肩关节特殊体查试验对肩胛下肌腱撕裂诊断的价值  

The value of shoulder special physical test in the diagnosis of subscapular tendon tear

作　　者：崔德栋 周敏 周传海 龙毅 侯景义[1] 杨睿[1] Cui Dedong;Zhou Min;Zhou Chuanhai;Long Yi;Hou Jingyi;Yang Rui(Department of Orthopedics,SunYat-sen Memorial Hospital,SunYat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院骨外科,广州510120

出　　处：《中华肩肘外科电子杂志》2024年第1期14-20,共7页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的探讨肩关节特殊体查试验在肩胛下肌腱撕裂诊断中的价值。方法回顾性分析2021年1月1日至2022年12月31日以肩袖损伤为诊断入院行肩关节镜手术治疗的211例患者,术前分别行肩关节特殊体查试验:抬离试验、压腹试验、熊抱试验、内旋迟滞试验。以术中关节镜检查结果为金标准,通过对比分析四项体查试验诊断肩胛下肌腱损伤的敏感性、特异性、ROC曲线下面积等。结果经关节镜检查证实,211例患者中有108例肩胛下肌腱完整,72例肩胛下肌腱部分撕裂(Lafossa I型),31例全层撕裂(Lafossa II-V型)。对Lafossa I-V型损伤,各项体查试验的敏感性为熊抱试验(81.6%)>抬离试验(71.8%)>压腹试验(68.0%)>内旋迟滞试验(48.5%),特异性为内旋迟滞试验(71.3%)>熊抱试验(63.0%)>抬离试验(50.0%)>压腹试验(46.3%),ROC曲线下面积为熊抱试验(0.609)>抬离试验(0.573)>压腹试验(0.568)>内旋迟滞试验(0.538)。对Lafossa II-V型损伤,各项体查试验的敏感性为熊抱试验(93.5%)>压腹试验(80.6%)>抬离试验(77.4%)>内旋迟滞试验(45.2%),特异性为内旋迟滞试验(62.8%)>抬离试验(57.8%)>熊抱试验(47.2%)>压腹试验(42.3%)。ROC曲线下面积为熊抱试验(0.682)>抬离试验(0.644)>内旋迟滞试验(0.599)>压腹试验(0.571)。上述各项试验并不具备区分肩胛下肌腱部分撕裂和全层撕裂的能力(P>0.05)。联合试验可提高特殊体查试验的敏感性(84.5%)和ROC曲线下面积(0.723)。结论在纳入研究的四项肩关节特殊体查试验中,熊抱试验具有最高的诊断效能,特别是肩胛下肌腱全层撕裂的病例。同时也建议行四项体查试验联合检查,以进一步提高诊断效能。尽管如此,肩胛下肌腱撕裂仍有漏诊,尤其是部分撕裂。因此,为了防止肩胛下肌腱撕裂的漏诊,在关节镜手术过程中必须对肩胛下肌腱仔细探查。Background Subscapularis muscle(SSc)is one of the critical components of rotator cuff muscles,the largest and strongest muscle in the rotator cuff muscle group,and the only rotator cuff muscle located in front.SSc is a robust internal rotator and dynamic anterior stabilizer of the glenohumeral joint,so the integrity of the SSc tendon is essential.However,SSc tendon injury is often overlooked,so it is named a"forgotten tendon".SSc tendon tear is not rare.According to previous literature reports on open shoulder surgery and cadaver studies,the prevalence of SSc tendon tear is 3.5%-29.4%.However,with the progress and widespread use of shoulder arthroscopy technology,the prevalence of SSc tendon tear is much higher than 29.4%.The incidence of SSc tear in arthroscopic rotator cuff surgery is 31.4%-69.5%.Missed diagnosis of SSc tendon tear can lead to postoperative symptom residue and poor functional recovery,which are potential risk factors for medical disputes.Therefore,accurate preoperative prediction of SSc tendon tear is significant for both patients and shoulder surgeons.Despite the breakthroughs in high-resolution magnetic resonance imaging technology,diagnosing SSc tendon tears is still challenging due to the relatively particular anatomical structure of the insertion site of the SSc tendon,especially in patients with partial or minor tears.In addition,MRI is currently one of the large-scale examinations that cost a lot of money and time in China;in primary hospitals,the conditions for high-resolution MRI examinations may not be available.Therefore,if there is an inexpensive,accurate,and repeatable physical examination of the shoulder joint that can detect SSc tendon tears early,it can reduce the waste of medical resources and the economic burden on patients.In foreign countries,there have been relevant special physical examination tests of the shoulder joint for the diagnosis of SSc tendon injuries,such as the lifting test,abdominal pressure test,bear-hug test,and internal rotation hysteresis test,etc.,and hav

关 键 词：肩胛下肌腱撕裂 体查试验 诊断 评价 

分 类 号：R687.2[医药卫生—骨科学]