Steadman Hawkins Clinic of the Carolinas, Greenville Hospital System, Greenville, SC, USA.
North Mississippi Sports Medicine and Orthopaedic Clinic, Tupelo, MS, USA.
J Shoulder Elbow Surg. 2014 Jul;23(7):1023-7. doi: 10.1016/j.jse.2014.02.014.
We hypothesize that patients with a positive tangent sign will have rotator cuff tears that are not able to be repaired primarily.
We performed a retrospective review of the charts of patients who had undergone surgery for repair of a rotator cuff tear. The operative note was reviewed to determine whether the cuff tear was primarily repaired. The magnetic resonance imaging study of each patient was reviewed to assess for a positive or negative tangent sign. The reviewer was blinded to the result of each measurement.
Eighty-one patients met the inclusion criteria. Of the 79 included in our analyses, 17 had a positive tangent sign and 62 had a negative tangent sign. There was only 1 patient with a negative tangent sign who had an irreparable rotator cuff tear. There were 3 patients with a positive tangent sign who had a repairable rotator cuff. With a pretest prevalence of irreparable tears of 18.9%, a positive finding suggested a post-test probability of 82.3% with a positive tangent sign and a post-test probability of only 1.6% when the tangent sign was negative.
Our results showed decision-making value in both a negative tangent sign and a positive tangent sign. The tangent sign is an easily performed and reproducible tool with good intraobserver and interobserver reliability that is a powerful predictor of whether a rotator cuff tear will be repairable.
我们假设正切征阳性的患者肩袖撕裂将无法进行初次修复。
我们对接受肩袖撕裂修复手术的患者的病历进行了回顾性研究。手术记录用于确定肩袖撕裂是否进行了初次修复。每位患者的磁共振成像研究用于评估正切征的阳性或阴性。评估者对每个测量结果均不知情。
81 名患者符合纳入标准。在纳入我们分析的 79 例中，17 例有正切征阳性，62 例有正切征阴性。仅有 1 例正切征阴性患者存在不可修复的肩袖撕裂。有 3 例正切征阳性患者存在可修复的肩袖撕裂。在不可修复撕裂的术前患病率为 18.9%的情况下，正切征阳性提示的阳性后验概率为 82.3%，而正切征阴性的阳性后验概率仅为 1.6%。
我们的结果表明，负切征和正切征均具有决策价值。正切征是一种易于操作且可重复的工具，具有良好的观察者内和观察者间可靠性，是肩袖撕裂是否可修复的有力预测指标。
