一种肱二头肌长头腱及滑车损伤的筛查试验——俘获试验  

A screening test for biceps long head tendon and pulley injuries:the capture test

作　　者：弓爵 魏志亨 王浩丞 贾梦阳 王卫明 向先祥 Gong Jue;Wei Zhiheng;Wang Haocheng;Jia Mengyang;Wang Weiming;Xiang Xianxiang(Department of Sports Medicine,Xinhua Hospital Affiliated to Dalian University,Dalian 116000,China)

机构地区：[1]辽宁省大连市大连大学附属新华医院运动医学科,大连116000

出　　处：《中国运动医学杂志》2024年第12期954-963,共10页Chinese Journal of Sports Medicine

基　　金：大连市医学科学研究计划(2311038)。

摘　　要：目的:评价传统肩关节查体试验和俘获试验在诊断肱二头肌长头腱(long head of biceps tendon,LHBT)及滑车(pully)损伤中的能力。方法:回顾性分析在单一研究中心(大连大学附属新华医院)216例因肩关节疼痛就诊并进行关节镜手术的的患者,进行多种传统的肩关节查体试验,如Yergason试验、Speed试验、Upper cut试验、BT试验等,同时提出一种新的检查方法——俘获试验。以关节镜下探查结果作为金标准,比较各项试验在诊断LHBT损伤、滑车损伤方面的灵敏度、特异性、阳性似然比、阴性似然比,以及确定各项查体试验对临床诊断的预测价值。结果:共有216例患者参与本项研究并接受手术干预,其中男性101例,女性115例,年龄范围22~71岁。在诊断LHBT方面,俘获试验具有最高的灵敏度0.77(P<0.05),在特异性上较Speed试验表现出优势(0.57 vs.0.68,P=0.016),而较其它三项查体试验无显著差异(P>0.05)。在诊断滑车损伤方面,俘获试验具有最高的灵敏度0.84(P<0.05),在特异性上较Speed试验表现出优势(0.44 vs.0.61,P=0.017),而较其它三项查体试验无显著差异(P>0.05)。俘获试验在诊断LHBT损伤以及滑车损伤中均表现出最低的阴性似然比(0.40/0.36)(P<0.05)。回归性分析结果显示,在诊断滑车损伤方面,俘获试验OR=29.85(P<0.05),Yergason试验OR=0.43(P=0.006),BT试验OR=3.82(P=0.014),Upper cut试验OR=1.2、Speed试验OR=0.59(均P>0.05)。在诊断肱二头肌长头腱损伤方面,俘获试验OR=30.1(P<0.05),Yergason试验OR=0.034(P<0.05),BT试验OR=4.472(P=0.006),Upper cut试验OR=3.34、Speed试验OR=0.07(均P>0.05)。结论:在诊断肱二头肌长头腱和滑车损伤方面,与传统查体相比,俘获试验具有最高的灵敏度和最低的阴性似然比,可以作为肱二头肌长头腱及滑车损伤的筛查试验。Objective To evaluate the value of conventional shoulder physical examination tests as well as the capture test in the diagnosis of long head of biceps tendon(LHBT)and pully injuries.Methods Totally 216 shoulder painpatients undergoing arthroscopic surgery in Xinhua Hospital,Dalian University were performed such conventional shoulder examination tests as the Yergason test,Speed test,Upper cut test,and BT test,as well as the new examination method--the capture test.The sen⁃sitivity,specificity,positive likelihood ratio and negative likelihood ratio of each test were compared with the results of arthroscopic examination as the gold standard in the diagnosis of LHBT injury and gliding injury,so as to determine their predictive value for clinical diagnosis.Results A total of 216 patients underwent surgery,101 males and 115 females,ranging in age from 22 to 71 years.For the diagnosis of LHBT and pully injury,the Capture test had the highest sensitivity of 0.77 and 0.84(P<0.05)and showed an advantage over the Speed test in terms of specificity(0.57 vs.0.68,P=0.016;0.44 vs.0.61,P=0.017),without significant differences from the other three tests(P>0.05).The cap⁃ture test had the lowest negative likelihood ratio(0.40/0.36)for diagnosing both LHBT and scooter inju⁃ries(P<0.05).Moreover,according to regression analysis,it can be concluded that in the diagnosis of pulley injuries,OR of the capture test,the Yergason test,the BT test,the Upper cut test and the Speed test were 29.85(P<0.05),0.43(P=0.006),3.82(P=0.014),1.2 and 0.59(P>0.05),respectively.However,in the diagnosis of biceps long head tendon injury,the corresponding values were 30.1(P<0.05),0.034(P<0.05),4.472(P=0.006),3.34 and 0.07(P>0.05),respectively.Conclusion In the diag⁃nosis of LHBT and pully injuries,the Capture test has the highest sensitivity and lowest negative like⁃lihood ratio compared to conventional testing and can be used as a promising screening test in the fu⁃ture.

关 键 词：体格检查 长头腱损伤 滑车损伤 俘获试验 

分 类 号：R873[医药卫生—运动医学]