四种试验对肩胛部上盂唇前后位损伤的诊断价值比较  

Comparison of the diagnostic value of four tests for superior labrum anterior and posterior lesions of the shoulder

作　　者：郑昱新[1] 王鹤岐[1] 

机构地区：[1]上海中医药大学附属曙光医院骨伤科,200021

出　　处：《中华骨科杂志》2005年第4期197-200,共4页Chinese Journal of Orthopaedics

摘　　要：目的比较四种试验对肩胛部上盂唇前后位(superiorlabrumanteriorand posterior,SLAP)损伤的诊断价值。方法81例患者随机按不同顺序进行Kibler前方滑动试验、Liu曲轴试验、O'Brien主动压迫试验、Kim肱二头肌负荷试验Ⅱ的检查。其中男65例,女16例;年龄17～48岁,平均26.9岁;右肩59例,左肩22例。对所有患者均进行肩关节镜检查。以关节镜下的诊断为标准,将临床诊断与关节镜下诊断相比较,根据临床流行病学对诊断试验的评价方法计算出这些试验诊断SLAP损伤的敏感性、特异性、阳性预测值、阴性预测值和准确度。结果经关节镜检查证实为SLAP损伤的患者有21例,在四种试验中Kim肱二头肌负荷试验Ⅱ的真阳性19例,真阴性59例,假阳性1例,假阴性2例;计算得出敏感性为90.48%,特异性为98.33%,阳性预测值为95.00%,阴性预测值为96.72%,准确度为96.30%。Kibler前方滑动试验的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为76.19%,96.67%,88.89%,92.06%,91.33%;Liu曲轴试验分别为85.71%,93.33%,81.82%,94.92%,91.35%;O'Brien主动压迫试验分别为80.95%,91.66%,77.27%,93.22%,88.89%。结论Kim肱二头肌负荷试验Ⅱ对SLAP损伤的诊断价值较高。Objective To compare the diagnostic value of four signs for superior labrum anterior and posterior (SLAP) lesions of the shoulder. Methods The physical examination was performed randomly on 81 cases with abnormalities of the shoulder. There were four tests, including Kibler anterior sliding test, Liu crank test, O'Brien active compression test and Kim biceps load test Ⅱ. The arthroscopic examination were also performed. The result of the arthroscopic examination was considered as a golden standard, so that we could estimate the diagnosis value of the four tests according to the method of evaluation of diagnosis test on clinical epidemiology, their sensitivity, specificity, positive and negative predictive value, accuracy. Results There were 21 cases diagnosed as SLAP lesions by arthroscopy. The diagnosis value of Kim biceps load test Ⅱ was the highest among the four tests, in which 19 of true positive, 59 of true negative, 1 of false positive, only 2 of false negative case; while the sensitivity was 90.48%, specificity was 98.33%, positive predictive value was 95.00%, negative predictive value was 96.72%, and accuracy was 96.30%. However the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Kibler anterior sliding test were 76.19%, 96.67%, 88.89%, 92.06%, 91.33%; and those of Liu crank test were 85.71%, 93.33%, 81.82%, 94.92%, 91.35%; those of O'Brien active compression test were 80.95%, 91.66%, 77.27%, 93.22%, 88.89%. Conclusion Kim Biceps load test Ⅱ may be the best for clinical diagnosis of SLAP lesions of the shoulder.

关 键 词：诊断价值 前后位 肩胛部 SLAP损伤 阳性预测值 阴性预测值 关节镜检查 负荷试验 肱二头肌 临床流行病学 唇 关节镜下 敏感性 特异性 准确度 临床诊断 诊断试验 and 患者 评价方 真阳性 假阳性 假阴性 前方 压迫 

分 类 号：R686[医药卫生—骨科学]