[目的]对比术前MRI测量与术中所见,探讨MRI诊断冈上肌腱全层撕裂的价值。[方法]回顾性分析2017年1月—2023年12月冈上肌腱全层撕裂41例患者的临床资料。根据术中镜下测量撕裂长度分重度组(长度≥3 cm)与轻中度组(长度<3 cm)。比较两...[目的]对比术前MRI测量与术中所见,探讨MRI诊断冈上肌腱全层撕裂的价值。[方法]回顾性分析2017年1月—2023年12月冈上肌腱全层撕裂41例患者的临床资料。根据术中镜下测量撕裂长度分重度组(长度≥3 cm)与轻中度组(长度<3 cm)。比较两组术前MRI和术中指标。对组间差异有统计学意义的MRI评估指标行ROC分析。[结果]依据术中肩袖撕裂程度所见将患者分为重度组14例,轻中度组27例。重度组的术中测量撕裂长度[(40.0±7.8) mm vs(17.9±4.2) mm, P<0.001]、冠状面肌腱撕裂长度(coronal length, CL)[(13.6±5) mm vs(6.2±3.1) mm, P<0.001]、水平面肌腱撕裂长度(horizontal length, HL)[(16.1±5.5) mm vs(9.0±2.3) mm, P<0.001]、肌腱撕裂校正长度(combined length, CoL)[(21.8±5.3) mm vs(11.1±3.1) mm, P<0.001]、肩峰下积液厚度(subacromial thickness of fluid accumulation, STFA)[(4.1±2.1) mm vs(2.7±1.7) mm, P=0.033]均显著大于轻中度组。但是,两组在肩关节前方和内侧积液发生率、肩峰肱骨间距(acromiohumeral interval distance, AHID)、横断面喙肱距离(coracohumeral dis-tance, CHD横断)的差异均无统计学意义(P>0.05)。ROC分析表明,MRI测得冈上肌腱CoL、CL、HL和STFA预测术中测量撕裂大小的曲线下面积(area under curve, AUC)分别为0.950、0.878、0.865、0.694。[结论]综合两个或两个以上MRI测量指标可以准确评估冈上肌腱全层撕裂的严重程度,校正撕裂长度的诊断效能最高。展开更多
Background: The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection ofa supraspinatus tear using an accurate physical examination is, therefore, important. However, the cur...Background: The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection ofa supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests. Methods: Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically tbr their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer. Results: The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (X2 = 0.578, P = 0.898) and size (Fisher's exact test, P 〉 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823. Conclusions: The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.展开更多
目的探讨临床常见的退行性中、小型肩袖撕裂保守与手术两种治疗方案的临床效果对比。方法选取本院2022年1月至12月治疗的137例退行性中、小型肩袖撕裂患者。根据肩袖撕裂大小分为小型撕裂(<1 cm)、中型撕裂(1~3 cm),再按照治疗方式...目的探讨临床常见的退行性中、小型肩袖撕裂保守与手术两种治疗方案的临床效果对比。方法选取本院2022年1月至12月治疗的137例退行性中、小型肩袖撕裂患者。根据肩袖撕裂大小分为小型撕裂(<1 cm)、中型撕裂(1~3 cm),再按照治疗方式分保守组、手术组(手术采用肩关节镜)。治疗效果采用视觉模拟评分(visual analogue scale,VAS),肩关节前屈及外展活动度,治疗前、末次随访时Constant-Murley评分(constant shoulder score,CMS),美国加州大学洛杉矶分校肩关节评分(the university of California at Los Angeles shoulderrating scale,UCLA)。所有患者均于治疗后1个月、3个月、6个月、12个月进行随访。结果小型肩袖撕裂的患者在治疗后1个月随访时,发现两组VAS评分及肩关节前屈、外展活动度有差异,两组对比差异有统计学意义(P<0.001),在3个月、6个月、12个月随访时差异无统计学意义(P>0.05)。中型肩袖撕裂患者在治疗后1个月及3个月随访时,两组VAS评分及肩关节前屈、外展活动度有明显差异,差异具有统计学意义(P<0.001);在治疗后中长期的随访中发现两组仅在VAS评分的差异有统计学意义(P<0.001)。末次随访时,两种撕裂的CMS评分、UCLA评分较治疗前差异显著(P<0.001),但二者之间的差异无统计学意义(P>0.05)。结论保守及手术治疗对中、小型退行性肩袖撕裂均取得良好的临床疗效。术后短期疗效对比,手术治疗的效果要明显优于保守治疗,中长期疗效,两种治疗方案无明显差异。展开更多
目的探讨关节镜下改良阻挡线减张(modified load-sharing rip-stop,mLSRS)技术及双排缝线桥技术治疗大型肩袖撕裂的疗效,并分析其预后。方法选取2019年1月至2021年12月在本院诊治的大型肩袖撕裂患者84例,根据治疗方法不同分为mLSRS组41...目的探讨关节镜下改良阻挡线减张(modified load-sharing rip-stop,mLSRS)技术及双排缝线桥技术治疗大型肩袖撕裂的疗效,并分析其预后。方法选取2019年1月至2021年12月在本院诊治的大型肩袖撕裂患者84例,根据治疗方法不同分为mLSRS组41例和双排缝线桥组43例,mLSRS组给予关节镜下mLSRS技术治疗,双排缝线桥组给予双排缝线桥技术治疗,比较两组术前、术后1年视觉模拟评分量表(visual analogue rating scale,VAS)、肩关节Constant-Murley评分、美国加州大学肩关节评分系统(the university of California at Los Angeles shouler rating scale,UCLA)评分、美国肩肘外科协会(the American society of shoulder and elbow surgery,ASES)评分、肩关节活动度,以及预后和并发症发生情况。结果术后1年,两组VAS评分较术前均降低(P<0.05),两组Constant-Murley、UCLA、ASES评分较术前均升高(P<0.05),但mLSRS组VAS、Constant-Murley、UCLA、ASES评分与双排缝线桥组比较,差异均无统计学意义(P>0.05)。术后1年,两组体侧内旋较术前均降低(P<0.05),两组前屈、外展、体侧外旋较术前均升高(P<0.05),但mLSRS组前屈、外展、体侧外旋、体侧内旋与双排缝线桥组比较,差异均无统计学意义(P>0.05)。mLSRS组的愈合率为95.12%,明显高于双排缝线桥组的79.07%(P<0.05),mLSRS组的再撕裂率为4.88%,明显低于双排缝线桥组的20.93%(P<0.05)。mLSRS组的并发症发生率为9.76%,与双排缝线桥组的6.98%比较,差异无统计学意义(P>0.05)。结论关节镜下mLSRS技术及双排缝线桥技术治疗大型肩袖撕裂均可有效缓解疼痛,改善肩关节功能和肩关节活动度,且安全性高,但关节镜下mLSRS技术可更有效提高肩袖愈合率,降低再撕裂率,改善预后。展开更多
文摘[目的]对比术前MRI测量与术中所见,探讨MRI诊断冈上肌腱全层撕裂的价值。[方法]回顾性分析2017年1月—2023年12月冈上肌腱全层撕裂41例患者的临床资料。根据术中镜下测量撕裂长度分重度组(长度≥3 cm)与轻中度组(长度<3 cm)。比较两组术前MRI和术中指标。对组间差异有统计学意义的MRI评估指标行ROC分析。[结果]依据术中肩袖撕裂程度所见将患者分为重度组14例,轻中度组27例。重度组的术中测量撕裂长度[(40.0±7.8) mm vs(17.9±4.2) mm, P<0.001]、冠状面肌腱撕裂长度(coronal length, CL)[(13.6±5) mm vs(6.2±3.1) mm, P<0.001]、水平面肌腱撕裂长度(horizontal length, HL)[(16.1±5.5) mm vs(9.0±2.3) mm, P<0.001]、肌腱撕裂校正长度(combined length, CoL)[(21.8±5.3) mm vs(11.1±3.1) mm, P<0.001]、肩峰下积液厚度(subacromial thickness of fluid accumulation, STFA)[(4.1±2.1) mm vs(2.7±1.7) mm, P=0.033]均显著大于轻中度组。但是,两组在肩关节前方和内侧积液发生率、肩峰肱骨间距(acromiohumeral interval distance, AHID)、横断面喙肱距离(coracohumeral dis-tance, CHD横断)的差异均无统计学意义(P>0.05)。ROC分析表明,MRI测得冈上肌腱CoL、CL、HL和STFA预测术中测量撕裂大小的曲线下面积(area under curve, AUC)分别为0.950、0.878、0.865、0.694。[结论]综合两个或两个以上MRI测量指标可以准确评估冈上肌腱全层撕裂的严重程度,校正撕裂长度的诊断效能最高。
基金This work was supported by a grant from the Specialized Research Fund for the Doctoral Program of Higher Educationof China (No. 20120001120070).
文摘Background: The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection ofa supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests. Methods: Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically tbr their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer. Results: The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (X2 = 0.578, P = 0.898) and size (Fisher's exact test, P 〉 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823. Conclusions: The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.
文摘目的探讨临床常见的退行性中、小型肩袖撕裂保守与手术两种治疗方案的临床效果对比。方法选取本院2022年1月至12月治疗的137例退行性中、小型肩袖撕裂患者。根据肩袖撕裂大小分为小型撕裂(<1 cm)、中型撕裂(1~3 cm),再按照治疗方式分保守组、手术组(手术采用肩关节镜)。治疗效果采用视觉模拟评分(visual analogue scale,VAS),肩关节前屈及外展活动度,治疗前、末次随访时Constant-Murley评分(constant shoulder score,CMS),美国加州大学洛杉矶分校肩关节评分(the university of California at Los Angeles shoulderrating scale,UCLA)。所有患者均于治疗后1个月、3个月、6个月、12个月进行随访。结果小型肩袖撕裂的患者在治疗后1个月随访时,发现两组VAS评分及肩关节前屈、外展活动度有差异,两组对比差异有统计学意义(P<0.001),在3个月、6个月、12个月随访时差异无统计学意义(P>0.05)。中型肩袖撕裂患者在治疗后1个月及3个月随访时,两组VAS评分及肩关节前屈、外展活动度有明显差异,差异具有统计学意义(P<0.001);在治疗后中长期的随访中发现两组仅在VAS评分的差异有统计学意义(P<0.001)。末次随访时,两种撕裂的CMS评分、UCLA评分较治疗前差异显著(P<0.001),但二者之间的差异无统计学意义(P>0.05)。结论保守及手术治疗对中、小型退行性肩袖撕裂均取得良好的临床疗效。术后短期疗效对比,手术治疗的效果要明显优于保守治疗,中长期疗效,两种治疗方案无明显差异。
文摘目的探讨关节镜下改良阻挡线减张(modified load-sharing rip-stop,mLSRS)技术及双排缝线桥技术治疗大型肩袖撕裂的疗效,并分析其预后。方法选取2019年1月至2021年12月在本院诊治的大型肩袖撕裂患者84例,根据治疗方法不同分为mLSRS组41例和双排缝线桥组43例,mLSRS组给予关节镜下mLSRS技术治疗,双排缝线桥组给予双排缝线桥技术治疗,比较两组术前、术后1年视觉模拟评分量表(visual analogue rating scale,VAS)、肩关节Constant-Murley评分、美国加州大学肩关节评分系统(the university of California at Los Angeles shouler rating scale,UCLA)评分、美国肩肘外科协会(the American society of shoulder and elbow surgery,ASES)评分、肩关节活动度,以及预后和并发症发生情况。结果术后1年,两组VAS评分较术前均降低(P<0.05),两组Constant-Murley、UCLA、ASES评分较术前均升高(P<0.05),但mLSRS组VAS、Constant-Murley、UCLA、ASES评分与双排缝线桥组比较,差异均无统计学意义(P>0.05)。术后1年,两组体侧内旋较术前均降低(P<0.05),两组前屈、外展、体侧外旋较术前均升高(P<0.05),但mLSRS组前屈、外展、体侧外旋、体侧内旋与双排缝线桥组比较,差异均无统计学意义(P>0.05)。mLSRS组的愈合率为95.12%,明显高于双排缝线桥组的79.07%(P<0.05),mLSRS组的再撕裂率为4.88%,明显低于双排缝线桥组的20.93%(P<0.05)。mLSRS组的并发症发生率为9.76%,与双排缝线桥组的6.98%比较,差异无统计学意义(P>0.05)。结论关节镜下mLSRS技术及双排缝线桥技术治疗大型肩袖撕裂均可有效缓解疼痛,改善肩关节功能和肩关节活动度,且安全性高,但关节镜下mLSRS技术可更有效提高肩袖愈合率,降低再撕裂率,改善预后。
