标准化培训对提高超声评价滑膜炎和腱鞘炎分级评估的准确性的初步研究  

Standardized training can improve the validity of synovitis and tenosynovitis assessment by musculoskeletal ultrasound： a pilot study in Chinese doctors

作　　者：邓雪蓉[1] 耿研[1] 季兰岚[1] 张晓慧[1] 张卓莉[1] 

机构地区：[1]北京大学第一医院风湿免疫科,100034

出　　处：《中华风湿病学杂志》2017年第3期178-180,共3页Chinese Journal of Rheumatology

基　　金：首都卫生发展科研专项项目（首发2011-4021-03）;北京大学第一医院科研基金（2016GG-05）

摘　　要：目的评价标准化培训对提高中国医师用超声评价滑膜炎和腱鞘炎程度准确性的效果。方法针对滑膜炎和腱鞘炎的灰阶及多普勒分级进行30min的标准化培训。培训前后各应用10幅静态影像分别对滑膜炎和腱鞘炎的灰阶及多普勒的程度进行考核，各项指标均采用0-3级的半定量评估体系。记录每位医师每次评价时其答案与正确答案的偏差，应用配对t检验对比各项参数在培训前后的差异。结果共15名医师参与全程评价，其中13名为风湿科医师，2名为超声科医师。其中滑膜炎的灰阶、多普勒及腱鞘炎的多普勒评级在培训前后的差异均有统计学意义（培训前后其与正确答案的差距分别为0．61±0．30和0．45±0．23，0．57±0．26和0．31±0．18，0．56±0．15和0．31±0．16；t值分别为2．230，2．928，5．286，P均〈0．05）。而腱鞘炎的灰阶评级在培训前后的差异无统计学意义（t=-1．679，P〉0．05）。结论标准化培训有助于提高风湿科／超声科医师对超声下滑膜炎和腱鞘炎表现的认识和分级的准确性，对腱鞘炎的灰阶分级的判断水平还需再提高。Objective To evaluate the validity of assessing synovitis and tenosynovitis by using museuloskeletal ultrasound scoring systems after standardized training in Chinese doctors. Methods All participants received a 30 minutes＇ training for the ultrasound scoring systems of synovitis and tenosynovitis. Ten static images were applied to evaluate the changes before and after training, respectively. Each parameter was assessed by a four scale semi-quantitative system recommended by outcomes measures in rheumatoid arthritis clinical trials （OMERACT）. Paired t-test was used to assess the differences before and after training. Results Thirteen rheumatologists and two uhrasonographers completed the entire procedure. Significant differences were found before and after training when assessing the severity of gray-scale of synovitis （0.61± 0.30 vs 0.45±0.23; t=2.230, P〈0.05） and power Doppler of synovitis （0.57±0.26 vs 0.31±0.18; t=2.928, P〈0.05） and tenosynotis （0.56±0.15 vs 0.31±0.16; t=5.286, P〈0.05）, while no significant difference was found when assessing the gray scale of tenosynovitis （t=-1.679, P〉0.05）. Conclusion Standardized training is helpful to improve the validity of ultrasound scoring systems of synovitis and tenosynovitis in Chinese rheumatologists and ultrasonographers. The validity of assessing gray-scale of tenosynovits needs improvement.

关 键 词：超声检查 教育 滑膜炎 腱鞘炎 

分 类 号：R686[医药卫生—骨科学]