超声检查对肩袖损伤的诊断价值

The value of shoulder ultrasonography imaging in diagnosing rotator cuff tears

目的探讨超声检查对肩袖损伤的诊断价值。方法具有肩撞击综合征和(或)肩袖损伤体征患者53例56肩,男32例34肩,女21例22肩;年龄38～75岁,平均52岁。行超声检查和开放手术或关节镜治疗。通过超声检查对肩袖损伤进行分型,并与开放手术或关节镜所见进行比较。结果超声检查诊断肩袖损伤32肩,诊断正常肩袖24肩;手术诊断肩袖损伤33肩,诊断正常肩袖23肩。超声检查诊断的灵敏度为90.91%,特异度为91.30%,阳性预测值为93.75%,阴性预测值为87.50%。广泛和大面积肩袖损伤,超声检查诊断6肩,手术诊断6肩;中、小面积全层损伤,超声检查诊断10肩,手术诊断11肩;肩峰面部分损伤,超声检查诊断5肩,手术诊断5肩;关节面部分损伤,超声检查诊断11肩,手术诊断11肩。手术切开修补12肩,关节镜辅助探查有限切开修补16肩,关节镜下断端射频紧缩6肩,关节镜下肩峰成形术22肩。结论超声检查在诊断肩袖损伤方面具有较高的精确度,尤其适用于诊断肩袖全层损伤。

Objective To evaluate the sensitivity and specificity of uhrasonography, and to compare the operation or arthroscopic findings in detecting rotator cuff tears. Methods There were 56 shoulders of 53 patients with a history of shoulder pain for an average of 12.9 months （3-29 months）, and with impingement sign or rotator cuff tears sign on physical examination. The average age was 52 years （38-75 years）. Phillips series uhrasonography machines with commercially available 10 MHz linear-array transducer were applied to exam the shoulder under the standardized shoulder study protocols. The uhrasonography findings were classified into intact cuff, acrominal surface partial-thickness tears, articular surface partial-thickness tears, small and moderate full-thickness tears, and large to extensive tears. The normal rotator cuff tears ultrasonography image was a bark shape like tendon echo area between the deltoid muscle and the humeral head; the extensive or large full thickness cuff tears（size 〉3 cm） ultrasonography image was the absent of rotator cuff image （nonvisualization） or discontinuity （local nonvisualization）; moderate full thickness cuff tears （size 1-3 cm） uhrasonography image was the hypoechoic zone extending through the entire substance of the cuff; bursa surface partial thickness was small hypoechoic discontinuities of the external surfaces of the cuff; articular surface partial thickness was small hypoechoic discontinuities of the internal surfaces of the cuff. All the uhrasonography examination results were compared with findings at shoulder operation or arthroscopy as a golden standard. 12 shoulders were open repaired; 16 shoulders were limited open and arthroscope repaired; 6 shoulders were contracted under the radio frequency ablation; 22 shoulder were taken acrominal plasty under the arthroscope. Results The uhrasonography correctly depicted 30 of 33 rotator cuff tears with sensitivity 90.91%, specificity 91.30%, positive predictive value 93.75%, negative predictive value 87.50%. 6 large to extensive tears, 11 small and moderate full-thickness tears, 5 acrominal partial-thickness tears, 11 articular partial-thickness tears. Conclusion The uhrasonography is a highly accurate diagnostic method for detecting full-thickness rotator cuff tears, but is less sensitive in detecting partial-thickness rotator cuff tears.