肌骨超声诊断肱骨外上髁炎准确性的系统评价  

Systematic reviews of the accuracy of musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia

作　　者：王媛[1] 聂芳[1] 王挺[1] 李艳[1] 胥萍[1] Wang Yuan;Nie Fang;Wang Ting;Li Yan;Xu Ping(Department of Ultrasound,the Second Hospital of Lanzhou University,Lanzhou 730030,Gansu Province,China)

机构地区：[1]兰州大学第二医院超声科

出　　处：《中国组织工程研究》2019年第32期5233-5239,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:肌骨超声具有无创、实时动态的观察组织病变、重复性好等优点,近年来越来越多的医务工作者开始将其用于诊断肱骨外上髁炎。然而,目前尚无证据显示肌骨超声诊断肱骨外上髁炎的精确性。目的:探究肌骨超声诊断肱骨外上髁炎的准确性,为临床诊断提供一定的参考依据。方法:计算机检索PubMed、EMbase、The Cochrane Library(2018年06期)、CNKI、CBM、WanFang Data数据库,查找肌骨超声诊断肱骨外上髁炎诊断性试验,检索时限均为建库至2018-06-01。由2名研究员按照纳入与排除标准筛选文献,提取数据和采用QUADAS工具对文献质量进行评价,然后采用Meta-Disc 1.4和Stata 12.0进行Meta分析。结果与结论:共纳入17个研究,由于纳入研究之间存在较大的临床异质性,因此采用随机效应模型进行Meta分析及亚组分析。亚组分析结果显示:灰阶超声诊断肱骨外上髁炎纳入5篇研究,其敏感度和特异度分别为0.81(95%CI 0.76,0.85)和0.79(95%CI 0.73,0.85);而能量多普勒超声联合灰阶超声诊断外上髁炎纳入了4篇研究,其敏感度和特异度分别为0.69(95%CI 0.64,0.73)和0.82(95%CI 0.76,0.86)。提示:灰阶超声诊断肱骨外上髁炎具有较高的敏感度和特异度,但限于纳入研究数量较少,质量欠佳,该结论仍需进一步验证。BACKGROUND:Musculoskeletal ultrasound has the advantages of non-invasiveness,real-time dynamics and good repeatability,and has been gradually used in the diagnosis of lateral epicondylalgia.However,its diagnosis accuracy has not been confirmed.OBJECTIVE:To explore the accuracy of musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia for providing evidence for clinical practice.METHODS:The trials about musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia were searched in the databases of PubMed,EMbase,The Cochrane Library(Issue 6,2018),CNKI,CBM and WanFang from inception to June 1,2018.Two researchers independently screened literatures according to inclusion and exclusion criteria,extracted data,and assessed the risk of bias of included studies by using the Quality Assessment of Diagnostic Accuracy Studies tool.Then meta-analysis was performed by using Meta-Disc 1.4 software and Stata 12.0 tool.RESULTS AND CONCLUSION:Seventeen articles were included.The random effects model was used to analyze the heterogeneity among the results of studies.The subgroup results of meta-analysis showed that the pooled sensitivity,specificity for gray-scale ultrasonography diagnosis lateral epicondylalgia was 0.81(95%CI 0.76 to 0.85),0.79(95%CI 0.73 to 0.85),respectively.The pooled sensitivity,and specificity for gray-scale ultrasonography combined power Doppler ultrasonography diagnosis lateral epicondylalgia was 0.69(95%CI 0.64 to 0.73),and 0.82(95%CI 0.76 to 0.86),respectively.In summary,gray-scale ultrasonography holds high sensitivity and specificity in the diagnosis of lateral epicondylalgia.But it still needs more studies to validate the result because the limitation of quality and quantity of the included studies.

关 键 词：肌骨超声 肱骨外上髁炎 系统评价 诊断试验 灰阶超声 能量多普勒超声 敏感度 特异度 

分 类 号：R445.1[医药卫生—影像医学与核医学] R684[医药卫生—诊断学]