通过MRI片识别逗号征对前上肩袖撕裂诊治的临床意义

Clinical significance of magnetic resonance imaging for detection of comma sign in anterior-superior rotator cuff tears

目的评估术前通过MRI片识别逗号征的准确性,探讨其对前上肩袖撕裂诊治的临床意义。方法回顾性分析自2017-02—2020-12采用肩关节镜手术治疗的49例前上肩袖撕裂,13例出现逗号征(观察组),36例无逗号征(对照组)。比较两组年龄、术前疼痛持续时间、前屈上举角度、体侧外旋角度、疼痛VAS评分、Constant功能评分、假性麻痹率、肩胛下肌撕裂程度、肩袖肌腱回缩程度、冈上肌撕裂程度、冈上肌前缘撕裂率、冈上肌回缩程度、肱二头肌长头肌腱病变情况。结果49例均顺利完成手术,术前通过MRI片识别出逗号征12例,灵敏度92.3%,特异度97.2%,阳性预测值92.3%,阴性预测值97.2%,准确性95.9%,假阳性1例,假阴性1例。相比于对照组,观察组术前肩关节疼痛时间更长,Constant功能评分更低,假性麻痹发生率更高,肩胛下肌腱、冈上肌撕裂和回缩程度更严重,前缘撕裂率更高,肱二头肌长头肌腱发生脱位或半脱位合并断裂的概率更高,差异有统计学意义(P<0.05)。结论术前通过MRI片发现逗号征预示着肩胛下肌上部全层撕裂和冈上肌前缘撕裂,对这一特殊撕裂类型通过MRI片进行诊断具有高敏感度和高特异性。临床一旦发现逗号征应尽早采用手术治疗。

ObjectiveTo assess the accuracy of preoperative MRI for detection of the comma sign and its clinical significance in anterior-superior rotator cuff tears.MethodsForty-nine patients with anterior-superior rotator cuff tears undergoing shoulder arthroscopy from February 2017 to December 2020 were retrospectively analyzed, 13 cases had comma sign(observation group), 36 cases had no comma sign(control group).The average age, duration of pain, active anterior elevation, external rotation in 0°of abduction, pain VAS score, Constant score, presence of pseudoparalysis, tear and retraction types of subscapularis and supraspinatusand tendon lesion of long head of biceps brachii were compared.ResultsAll 49 patients were performed the operation successfully. Comma sign was identified on pre-operative MRI in 12 patients. MRI showed an overall accuracy of 95.9%in diagnosis of a comma sign, sensitivity 92.3%, specificity 97.2%, positive predictive value 92.3%, negative predictive value97.2%, 1 false-positive and 1 false-negative case. Compared with control group, observation group had longer duration of pain,lower constant score, higher incidence of pseudoparalysis, more severe tendon tear and retraction of subscapular and supraspinatus, higher rate of anterior supraspinatus tear and dislocation or subluxation or rupture of tendon of long head of biceps brachii(P<0.05).ConclusionPreoperative MRI illustrates excellent sensitivity and specificity for assessment of the comma sign and the comma sign indicates the full-thickness tears of upper portion of subscapularis and anterior portion of supraspinatus tendon.Once the comma sign is detected on MRI, early surgical management is recommended.