高频超声诊断冈上肌腱撕裂

High frequency ultrasonography in diagnosis of supraspinatus tendon tears

目的观察冈上肌腱撕裂超声声像图特征,评估高频超声诊断冈上肌腱撕裂的效能。方法纳入65例(65肩)超声诊断为冈上肌腱撕裂患者,以同期10名健康志愿者(20肩)为对照,对比超声与关节镜术中诊断结果,采用Cohen's Kappa系数分析二者诊断的一致性,评价超声诊断效能。结果冈上肌腱撕裂超声多表现为无回声、肌腱滑囊面凹陷及连续性不佳,据以诊断撕裂的敏感度分别为85.42%、89.58%及93.75%,特异度分别为76.47%、100.00%及76.47%;超声根据肌腱滑囊面凹陷诊断冈上肌腱撕裂与关节镜术中诊断的一致性最佳(Kappa=0.818),其次为肌腱连续性不佳(Kappa=0.716)及无回声区(Kappa=0.586)。超声根据上述特征诊断与关节镜术中诊断差异均无统计学意义(P均>0.05)。结论高频超声可较准确地诊断冈上肌腱撕裂;根据滑囊面凹陷诊断与关节镜诊断冈上肌腱撕裂的一致性最佳;回声特点结合动态观察肌腱连续性有助于减少漏、误诊。

Objective To observe the ultrasonographic features of supraspinatus tendon tears,and to evaluate the efficacy of high frequency ultrasonography in diagnosis of supraspinatus tendon tears.Methods A total of 65 patients(65 shoulders)diagnosed with supraspinatus tendon tears by ultrasound were included.At the same time,10 healthy volunteers(20 shoulders)were enrolled as the controls.The diagnostic results of ultrasound were compared with those of arthroscopic shoulder operations.Cohen's Kappa test was performed to evaluate the diagnostic consistency between these two methods and the diagnostic efficacy of ultrasonography.Results Focal echoless,bursa depression and poor continuity of tendon were the main ultrasonographic characteristics of tendon tears,the sensitivity of diagnosing tear was 85.42%,89.58%and 93.75%,and the specificity was 76.47%,100.00%and 76.47%,respectively.Bursal surface depression had the best consistency with arthroscopy results(Kappa=0.818),followed by poor tendon continuity(Kappa=0.716)and anechoic area(Kappa=0.586).No statistical difference was found between ultrasonographic and arthroscopic results(all P>0.05).Conclusion High frequency ultrasound could accurately diagnose supraspinatus tendon tears.Ultrasonographic diagnosis of supraspinatus tendon tears according to bursal surface depression had the best consistency with that of arthroscopy.Combining observation of echo characteristics and dynamic tendon continuity was helpful to avoiding missed diagnosis and misdiagnosis.