体格检查诊断冈上肌腱撕裂的灵敏度和特异度分析  

Sensitivity and specificity of conventional physical examination tests in evaluation of the supraspinatus tendon injuries

作　　者：黄德刚[1] 陈基明[2] 翟建[2] 陈远军 HUANG Degang CHEN Jiming ZHAI Jian CHEN Yuanjun(Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院关节骨科,安徽芜湖241001 [2]皖南医学院第一附属医院弋矶山医院医学影像中心,安徽芜湖241001

出　　处：《皖南医学院学报》2016年第4期355-357,共3页Journal of Wannan Medical College

摘　　要：目的：探讨4种常用的体格检查方法在肩关节冈上肌腱损伤诊断中的灵敏度和特异度,为临床诊断提供参考。方法：收集我院99例患者的临床资料,分别统计患者Hawkins检查、Neer检查、Jobe检查和ERLS检查的阳性数和阴性数,并以MRI诊断结果为对照,计算假阳性和假阴性数。结果：99例患者中,冈上肌腱撕裂31例,10例为部分撕裂,21例为全层撕裂,其中伴冈下肌或肩胛下肌损伤者8例。Hawkins试验组与对照组比较,χ~2=32.327,P=0.000,差异有统计学意义;Neer试验组与对照组比较,χ~2=20.078,P=0.000,差异有统计学意义;Jobe试验组与对照组比较,χ~2=1.161,P=0.281,差异无统计学意义;ERLS试验组与对照组比较,χ~2=3.704,P=0.054,差异无统计学意义。灵敏度和特异度：Hawkins为83.87%和30.88%,Neer为70.97%和38.24%,Jobe为61.29%和72.06%,ERLS为38.71%和88.24%。结论：所选的4种体格检查均在一定程度上反映冈上肌的损伤及程度,但都存在特异度高而灵敏度低,或灵敏度高而特异度低的特点,要进行相关辅助检查特别是MRI,才能得出较准确的诊断。Objective： To assess the sensitivity and specificity of four conventional physical examinations in estimating the supraspinatus tendon injuries for diagnostic evidence in clinical practice. Methods： Clinical data were collected in 99 patients with supraspinatus tendon injuries. All patients underwent Hawkins,Neer,Jobe and external rotation lag sign（ ERLS） test.The positive and negative findings were summed up and compared with the MRI detection for calculating the frequencies of false positive and false negative observations.Results： In 99 cases,tear of the supraspinatus tendon was found in 31,partial tear in 10,and full-thickness tear in 21,in which 8 cases were associated with infraspinatus and subscapularis injuries.By comparison with the MRI findings,the difference was significant by Hawkins test（ χ^2= 32.327,P = 0.000）,yet was not significant by Neer,Jobe and ERLS test（ χ^2= 20.078,P = 0.000;χ^2 = 1.161,P = 0.281; χ^2= 3.704,P = 0.054,respectively）.Sensitivity and specificity was 83.87% and 30.88% by Hawkins test,70.97% and 38.24% by Neer test,61.29% and 72.06% by Jobe test,and 38.71% and 88.24% by ERLS test.Conclusion： Although physical Hawkins,Neer,Jobe and ERLS tests may reveal the injury degree of the suprasinatus tendon,yet the sensitivity and specificity varies a lot.These findings suggest that additional MRI detection can exclusively lead to accurate diagnosis of this disorder.

关 键 词：物理检查 肩关节 冈上肌腱损伤 

分 类 号：R684[医药卫生—骨科学]