微创医学

目的探讨肩袖损伤诊断中的肩关节MRI与体格检查的诊断准确性。方法对经关节镜检查的80例肩部损伤患者，分析术前肩关节MRI检查和MRI造影及肩关节体检情况，并分析其敏感度和特异度。结果 80例患者经关节镜检查肩部损伤情况，发现64例为肩袖损伤，其中39例为完全撕裂、25例为部分撕裂、16例肩袖未见明显异常。64例肩袖损伤患者中，体检确诊为阳性者58例，6例阴性，敏感度为90.6%；MRI确诊阳性者54例，10例阴性，敏感度为84.4%。39例完全撕裂者中，体检确诊36例阳性，3例阴性，敏感度92.3%；MRI确诊32例阳性，7例阴性，敏感度82.1%。25例部分撕裂者中，体检证实阳性22例，阴性3例，敏感度88.0%；MRI证实阳性19例，阴性6例，敏感度76.0%。16例肩袖关节镜检查阴性者中，体检证实9例阳性，7例阴性，特异度为43.8%；MRI证实6例阳性，10例阴性，特异度为62.5%。肩关节造影MRI结果显示，确诊阳性59例，阴性5例，敏感度为92.2%；16例肩袖未损伤患者检查中，阳性3例，阴性13例，特异度为81.3%。结论肩袖损伤的诊断，体检敏感度高，特异性低；MRI检查特异度高，敏感性低；肩关节造影MRI敏感度和特异度均高于普通MRI检查。诊断肩袖损伤时，应先进行体格检查，再进行MRI扫描，可更好的诊断肩袖损伤，为临床治疗提供准确的诊断依据。

Objective To explore the diagnostic accuracy of MRI and physical examination for rotator cuff injury. Methods Eighty patients with shoulder injury who underwent arthroscopy were enrolled in the study. The data of preoperative assessment in shoulder joint by MRI, MRI arthrography and physical examination was retrospectively analyzed, and the sensitivity and specificity of the three approaches were evaluated. Results Of the 80 patients with shoulder injuries，60 cases were considered as rotator cuff injury according to arthroscopy. And the 80 cases consisted of 39 cases with complete laceration, 25 cases with partial laceration and 16 cases with normal rotator cuff. For the 64 patients with rotator cuff injury, there were 58 positive cases and 6 negative cases confirmed by physical examination compared with 54 positive cases and 10 negative cases confirmed by MRI, and the sensitivity of physical examination and MRI were 90.6% and 84.4% respectively. For the 39 cases with complete laceration, there were 36 positive cases and 3 negative cases confirmed by physical examination compared with 32 positive cases and 7 negative cases confirmed by MRI, and the sensitivity of physical examination and MRI were 92.3% and 82.1% respectively. For the 25 cases with partial laceration, there were 22 positive cases and 3 negative cases confirmed by physical examination compared with 19 positive cases and 6 negative cases confirmed by MRI, and the sensitivity of physical examination and MRI were 88.0% and 76.0% respectively. For the 16 cases without rotator cuff injury, there were 9 positive cases and 7 negative cases confirmed by physical examination compared with 6 positive cases and 10 negative cases confirmed by MRI, and the specificity of physical examination and MRI were 43.8% and 62.5% respectively. The results of MRI arthrography for shoulder joint revealed that there were 59 positive cases and 5 negative cases, and the sensitivity was 92.2%. For the 16 cases without rotator cuff injury, there were 3 positive cases and 13 negative cases confirmed by MRI arthrography, and the specificity was 81.3%. Conclusions For the diagnosis of rotator cuff injury, physical examination has high sensitivity and low specificity, whereas MRI has high specificity and low sensitivity. The sensitivity and specificity of MRI arthrography are higher than those of conventional MRI. MRI scan should be performed following physical examination in patients with rotator cuff injury, which is a better diagnostic process for rotator cuff injury and can provide accurate diagnostic basis for clinical treatment.