高频超声在原发性冻结肩诊断中的应用价值

Value of assessment on primary frozen shoulder by high frequency ultrasound

目的探讨高频超声对原发性冻结肩的诊断价值。方法回顾分析经我院临床确诊的86例原发性冻结肩患者91个肩关节(冻结肩组)和147例肩痛患者162个肩关节(对照组)的超声检查资料,对比两组盂肱关节下方关节囊(IC)及喙肱韧带(CHL)厚度、肩袖间隙回声及血流信号、盂肱关节、肱二头肌长头(LHB)腱鞘、肩峰下-三角肌下滑囊(SASD)积液等指标;应用Logistic回归分析筛选出两组间差异有统计学意义的指标建立回归方程;绘制ROC曲线分析各指标单独和联合诊断原发性冻结肩的价值。结果两组IC及CHL厚度、LHB腱鞘积液、肩袖间隙低回声、血流信号等指标比较差异均有统计学意义(均P<0.05)。Logistic回归分析示两组间IC厚度、CHL厚度及肩袖间隙低回声比较差异均有统计学意义(均P<0.001),回归方程为Logit(P)=-14.023+2.291×IC厚度+3.063×CHL厚度+3.462×肩袖间隙低回声。IC厚度、CHL厚度及肩袖间隙低回声单独诊断原发性冻结肩的曲线下面积分别为0.939、0.921、0.861,诊断敏感性分别为92.0%、85.1%、82.8%,特异性分别为92.7%、90.1%、89.4%;3项指标联合应用的曲线下面积为0.985,诊断敏感性97.7%,特异性97.4%。结论高频超声可通过IC厚度、CHL厚度及肩袖间隙低回声为原发性冻结肩患者提供诊断依据,单独诊断以IC厚度价值最高,3项指标联合诊断具有更高临床应用价值。

Objective To explore the application value of high frequency ultrasound in diagnosis of primary frozen shoulder.Methods Ultrasonic examination data of 91 shoulder joints in 86 patients with primary frozen shoulder and 162 shoulder joints in 147 patients with shoulder pain were enrolled in frozen shoulder group and the control group,respectively.The thickness of glenohumeral joint capsule(IC),coracobrachial ligament(CHL),echo and blood flow signal of rotator cuff space,glenohumeral joint,tendon sheath of long head of biceps(LHB)tendon sheath,subacromial-subdeltoid bursa(SASD)were measured and compared between the two groups.Logistic regression analysis was applied to screen out indexes with statistically significant differences between the two groups to establish regression equations.The ROC curve was drawn to analyze the value of each index in diagnosing primary frozen shoulder separately and combined the two.Results The differences of IC and CHL thickness,LHB tendon sheath effusion,rotator cuff space hypoecho and blood flow signal between the two groups were statistically significant(all P<0.05).The regression equation was Logit(P)=-14.023+2.291×IC thickness+3.063×CHL thickness+3.462×rotator cuff gap hypoecho.The areas under the curve of IC thickness,CHL thickness and hypoechoic rotator cuff gap were 0.939,0.921 and 0.861,respectively.The sensitivity,specificity and specificity of diagnosing frozen shoulder were 92.0%,85.1% and 82.8%,92.7%,90.1% and 89.4%,respectively.The area under the curve of the combined application of the three indexes was 0.985,the diagnostic sensitivity was 97.7%,and the specificity was 97.4%.Conclusion High-frequency ultrasound can provide diagnostic basis in patients with primary frozen shoulder through IC thickness,CHL thickness and hypoechoic rotator cuff space.Among these indexes,IC thickness is of the highest diagnosis value for frozen shoulder,and the combined diagnosis of the three indexes has higher clinical application value.