Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A..
Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A.
Arthroscopy. 2021 Apr;37(4):1170-1178. doi: 10.1016/j.arthro.2020.12.184. Epub 2020 Dec 17.
To determine if any association exists between physical examination, imaging findings [ultrasound (US) and magnetic resonance imaging (MRI)], and iliopsoas tendinitis (IPT) to characterize the reliability of these diagnostic modalities.
Patients who had undergone US-guided iliopsoas tendon sheath injection (of lidocaine and a corticosteroid agent) as well as MRI performed within 1 year of injection from 2014 to 2019 were retrospectively reviewed. Demographic data, response to physical exam maneuvers, and response to injection were queried from patient records. US and MRI were reviewed by 2 independent musculoskeletal-trained radiologists. Response to injection was considered positive if the patient improved by >2 points on a 0- to 10-point VAS score. Chi-squared and Fisher exact testing were used to assess for any associations. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated.
Sixty-three patients, age 52.3 ± 17.3 years (mean ± standard deviation), body mass index 27.4 ± 4.3 kg/m, and follow-up 33.6 ± 20.6 months, met inclusion criteria. No physical exam maneuvers, sonographic features, or MRI findings were significantly associated with response to iliopsoas tendon injection (P > .05). Groin pain had a sensitivity of 100% but a specificity of 7%. Snapping hip had a specificity of 82% but a sensitivity of 24%. Pain with resisted straight leg raise (SLR) (sensitivity 62%, specificity 25%) and weakness with resisted SLR (sensitivity 15%, specificity 71%) both were nonreliable. Sonographic bursal distension and tendinosis had low sensitivities (67% and 63%, respectively) and specificities (35% and 32%). Bursal distension on MRI had sensitivity and specificity of 64% and 45%, respectively. Tendon thickening had sensitivity and specificity of 55% and 60%, respectively, and heterogeneity had sensitivity and specificity of 52% and 65%.
Neither physical examination nor US or MRI findings were associated with a positive response to peritendinous iliopsoas corticosteroid injections in patients with suspected IPT.
III, retrospective comparative trial limited by lack of a reference standard for iliopsoas tendonitis diagnosis.
确定体格检查、影像学表现（超声[US]和磁共振成像[MRI]）与髂腰肌肌腱炎（IPT）之间是否存在关联，以确定这些诊断方法的可靠性。
回顾性分析了 2014 年至 2019 年期间接受过 US 引导的髂腰肌肌腱鞘内注射（利多卡因和皮质类固醇药物）且在注射后 1 年内进行 MRI 检查的患者。从病历中查询了患者的人口统计学数据、体格检查操作的反应和注射的反应。由 2 名独立的肌肉骨骼放射科医生对 US 和 MRI 进行了审查。如果患者在 0-10 分视觉模拟量表（VAS）评分上的改善超过 2 分，则认为注射反应为阳性。使用卡方检验和 Fisher 确切检验评估任何关联。计算了敏感性、特异性、阳性预测值和阴性预测值。
63 名年龄 52.3±17.3 岁（均值±标准差）、体重指数 27.4±4.3kg/m2、随访 33.6±20.6 个月的患者符合纳入标准。没有任何体格检查操作、超声特征或 MRI 发现与髂腰肌肌腱注射后的反应有显著相关性（P＞.05）。腹股沟疼痛的敏感性为 100%，但特异性为 7%。弹响髋的特异性为 82%，但敏感性为 24%。直腿抬高抵抗试验（SLR）时的疼痛（敏感性 62%，特异性 25%）和直腿抬高抵抗试验时的无力（敏感性 15%，特异性 71%）均不可靠。超声下滑囊扩张和肌腱病的敏感性较低（分别为 67%和 63%），特异性较低（分别为 35%和 32%）。MRI 下滑囊扩张的敏感性和特异性分别为 64%和 45%，肌腱增厚的敏感性和特异性分别为 55%和 60%，异质性的敏感性和特异性分别为 52%和 65%。
在疑似患有髂腰肌肌腱炎的患者中，体格检查、US 或 MRI 检查结果与经皮髂腰肌皮质类固醇注射后的阳性反应均无关联。
III 级，回顾性比较试验，因缺乏髂腰肌肌腱炎诊断的参考标准而受到限制。
