前言
大部分大範圍旋轉肌袖撕裂傷(large-to-massive rotator cuff tears)需要接受開刀治療，而手術修復性與旋轉肌袖肌肉品質有關，如果旋轉肌袖肌肉品質不佳，有可能會導致手術無法做到完全修復(complete repair)。手術中骨科醫師根據肌腱撕裂傷斷端(torn stump)是否能復位回原本的解剖位置來判斷是否可以進行完全修復，而這從術前的核磁共振(magnetic resonance imaging, MRI)便可以預測大部分狀況；然而，由於核磁共振的可近性不高，超音波開始被用於旋轉肌袖撕裂傷術前評估。我們假設超音波(ultrasound)可以預測大範圍旋轉肌袖撕裂傷的手術修復性。

方法
這是一個橫斷面研究(cross-sectional study)，受試者為即將接受大範圍旋轉肌袖撕裂傷手術之病人。研究者會評估受試者的臨床表現，例如術前肩功能，包括主動關節活動及UCLA肩功能量表；之後用超音波評估受試者旋轉肌袖肌肉(包括棘上肌(supraspinatus)和棘下肌(infraspinatus))的肌肉品質，為了檢測超音波之信度(reliability)，由兩位醫師分別針對其中收案的25位受試者做信度測試。另外，核磁共振會被用來評估撕裂傷大小、肌腱回縮的程度、脂肪浸潤、以及肌肉萎縮程度。手術中，會由兩位資深的骨科醫師開刀並且判斷是否可完全修復。統計分析部分，先以相關性分析(correlational analysis)找出超音波、核磁共振、臨床表徵之關聯性，後續使用接收者操作特徵曲線(receiver operating characteristic curve, ROC curve)分析超音波對於手術修復性的預測能力。

結果
總共收錄50位受試者，其中包括32位完全縫合(complete repair)以及18位部分縫合(partial repair)的病人。棘上肌(supraspinatus)和棘下肌(infraspinatus)肌肉的超音波測量部分，施測者間信度(inter-rater reliability)和施測者內信度(intra-rater reliability)皆是良好的，超音波與核磁共振(MRI)影像參數之間的相關性皆呈現中度至高度效應(相關係數0.4 ~ 0.8)。核磁共振影像中，棘下肌(infraspinatus)的Goutallier classification對於手術修復性有最佳的鑑別力(AUC = 0.89, 95% CI 0.81 to 0.98)；超音波影像中，棘下肌(infraspinatus)的Heckmatt scale則是對於手術修復性的預測力是最好的(AUC = 0.85, 95% CI 0.74 to 0.96)，然而，不管是核磁共振還是超音波，這些影像參數的曲線下面積(AUC)並沒有顯著的差異。

結論
超音波是一個可靠的檢查工具，而且對於大範圍旋轉肌袖撕裂傷的手術修復性的預測能力與核磁共振是相似的。

The objective of this study was to investigate the predictive validity of ultrasound for surgical reparability in patients with large-to-massive rotator cuff tears. Patients with ultrasound or MRI confirmed large-to-massive rotator cuff tears and ready for surgeries were enrolled into this study. The ultrasound was used to evaluate the muscle quality of supraspinatus and infraspinatus using Heckmatt scale, and the MRI was used to evaluate the torn size, degree of tendon retraction (Patte classification), fatty infiltration (Goutallier classification), and muscle atrophy (Tangent sign). Whether the torn stumps could be completely repaired during the surgeries was defined by two experienced orthopedic surgeons. Among the imaging predictors of MRI, the Goutallier classification of infraspinatus had the best discriminative ability for surgical reparability. Among the imaging predictors of ultrasound, the Heckmatt scale of infraspinatus had the best predictive power for surgical reparability. The predictability of the above two imaging predictors had no significant difference. We concluded that the ultrasound is a reliable exam tool to predict the surgical reparability of large-to-massive rotator cuff tears, and its predictability is similar to that of MRI.

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