超声和磁共振成像在肩胛下肌肌腱撕裂诊断中的效能分析  

Detection of Subscapularis Tears: The Value of Ultrasound and Magnetic Resonance Imaging

作　　者：张永强 吴勐 张朝 方小东 许家辉 杨辉 周亚东 杨亚龙 李阳 刘俊良 王博 米守湖 Zhang Yongqiang;Wu Meng;Zhang Zhao;Fang Xiaodong;Xu Jiahui;Yang Hui;Zhou Yadong;Yang Yalong;Li Yang;Liu Junliang;Wang Bo;Mi Shouhu(Department of Joints and Sports Medicine,Weapon Industry 521 Hospital,Xi'an 710065,China)

机构地区：[1]兵器工业五二一医院关节外科,西安710065

出　　处：《中国运动医学杂志》2022年第8期612-616,共5页Chinese Journal of Sports Medicine

摘　　要：目的:以肩关节镜诊断肩胛下肌肌腱撕裂作为金标准,分析比较术前肩关节超声和磁共振成像(MRI)诊断肩胛下肌肌腱撕裂的效能,包括准确性、敏感性、特异性等。方法:回顾性纳入我院关节外科180例肩关节镜手术患者作为研究对象,其中,男78例、女102例,年龄为51.0±3.8岁(31~70岁);左肩手术者56例,右肩手术者124例。分析比较术前超声、MRI检查和肩关节镜术中发现肩胛下肌肌腱撕裂的结果,计算超声、MRI检测肩胛下肌撕裂的准确性、敏感性和特异性等。通过kappa系数一致性检验评估超声和MRI诊断肩胛下肌肌腱撕裂结果的一致性。结果:经关节镜诊断,有76例存在肩胛下肌肌腱撕裂(76/180),而超声诊断肩胛下肌肌腱撕裂有66例(66/180),其中45例经关节镜证实诊断正确。超声诊断的敏感性为33.5%,特异性为93.4%。超声诊断的准确率为68.1%。对于较小的撕裂(1、2型),超声敏感性为31.6%,而对于较大的撕裂(3~5型),超声敏感性为74.2%。MRI诊断肩胛下肌肌腱撕裂患者为78例(78/180),经关节镜手术证实,其中69例诊断正确。MRI诊断的敏感性为37.6%,特异性为94.3%。MRI诊断的准确率为88.5%。对于1、2型撕裂,MRI敏感性较低(22.2%),对于3~5型撕裂,MRI敏感性为79.3%。结论:MRI在诊断肩胛下肌肌腱撕裂时,准确性和敏感性均优于超声,特别是对于较大的撕裂(3~5型),MRI敏感性高于超声。但在诊断较小撕裂(1、2型)时,超声诊断的敏感性高于MRI诊断。Objective To analyze and compare the efficacy of preoperative shoulder ultrasound and magnetic resonance imaging(MRI) in the diagnosis of subscapularis tear,including its accuracy,sensitivity and specificity,and confirm the gold standard of diagnosing subscapularis tear through shoulder arthroscopy. Methods A total of 180 patients(mean age: 51.0 ± 3.8 years,78 males and 102 females)undergoing arthroscopic shoulder operation were retrospectively enrolled as the research objects. The results of preoperative ultrasound and MRI were compared with the results of shoulder arthroscopy in the diagnosis of subscapularis tears, so as to evaluate the accuracy, sensitivity and specificity of ultrasound and MRI in the detection of subscapularis tears. The consistency of ultrasound and MRI in the diagnosis of subscapularis tendon tears was assessed using the Kappa coefficient consistency test. Results Subscapularis tears were diagnosed arthroscopically in 76 cases(76/180) and sonographically in 66cases(66/180),of which 45 cases were confirmed arthroscopically,with the sensitivity and specificity of 33.5% and 93.4% respectively. The accuracy of ultrasonic diagnosis was 68.1%. The ultrasonic sensitivity of smaller(type 1 and 2) and larger(type 3-5) tears,were 31.6% and 74.2% respectively. Totally 78 patients(78/180) were diagnosed as subscapularis tears according to MRI,of which 69 cases were confirmed by arthroscopy. Therefore, the sensitivity, specificity and accuracy of MRI diagnosis were 37.6%,94.3% and 88.5%. MRI was of low sensitivity(22.2%) in diagnosing type 1 and 2 tears,but of high sensitivity in type 3-5 tears(79.3%). Conclusion MRI has better accuracy and sensitivity in diagnosing subscapularis tears than ultrasound,especially for large tears(type 3-5). However,ultrasound is superior to MRI in the sensitivity of diagnosing small tears(type 1 and 2).

关 键 词：肩胛下肌 肩袖撕裂 超声 MRI 诊断 

分 类 号：R686[医药卫生—骨科学]