| 物理查体对肩峰下撞击综合征诊断价值的临床研究 |
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Received:December 06, 2015
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陈成帷 |
CHEN Cheng-wei |
温州医科大学附属第一医院, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
crystalmon@126.com |
| 潘哲尔 |
PAN Zhe-er |
温州医科大学附属第一医院, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 张超 |
ZHANG Chao |
温州医科大学附属第一医院, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 刘彩龙 |
LIU Cai-long |
温州医科大学附属第一医院, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 陈雷 |
CHEN Lei |
温州医科大学附属第一医院, 浙江 温州 325000 |
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2016年29卷，第5期，第434-438页 |
| DOI：10.3969/j.issn.1003-0034.2016.05.009 |
| 基金项目:浙江省自然科学基金资助项目(编号:LY13H060007) |
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| 目的:评价5种常用临床物理查体及联合查体对肩峰下撞击综合征(subacromial impingement syndrome,SAIS)的诊断价值。方法:采用前瞻性、盲法队列设计共纳入105例肩关节疼痛患者,所有患者接受5种物理查体(包括Neer征,Hawkins-Kennedy征,疼痛弧,空罐试验,外旋抗阻试验)及肩关节镜检查,记录结果,依据Nikolaus的诊断标准为SAIS诊断的金标准。对各种查体进行诊断试验相关评价,包括灵敏度、特异度、阳性似然比、阴性似然比和ROC曲线分析。采用逐步前进法的二元Logistic回归分析、ROC曲线分析、Kappa分析及符合率评估联合查体的最佳组合、效力、查体的可靠性。结果:ROC曲线分析显示除Hawkins-Kennedy征外,其他查体AUC均有统计学意义(AUC=0.62～0.73,P<0.05),阳性似然比≥2.0的查体为疼痛弧、空罐试验和外旋抗阻试验,阴性似然比≤0.5的查体为Neer征、疼痛弧和外旋抗阻试验。Logistic回归分析显示疼痛弧、空罐试验、外旋抗阻试验的组合为诊断SAIS的最佳组合,疼痛弧、外旋抗阻试验的组合为排除SAIS的最佳组合。ROC曲线分析结果显示联合查体的AUC有统计学意义(AUC=0.85,P=0.000),高于所有单独查体,最佳截断值为出现任意3项阳性查体。5种物理查体的Kappa值范围为0.42～0.71,符合率范围70.50%～87.60%.结论:3项独立查体(疼痛弧、空罐试验、外旋抗阻试验)阳性及5项查体中出现3个或以上阳性查体有助于SAIS的确诊,3项独立查体(Neer征、疼痛弧、外旋抗阻试验)阴性有助于SAIS的排除。5项查体均具备中到高度的可靠性。疼痛弧、空罐试验、外旋抗阻试验的组合(出现2项或以上阳性查体)为诊断SAIS的最佳组合,疼痛弧、外旋抗阻试验的组合(均为阴性)为排除SAIS的最佳组合。任意3项阳性查体为使用5种物理查体联合诊断和排除SAIS的最佳截断值。 |
| [关键词]:肩峰下撞击综合征 诊断 敏感性 特异性 |
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| Clinical research on the efficiency of physical examinations used for diagnosis of subacromial impingement syndrome |
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| Abstract:Objective: To evaluate the reliability and diagnosis accuracy of 5 special tests used for the diagnosis of subacromial impingement syndrome(SAIS). Methods: A prospective blinded cohort study was taken,in which 105 patients with shoulder pain were reviewed. All the patients took 5 special syndrome tests including Neer syndrome,Hawkins-Kennedy syndrome,painful arc,empty can test and external rotation resistance test,also underwent arthroscopic surgical examination. The Nikolaus's criterion was regarded as a golden standard for SAIS. Data accuracy analysis was calculated through a receiver operating characteristic(ROC) curve,sensitivity,specificity,positive likelihood ratio(+LR),and negative likelihood ratio(-LR). The binary Logistic regression analysis was used to find out the best test combination for ruling in or out SAIS. The interrater reliability was assessed by the Kappa coefficient and percent agreement. Results: The ROC analysis indicated a significant area under the curve(AUC)(AUC=0.62 to 0.73,P<0.05) for all tests except the Hawkins-Kennedy. Tests with a +LR greater or equal to 2.0 were the painful arc,empty can,external rotation resistance,Tests with a-LR less than 0.5 were Neer,painful arc,external rotation resistance. The regression analysis found the painful arc,empty can and external rotation resistance made the best combination for diagnosis SAIS,while the painful arc and external rotation resistance made the best combination for ruling out SAIS. The difference of ROC analysis was significant with a cut-off of 3 positive tests out of 5 tests. All tests had moderate to good agreement (Kappa=0.42 to 0.71). Conclusion: The single test of painful arc,empty can and external rotation resistance,as well as 3 or more positive tests of the 5 tests can help confirm the diagnosis of SAIS,while the single test of Neer,painful arc and external rotation resistance are help rule out the diagnisis of SAIS. The tests of painful arc,empty can and external rotation resistance are the best combination for the diagnosis of SAIS(when 2 or more are positive),while the tests of painful arc and external rotation resistance are the best combination for ruling out SAIS (when both are negative). |
| KEYWORDS:Subacromial impingement syndrome Diagnosis Sensitivity Specificity |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈成帷,潘哲尔,张超,刘彩龙,陈雷.物理查体对肩峰下撞击综合征诊断价值的临床研究[J].中国骨伤,2016,29(5):434~438 |
| 英文格式: | CHEN Cheng-wei,PAN Zhe-er,ZHANG Chao,LIU Cai-long,CHEN Lei.Clinical research on the efficiency of physical examinations used for diagnosis of subacromial impingement syndrome[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(5):434~438 |
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