Chang Ke-Vin, Chen Wen-Shiang, Wang Tyng-Guey, Hung Chen-Yu, Chien Kuo-Liong
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
PLoS One. 2014 Nov 20;9(11):e113803. doi: 10.1371/journal.pone.0113803. eCollection 2014.
Pathology of the long head biceps tendon (LHBT) is associated with rotator cuff tears but whether the LHBT texture changes following supraspinatus tendon full thickness tear (SSFT) can be detected at the extra-articular segment remains unknown. This cross-sectional study aimed to explore the morphological differences of the LHBT in shoulders with and without deficient rotator cuffs by using quantitative ultrasound.
We selected 145 cases with SSFT and 145 age-and- gender-matched controls. The width, thickness, flattening ratio, cross-sectional area, and echogenicity ratio of the LHBT were measured and a general linear model was used to clarify the relationship between rotator cuff pathology and LHBT morphology. The receiver operating characteristic curves of each parameter were constructed for SSFT discrimination and the maximal Youden indexes were used to define the best cut-off points.
We found increased thickness and cross-sectional area but decreased flattening ratio in shoulders with SSFT, and no between-group differences in the width and echogenicity ratio. The LHBT appearance was modified by biceps peritendinous effusion and medial subluxation, but not by the size of SSFT. The flattening ratio was the best discriminator for SSFT with an area under curve of 0.81 (95% confidence interval, 0.76-0.86). The cut-off values to differentiate between the non-tear and tear groups were 2.00 mm of the thickness, 1.73 of the flattening ratio and 10.53 mm(2) of the cross-sectional area.
Quantitative ultrasound facilitated the detection of the LHBT morphological changes following SSFT and demonstrated its potential utility in discriminating rotator cuff deficiency.
肱二头肌长头肌腱(LHBT)的病理改变与肩袖撕裂相关,但肩袖全层撕裂(SSFT)后LHBT在关节外部分的质地变化能否被检测到仍不清楚。本横断面研究旨在通过定量超声探索肩袖完整和不完整的肩部LHBT的形态学差异。
我们选取了145例SSFT患者和145例年龄及性别匹配的对照者。测量LHBT的宽度、厚度、扁平率、横截面积和回声率,并使用一般线性模型阐明肩袖病理与LHBT形态之间的关系。构建每个参数的受试者工作特征曲线以鉴别SSFT,并使用最大约登指数确定最佳截断点。
我们发现SSFT患者肩部的LHBT厚度和横截面积增加,但扁平率降低,宽度和回声率在组间无差异。LHBT的表现受肱二头肌肌腱周围积液和内侧半脱位的影响,但不受SSFT大小的影响。扁平率是鉴别SSFT的最佳指标,曲线下面积为0.81(95%置信区间,0.76 - 0.86)。区分无撕裂组和撕裂组的截断值分别为:厚度2.00 mm、扁平率1.73、横截面积10.53 mm²。
定量超声有助于检测SSFT后LHBT的形态学变化,并显示出其在鉴别肩袖损伤方面的潜在效用。