并髋关节病变,具有典型超声影像学特征,高频超声可明确诊断。
Objective To analyze the clinical and ultrasonographic features of dilated bursa of the iliopsoas muscle,and to investigate the clinical value of high-frequency ultrasound in the diagnosis of dilated bursa of the iliopsoas muscle.Methods Forty-five patients with dilated bursa of the iliopsoas muscle confirmed by arthroscopic surgery,needle biopsy and clinical pathology were selected as dilatation group. Additionally,62 patients with hit pain accompanied by no dilated bursa of the iliopsoas muscle were randomly selected as control group. Clinical data of the 2 groups were retrospectively and statistically analyzed. The clinical and ultrasonographic features of dilated bursa of the iliopsoas muscle were summarized. Results In the dilatation group,there were 41 patients with unilateral involvement,4 patients with bilateral involvement,and 35 patients with combined hip joint lesions. In the control group,there were 47 patients with unilateral involvement,15 patients with bilateral involvement,and 33 patients with combined hip joint lesions. Single/bilateral dilatation and combination with other lesions in the hip joint showed statistical significance between the two groups( P < 0. 05),while gender and age shown non-statistical significance( P>0.05). In the dilatation group,38 cases was comfirmed by ultrasound diagnose. Four cases was missed diagnosis,and 3 cases was misdiagnosed by ultrasound. The diagnostic coincidence rate of ultrasound was 84. 4%. Main ultrasonographic features of dilated bursa of the iliopsoas muscle were mono or multilocular cystic mass with different sizes and shapes in anterior capsule of the hip joint and between tendons( bellies) of the iliopsoas muscle,upwards to the iliocsoas belly and downwards to the lesser trochanter. The femoral vein can be compressed when the mass was enlarged.Conclusion Dilated bursa of the iliopsoas muscle occurs mostly at single side in adults,and is always combined with ipsilateral lesions in the hip joint,characterizedby typical ultrasonographic features. High-frequency ultrasound can clearly diagnose this disease.
Objective To analyze the clinical and ultrasonographic features of dilated bursa of the iliopsoas muscle,and to investigate the clinical value of high-frequency ultrasound in the diagnosis of dilated bursa of the iliopsoas muscle.Methods Forty-five patients with dilated bursa of the iliopsoas muscle confirmed by arthroscopic surgery,needle biopsy and clinical pathology were selected as dilatation group. Additionally,62 patients with hit pain accompanied by no dilated bursa of the iliopsoas muscle were randomly selected as control group. Clinical data of the 2 groups were retrospectively and statistically analyzed. The clinical and ultrasonographic features of dilated bursa of the iliopsoas muscle were summarized. Results In the dilatation group,there were 41 patients with unilateral involvement,4 patients with bilateral involvement,and 35 patients with combined hip joint lesions. In the control group,there were 47 patients with unilateral involvement,15 patients with bilateral involvement,and 33 patients with combined hip joint lesions. Single/bilateral dilatation and combination with other lesions in the hip joint showed statistical significance between the two groups( P < 0. 05),while gender and age shown non-statistical significance( P>0.05). In the dilatation group,38 cases was comfirmed by ultrasound diagnose. Four cases was missed diagnosis,and 3 cases was misdiagnosed by ultrasound. The diagnostic coincidence rate of ultrasound was 84. 4%. Main ultrasonographic features of dilated bursa of the iliopsoas muscle were mono or multilocular cystic mass with different sizes and shapes in anterior capsule of the hip joint and between tendons( bellies) of the iliopsoas muscle,upwards to the iliocsoas belly and downwards to the lesser trochanter. The femoral vein can be compressed when the mass was enlarged.Conclusion Dilated bursa of the iliopsoas muscle occurs mostly at single side in adults,and is always combined with ipsilateral lesions in the hip joint,characterizedby typical ultrasonographic features. High-frequency ultrasound can clearly diagnose this disease.
引文
[1]杨志远,黄伟,余东,等.髂腰肌滑囊扩张的临床特点和影像学表现[J].中国临床医学影像杂志,2011,22(3):56-58.
[2]杨焱,丁长青,单素平.创伤性髂腰肌滑囊炎的CT和MR影像表现特征[J].中医正骨,2017,29(1):49-51.
[3]刘双爱,贺晓军.超声在围髋关节相关滑囊炎诊断中的价值[J].浙江临床医学,2017,19(11):1337-1338.
[4]吴丽萍,孙英姿,姜士芹,等.髂腰肌滑囊炎的超声表现及鉴别诊断[J].医学影像学杂志,2017,27(12):2384-2386.
[5]石景芳,何慧,桂季涛,等.髂腰肌囊扩张高频彩超误诊分析及其临床意义[J].医学影像学杂志,2017,27(3):573-575.
[6]傅先水,刘吉斌,王金锐,等.肌肉骨关节超声检查规范(草案)美国超声医学会(AIUM)美国放射学会(ACR)制定[J/CD].中华医学超声杂志(电子版),2010,7(1):141-152.
[7]中国超声医学工程学会肌肉骨骼系统超声专业委员会.肌肉骨骼超声检查及报告规范[J/CD].中华医学超声杂志(电子版),2015,12(1):11-17.
[8] Varma DG,Richli WR,Charnsangavej C,et al.MR appearance of the distended iliopsooas bursa[J].Am J Roentgenol,1991,156(5):1025-1028.
[9]刘琦,吴长君.超声在肌肉骨骼系统中应用的研究进展[J].医学综述,2017,23(12):24332437.
[10]高慧,胡建群.彩色多普勒超声对胫前动脉穿支皮瓣血管的研究[J].东南国防医药,2015,17(5):496-498.
[11]马静丽,程琦,朱贤胜,等.高频超声诊断白线疝的临床价值及误诊分析[J].医学研究生学报,2014,27(2):174-175.
[12]王士芳,王珍,李紫瑶,等.超声在诊断髋臼盂唇损伤中的应用价值[J].中华超声影像学杂志,2016,25(12):1064-1068.
[13]游淑红,洪涛,陶荣,等.高频超声在膝骨关节疾病诊断及治疗中的应用价值[J].东南国防医药,2016,18(6):578-580.
[14]宋金钧,熊基玲,曹之清,等.滑膜脂肪瘤的临床病理诊断[J].东南国防医药,2014,16(2):153-156.
[15]叶郁青,郭学利,耿远璋,等.髋关节滑膜囊肿压迫股静脉的临床诊疗分析[J].中华普通外科学杂志,2018,33(1):53-56.
[2]杨焱,丁长青,单素平.创伤性髂腰肌滑囊炎的CT和MR影像表现特征[J].中医正骨,2017,29(1):49-51.
[3]刘双爱,贺晓军.超声在围髋关节相关滑囊炎诊断中的价值[J].浙江临床医学,2017,19(11):1337-1338.
[4]吴丽萍,孙英姿,姜士芹,等.髂腰肌滑囊炎的超声表现及鉴别诊断[J].医学影像学杂志,2017,27(12):2384-2386.
[5]石景芳,何慧,桂季涛,等.髂腰肌囊扩张高频彩超误诊分析及其临床意义[J].医学影像学杂志,2017,27(3):573-575.
[6]傅先水,刘吉斌,王金锐,等.肌肉骨关节超声检查规范(草案)美国超声医学会(AIUM)美国放射学会(ACR)制定[J/CD].中华医学超声杂志(电子版),2010,7(1):141-152.
[7]中国超声医学工程学会肌肉骨骼系统超声专业委员会.肌肉骨骼超声检查及报告规范[J/CD].中华医学超声杂志(电子版),2015,12(1):11-17.
[8] Varma DG,Richli WR,Charnsangavej C,et al.MR appearance of the distended iliopsooas bursa[J].Am J Roentgenol,1991,156(5):1025-1028.
[9]刘琦,吴长君.超声在肌肉骨骼系统中应用的研究进展[J].医学综述,2017,23(12):24332437.
[10]高慧,胡建群.彩色多普勒超声对胫前动脉穿支皮瓣血管的研究[J].东南国防医药,2015,17(5):496-498.
[11]马静丽,程琦,朱贤胜,等.高频超声诊断白线疝的临床价值及误诊分析[J].医学研究生学报,2014,27(2):174-175.
[12]王士芳,王珍,李紫瑶,等.超声在诊断髋臼盂唇损伤中的应用价值[J].中华超声影像学杂志,2016,25(12):1064-1068.
[13]游淑红,洪涛,陶荣,等.高频超声在膝骨关节疾病诊断及治疗中的应用价值[J].东南国防医药,2016,18(6):578-580.
[14]宋金钧,熊基玲,曹之清,等.滑膜脂肪瘤的临床病理诊断[J].东南国防医药,2014,16(2):153-156.
[15]叶郁青,郭学利,耿远璋,等.髋关节滑膜囊肿压迫股静脉的临床诊疗分析[J].中华普通外科学杂志,2018,33(1):53-56.