不同超声征象诊断肩袖撕裂的效能比较

Effectiveness of different ultrasonographic features in diagnosis of rotator cuff tear

目的探讨不同超声征象对肩袖撕裂的诊断效能,筛选出诊断肩袖撕裂的特异性超声征象。方法收集133例因肩痛行肩关节超声检查病例资料,应用Logistic回归及诊断试验评估不同超声特征对肩袖撕裂的诊断效能,分析诊断肩袖撕裂的影响因素。结果以关节镜及长期随访(≥6个月)为金标准,超声诊断肩袖撕裂的敏感性、特异性和准确率分别为89.13%、79.31%、82.70%。不同超声征象中,诊断肩袖撕裂敏感性最高的为肩峰下滑膜囊积液(56.62%),特异性最高为肩袖缺损(100%)。单因素分析显示腱内异常回声、肩袖缺损、肌腱变薄、肩峰撞击综合征、肩峰下滑膜囊增厚、肱骨头骨质不整与肩袖撕裂均显著相关(均P<0.05)。多因素分析显示腱内异常回声是肩袖撕裂的独立危险因素(P<0.05,OR=1.12)。腱内异常回声和肩袖缺损均可作为诊断肩袖撕裂的主要超声征象,二者与其他超声征象联合可以明显提高诊断敏感性和特异性。结论腱内异常回声和肩袖缺损在肩袖撕裂的超声诊断中具有较高的敏感性和特异性,有一定的临床诊断价值。

Objective To explore the effectiveness of different ultrasonographic features in the diagnosis of rotatorcuff tear(RCT),and to screen out specific ultrasonic signs for the diagnosis of RCT.Methods A total of 133 patients of shoulderjoints of RCT were examined by ultrasound.The ultrasonographic features were analyzed by Logistic regression and diagnostictest,and to assess the diagnostic efficiency of different ultrasonographic features on RCT.ResultsIn the gold standard ofarthroscopy and long-term follow-up(≥6 months),the sensitivity,specificity and diagnostic accuracy rate of rotator cuff tearswere 89.13%,79.31%and 82.70%,respectively.Among those ultrasonographic signs,the most sensitive was the acromiocysticeffusion(56.62%),and the most specific was the rotator cuff disappearance(100%).Univariate analysis showed that intra-tendinous abnormal echo,rotator cuff structure defect,tendon thinning,acromion impact syndrome,subacromial synovial sacthickening and humeral head irregularity were significantly correlated with RCT(all P<0.05).Multivariate analysis showed thatintra-tendinous abnormal echo was an independent risk factor for RCT(P<0.05,OR=1.12).The intra-tendinous abnormal echoand the cuff structure defect were the main ultrasonographic signs in the diagnosis of RCT.Combined with other ultrasound signs,the sensitivity and specificity could be significantly improved.Conclusion The intra-tendinous abnormal echo and rotator cuffdefect has higher sensitivity and specificity in the diagnosis of RCT,which has a certain clinical diagnostic value.