高频超声测量盂肱关节囊厚度及其差值评估冻结肩

High frequency ultrasound for measurement of glenohumeral joint capsule thickness and difference for evaluating frozen shoulder

目的观察高频超声测量盂肱关节囊(GJC)厚度及其差值诊断冻结肩(FS)的价值。方法纳入215例单侧FS患者(FS组)及211名健康受试者(对照组),以高频超声测量并比较组间及组内双侧肩关节GJC厚度差异,并计算GJC厚度差值。绘制受试者工作特征曲线,计算曲线下面积(AUC),评价GJC厚度及双侧GJC厚度差值用于诊断FS的效能。结果FS组患侧GJC厚度大于对侧及对照组双侧(P均<0.01);FS组对侧GJC厚度与对照组双侧差异均无统计学意义(P均>0.05);对照组双侧GJC厚度差异无统计学意义(P>0.05)。FS组双侧GJC厚度差值明显大于对照组(P<0.01)。以2.65 mm为患侧GJC厚度的截断值,其诊断FS的AUC为0.98,敏感度为94.88%、特异度为89.48%、准确率为84.37%;以GJC厚度差值0.85 mm为截断值,其诊断FS的AUC为0.98,敏感度为92.56%、特异度为97.63%、准确率为90.19%。结论利用高频超声测量GJC厚度及其双侧差值可有效诊断FS。

Objective To observe the value of high frequency ultrasound in diagnosis of frozen shoulder(FS)through measuring the thickness of glenohumeral joint capsule(GJC)and evaluate its bilateral difference.Methods Totally 215 patients with unilateral FS(FS group)and 211 healthy subjects(control group)were enrolled.GJC thickness and its difference of bilateral shoulder joints were measured using high-frequency ultrasound and compared between and within groups,and the bilateral difference of GJC thickness was calculated.The receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficiency of GJC thickness and the difference of bilateral GJC thickness for diagnosing FS.Results The thickness of GJC of the affected side in FS group was greater than that of the non-involved side and that in control group(all P<0.01).The thickness of GJC in non-involved side in FS group was not significantly different from that in control group(both P>0.05).No significant difference of the thickness of bilateral GJC was found in control group(P>0.05).The thickness difference of bilateral GJC in FS group was significantly greater than that in control group(P<0.01).Taken 2.65 mm as the cut-off value of GJC thickness of the affected side,the AUC for diagnosing FS was 0.98,with sensitivity of 94.88%and specificity of 89.48%,and the accuracy rate was 84.37%.Taken 0.85 mm as the cut-off value of the thickness difference of GJC,the AUC for diagnosing FS was 0.98,with sensitivity of 92.56%and specificity of 97.63%,and the accuracy rate was 90.19%.Conclusion High frequency ultrasound could be used to effectively diagnose FS through measuring GJC thickness and its bilateral difference.