Iossifidis Anestis, Ibrahim Edward F, Petrou Charalambos
Shoulder and Upper Limb Unit, Croydon University Hospital, London, UK.
Shoulder Elbow. 2015 Jul;7(3):158-62. doi: 10.1177/1758573214557146. Epub 2014 Oct 30.
The present study aims to add to the body of evidence delineating the learning curve for a shoulder surgeon to become proficient in focussed ultrasound for the detection of full-thickness rotator cuff tears, as well as to describe a learning method for this skill.
Consecutive patients who were scheduled to undergo an arthroscopy for rotator cuff disease were scanned immediately before surgery by a senior shoulder surgeon with limited previous experience of shoulder ultrasound. The presence or absence of a full-thickness rotator cuff tear on scan was compared with intra-operative findings as the gold standard.
Two hundred and ten shoulders were scanned over three equal learning periods. Comparing predictive values from the first to the third training period, sensitivity improved from 0.86 to 0.95, specificity from 0.92 to 0.98, negative predictive value from 0.94 to 0.98, and positive predictive value from 0.82 to 0.95.
The high predictive values obtained in the present study for surgeon-led detection of cuff tears using ultrasound are comparable with those quoted for musculoskeletal radiologists in the literature. The present study adds evidence that a shoulder surgeon can achieve accelerated learning of this skill and offers some potentially time-saving and patient-friendly alternatives to existing guidelines.
本研究旨在补充现有证据，描绘肩部外科医生熟练掌握聚焦超声检测全层肩袖撕裂的学习曲线，并描述该技能的学习方法。
对计划接受肩袖疾病关节镜手术的连续患者，在手术前由一位此前肩部超声经验有限的资深肩部外科医生进行扫描。将扫描中肩袖全层撕裂的有无与作为金标准的术中发现进行比较。
在三个相等的学习阶段共扫描了210个肩部。比较第一个训练阶段到第三个训练阶段的预测值，敏感性从0.86提高到0.95，特异性从0.92提高到0.98，阴性预测值从0.94提高到了0.98，阳性预测值从0.82提高到0.95。
本研究中外科医生使用超声检测肩袖撕裂所获得的高预测值与文献中报道的肌肉骨骼放射科医生的预测值相当。本研究补充了证据，表明肩部外科医生可以加速掌握这项技能，并为现有指南提供了一些可能节省时间且对患者友好的替代方案。
