Gaenslen E S, Satterlee C C, Hinson G W
Department of Orthopaedic Surgery, University of Missouri, Kansas City, USA.
J Bone Joint Surg Am. 1996 Sep;78(9):1391-6. doi: 10.2106/00004623-199609000-00015.
We used magnetic resonance imaging to evaluate thirty shoulders in twenty-nine patients who had unacceptable pain and loss of function after at least one operative procedure for a lesion of the rotator cuff. A preoperative history was recorded and physical and radiographic examinations were performed before magnetic resonance imaging. All patients had a reoperation two to 156 months (average, thirty-two months) after the operation. The results of the magnetic resonance imaging and the findings at the most recent operation were then compared with regard to the integrity of the rotator cuff, the deltoid muscle, and the long head of the biceps tendon. The sensitivity and specificity of magnetic resonance imaging for the diagnosis of full-thickness tears, partial-thickness tears, and intact rotator cuffs were 84 and 91 per cent, 83 and 83 per cent, and 80 and 100 per cent, respectively. The positive and negative predictive values were 94 and 77 per cent, 56 and 95 per cent, and 100 and 96 per cent, respectively. Three shoulders had a clinically detached and retracted origin of the deltoid muscle that was identified correctly on magnetic resonance imaging, and this finding was confirmed operatively. A rupture of the long head of the biceps tendon was identified correctly in four of six shoulders. In one of the two remaining shoulders, the rupture was obscured on magnetic resonance imaging because of a so-called balloon artefact from a nearby metal suture anchor. Magnetic resonance imaging detected two unexpected lesions: a denudation of the articular cartilage in one shoulder and a ganglion cyst in the supraspinatus muscle in another.
我们使用磁共振成像对29例患者的30个肩部进行了评估，这些患者在至少接受了一次针对肩袖损伤的手术治疗后仍有难以忍受的疼痛和功能丧失。记录了术前病史，并在磁共振成像前进行了体格检查和影像学检查。所有患者在初次手术后2至156个月（平均32个月）接受了再次手术。然后将磁共振成像结果与最近一次手术的发现进行比较，涉及肩袖、三角肌和肱二头肌长头肌腱的完整性。磁共振成像诊断全层撕裂、部分层撕裂和完整肩袖的敏感性和特异性分别为84%和91%、83%和83%、80%和100%。阳性和阴性预测值分别为94%和77%、56%和95%、100%和96%。三个肩部的三角肌起点在临床上出现分离和回缩，磁共振成像正确识别了这一情况，手术中也得到了证实。在六个肩部中的四个正确识别出了肱二头肌长头肌腱断裂。在其余两个肩部中的一个，由于附近金属缝合锚钉产生的所谓“气球伪影”，磁共振成像未能清晰显示肌腱断裂。磁共振成像还检测到两个意外病变：一个肩部的关节软骨剥脱和另一个肩部冈上肌内的腱鞘囊肿。
