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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears
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Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears

机译：隐藏着二头肌肌腱不稳定性和隐藏的脑内潜水泪

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Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (&5 mm), medium (5-10 mm), and large (&10 mm). We performed repair (≥50%) or debridement (&50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.
机译：背景：少数研究描述了隐藏的脑内患者泪液（CIST）的特征，缺乏对这种病变的术前预测性的研究。目的：描述在磁共振成像（MRI）上看到的CIS的特征和术中，并开发用于预测这种病变的评分系统。研究设计：案例系列;证据水平：方法：回顾性，我们确定了43名患有44名患有442名连续患者的患者，该患者在2014年7月至2016年6月到达旋转器袖口修复。运动范围，视觉模拟规模结果疼痛和功能，患者报告术前和术后1和2年评估结果评分。将CIST在关节诊断下分类为小（＆ 5 mm），中等（5-10mm），大（＆ 10 mm）。根据包括CIST的总亚面腱倾斜尺寸，我们执行了修复（≥50％）或清卓人（＆ 50％）。通过2个观察者分析术前MRI调查结果，并与关节镜检查结果相关。基于体检期间（前柔软，熊拥抱标志），MRI（二头肌肌腱位移和子宫，亚像素信号变化只是横向于较小的结节的潜伏期）和关节镜手术（内侧二头肌肌腱病变，组合船只肌腱撕裂），截止值≥7的截止值预测。在回顾性研究之后，我们展示了95名患者验证了10点CIST评分系统。结果：在回顾期间，所有43名患者被诊断出患有CISS的患者，研究术后1年改善了两种运动和功能分数。 2观察者的Interrarder Anglate在评估除亚西瓜撕裂分类外，这是适当的。在关节镜手术中，检测到11个小，19个中等和13个大小型。初步前瞻性研究显示敏感性为61.9％，特异性为94.3％，阳性预测值为89.0％，负预测值为75.7％，当截止值在CIST评分系统达到≥7时，准确度为80.0％。结论：使用术前MRI和关节内诊断关节镜检查的组合可以怀疑CISS，但明确的诊断需要关节镜视图。在10点CIST评分系统上，得分≥5分钟可以提示一下CIST，并且得分≥7最有可能预测一名卡斯特。

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