Shi Lewis L, Mullen Martin G, Freehill Michael T, Lin Albert, Warner Jon J P, Higgins Laurence D
Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Chicago, Illinois, U.S.A.
Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.
Arthroscopy. 2015 Apr;31(4):615-9. doi: 10.1016/j.arthro.2014.11.034. Epub 2015 Jan 28.
The aim of this study is to understand the relation between long head of the biceps tendon (LHBT) subluxation and full-thickness tears of the subscapularis.
Magnetic resonance imaging (MRI) scans of 94 patients undergoing shoulder arthroscopy were evaluated preoperatively for the presence or absence of LHBT subluxation. Intraoperative pathology of the biceps and subscapularis tendons was recorded. The diagnostic accuracy of LHBT subluxation on preoperative MRI in determining full-thickness subscapularis tendon tears was calculated.
Of the 94 patients in this study, 26 were diagnosed with LHBT subluxation preoperatively. Of these 26 patients, 9 were confirmed to have full-thickness tears of the subscapularis tendon (Lafosse grade 2 or higher). Of the remaining 68 patients who did not appear to have LHBT subluxation preoperatively, 2 were confirmed to have full-thickness tears of the subscapularis tendon. Thus LHBT subluxation on MRI as a predictor for full-thickness subscapularis tears had a sensitivity of 82%, specificity of 80%, positive predictive value of 35%, and negative predictive value of 97%. LHBT subluxation was directly correlated with the severity of the subscapularis tendon tear (P < .001).
The diagnostic value of subluxation of the LHBT, as seen on an axial MRI scan, lies primarily in its negative predictive value. If the LHBT is not subluxated, it is unlikely that a full-thickness tear of the subscapularis tendon is present. Surgeons should be cautious about relying on biceps subluxation as a primary diagnostic tool in predicting subscapularis tears.
Level IV, study of diagnostic test.
本研究旨在了解肱二头肌长头肌腱（LHBT）半脱位与肩胛下肌全层撕裂之间的关系。
对94例接受肩关节镜检查的患者术前的磁共振成像（MRI）扫描进行评估，以确定是否存在LHBT半脱位。记录术中肱二头肌和肩胛下肌肌腱的病理情况。计算术前MRI上LHBT半脱位在诊断肩胛下肌肌腱全层撕裂方面的诊断准确性。
本研究的94例患者中，26例术前被诊断为LHBT半脱位。在这26例患者中，9例被证实存在肩胛下肌肌腱全层撕裂（Lafosse分级为2级或更高）。在术前未表现出LHBT半脱位的其余68例患者中，2例被证实存在肩胛下肌肌腱全层撕裂。因此，MRI上的LHBT半脱位作为肩胛下肌全层撕裂的预测指标，其敏感性为82%，特异性为80%，阳性预测值为35%，阴性预测值为97%。LHBT半脱位与肩胛下肌肌腱撕裂的严重程度直接相关（P <.001）。
轴位MRI扫描显示的LHBT半脱位的诊断价值主要在于其阴性预测值。如果LHBT未半脱位，则肩胛下肌肌腱全层撕裂的可能性不大。外科医生在将肱二头肌半脱位作为预测肩胛下肌撕裂的主要诊断工具时应谨慎。
IV级，诊断试验研究。
