Lecturer, Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
J Orthop Sports Phys Ther. 2012 Sep;42(9):760-71. doi: 10.2519/jospt.2012.4000. Epub 2012 Jul 19.
Systematic literature review and meta-analysis.
To evaluate the diagnostic accuracy of clinical tests to identify stress fractures in the lower limb.
Stress fractures are a bone-related overuse injury primarily occurring in the lower limb and commonly affecting running athletes and military personnel. Physical examination procedures and clinical tests are suggested for diagnosing stress fractures; however, data on the diagnostic accuracy of these tests have not been investigated through a systematic review of the literature.
A systematic review was conducted in 8 electronic databases to identify diagnostic accuracy studies, published between January 1950 and June 2011, that evaluated clinical tests against a radiological diagnosis of lower-limb stress fracture. Retrieved articles were evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool, and a meta-analysis was performed where appropriate.
Nine articles investigating 2 clinical procedures, therapeutic ultrasound (n = 7) and tuning fork testing (n = 2), met the study inclusion criteria. Meta-analysis was used to statistically analyze the data extracted from the ultrasound articles and demonstrated a pooled sensitivity of 64% (95% confidence interval [CI]: 55%, 73%), specificity of 63% (95% CI: 54%, 71%), positive likelihood ratio of 2.1 (95% CI: 1.1, 3.5), and negative likelihood ratio of 0.3 (95% CI: 0.1, 0.9). Tuning fork test data could not be pooled; however, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio ranged from 35% to 92%, 19% to 83%, 0.6 to 3.0, and 0.4 to 1.6, respectively.
The results of this systematic review do not support the specific use of ultrasound or tuning forks as standalone diagnostic tests for lower-limb stress fractures. As the overall diagnostic accuracy of the tests investigated is not strong, based on the calculated likelihood ratios, it is recommended that radiological imaging should continue to be used for the confirmation and diagnosis of stress fractures of the lower limb.
Diagnosis, level 1a-.J Orthop Sports Phys Ther 2012;42(9):760-771, Epub 19 July 2012. doi:10.2519/jospt.2012.4000.
系统文献回顾和荟萃分析。
评估用于识别下肢应力性骨折的临床检查的诊断准确性。
应力性骨折是一种与过度使用有关的骨损伤，主要发生在下肢，常见于跑步运动员和军人。体格检查程序和临床检查被建议用于诊断应力性骨折；然而，尚未通过系统文献回顾来调查这些检查的诊断准确性数据。
在 8 个电子数据库中进行了系统的文献回顾，以确定在 1950 年 1 月至 2011 年 6 月期间发表的评估针对下肢应力性骨折的放射学诊断的临床检查的诊断准确性研究。使用诊断准确性研究质量评估工具评估检索到的文章，并在适当的情况下进行荟萃分析。
9 篇研究 2 种临床程序的文章符合纳入标准，包括治疗性超声（n = 7）和音叉测试（n = 2）。对超声文章的数据进行了荟萃分析，结果表明汇总敏感性为 64%（95%置信区间：55%，73%），特异性为 63%（95%置信区间：54%，71%），阳性似然比为 2.1（95%置信区间：1.1，3.5），阴性似然比为 0.3（95%置信区间：0.1，0.9）。音叉测试数据无法进行汇总；然而，敏感性、特异性、阳性似然比和阴性似然比的范围分别为 35%至 92%、19%至 83%、0.6 至 3.0 和 0.4 至 1.6。
本系统综述的结果不支持将超声或音叉单独用作下肢应力性骨折的诊断性检查。根据计算出的似然比，这些检查的总体诊断准确性并不高，因此建议继续使用放射影像学检查来确认和诊断下肢的应力性骨折。
诊断，1a 级。《美国骨科物理治疗杂志》2012 年；42（9）：760-771，2012 年 7 月 19 日在线发表。doi：10.2519/jospt.2012.4000.
