预测半月板撕裂的概率：比较病史和体格检查与 MRI。
Predicted probability of meniscus tears: comparing history and physical examination with MRI.
机构信息
Department of Radiology, First Affiliated Hospital of Xian Jiao Tong University, Xian, China.
出版信息
Swiss Med Wkly. 2011 Dec 14;141:w13314. doi: 10.4414/smw.2011.13314. eCollection 2011.
BACKGROUND
The indication for surgical treatment of a meniscal lesion should not only rely on magnetic resonance imaging (MRI) findings, but also on a detailed history and a thorough clinical examination. However, various intra-articular lesions may often produce similar symptoms. So, what kinds of symptoms are more associated with a meniscal tear? Is MRI worth doing?
OBJECTIVE
The aims of this study were to identify sensitive and specific clinical tests and elements of patients' history with a high predictive value, and to assess the combined diagnostic accuracy of sensitive and specific clinical tests and elements of patients' history with MRI.
METHODS
Data from 281 consecutive knee arthroscopies to investigate and treat suspected internal knee pathologies were retrospectively collected between March 2009 and April 2010. The study group consisted of 262 knees. Statistically significant factors in the clinical diagnosis of meniscal tears were screened by a chi-square test. Logistic regression analysis was used to determine which factors associated with meniscal tears found during arthroscopy. The diagnostic values of MRI and the sensitive and specific clinical tests and elements of patients' history with high predictive value for meniscal tears were calculated.
RESULTS
The overall diagnostic value of MRI for meniscal tears was: accuracy, 88.8%; sensitivity, 95.7%; specificity, 75.8%; positive predictive value (PPV), 88.2%; and negative predictive value (NPV), 90.4%. Giving way, locking and McMurray's test were independent diagnostic factors with a predicted correct percentage of 80.0% (p <0.05) for the diagnosis of meniscal tears found during arthroscopy. Locking, McMurray's test and MRI increased the predicted correct percentage of meniscal tears found during arthroscopy to 91.6% (p <0.05). For the diagnosis of meniscal tears found during arthroscopy, giving way, locking and McMurray's test had the following values for accuracy (49.2, 60.9, 76), sensitivity (43.5, 55.2, 75.8), specificity (84, 96, 76.9), PPV (94.4, 98.8, 95.1) and NPV (19.4, 25.8, 35.1). Combining MRI, the diagnostic values of giving way, locking, and McMurray's test were: accuracy, 88.3,89.9,89.4; sensitivity, 95.7,97.4,97.4; specificity, 74.2,75.8,74.2; PPV, 87.5,88.4,87.7; and NPV, 90.2,94,93.9.
CONCLUSIONS
Giving way, locking and McMurray's test are independent clinical diagnostic factors for the diagnosis of meniscal tears. MRI has higher accuracy, sensitivity and NPV for the diagnosis of meniscal tears than giving way, locking and McMurray's test. The combination of giving way, locking, McMurray's test and MRI for confirmation is typical for a meniscal lesion diagnosis. Based on these findings, MRI should be used in a standard manner to detect meniscal tears found during arthroscopy.
背景
半月板病变的手术适应证不仅应依据磁共振成像（MRI）检查结果，还应结合详细的病史和全面的临床检查。然而，各种关节内病变可能经常产生类似的症状。那么，哪些症状与半月板撕裂更相关？MRI 是否值得做？
目的
本研究旨在确定具有高预测价值的敏感和特异的临床检查和病史要素，并评估 MRI 联合敏感和特异的临床检查和病史要素对半月板撕裂的联合诊断准确性。
方法
回顾性收集 2009 年 3 月至 2010 年 4 月间 281 例连续膝关节镜检查和治疗疑似膝关节内病变患者的数据。研究组包括 262 例膝关节。采用卡方检验筛选半月板撕裂的临床诊断中有统计学意义的因素。采用 logistic 回归分析确定与关节镜检查中发现的半月板撕裂相关的因素。计算 MRI 以及具有高预测价值的敏感和特异的临床检查和病史要素对半月板撕裂的诊断价值。
结果
MRI 对半月板撕裂的总体诊断价值为：准确性为 88.8%，敏感度为 95.7%，特异度为 75.8%，阳性预测值（PPV）为 88.2%，阴性预测值（NPV）为 90.4%。膝关节交锁、McMurray 试验和研磨试验是诊断半月板撕裂的独立因素，预测正确百分比为 80.0%（p<0.05）。膝关节交锁、McMurray 试验和 MRI 联合使用可将半月板撕裂的预测正确百分比提高至 91.6%（p<0.05）。对于诊断关节镜检查中发现的半月板撕裂，研磨试验、膝关节交锁和 McMurray 试验的准确性分别为 49.2%、60.9%和 76%，敏感度分别为 43.5%、55.2%和 75.8%，特异度分别为 84%、96%和 76.9%，PPV 分别为 94.4%、98.8%和 95.1%，NPV 分别为 19.4%、25.8%和 35.1%。联合 MRI 后，研磨试验、膝关节交锁和 McMurray 试验的诊断价值为：准确性为 88.3%、89.9%和 89.4%，敏感度为 95.7%、97.4%和 97.4%，特异度为 74.2%、75.8%和 74.2%，PPV 为 87.5%、88.4%和 87.7%，NPV 为 90.2%、94%和 93.9%。
结论
膝关节交锁、研磨试验和 McMurray 试验是诊断半月板撕裂的独立临床诊断因素。MRI 对半月板撕裂的诊断准确性、敏感度和 NPV 均高于研磨试验、膝关节交锁和 McMurray 试验。研磨试验、膝关节交锁、McMurray 试验和 MRI 联合应用对半月板病变的诊断具有典型意义。基于这些发现，MRI 应作为标准方法用于检测关节镜检查中发现的半月板撕裂。
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