South West Sydney Clinical School, University of New South Wales, P,O, Box 906, Caringbah, NSW 2229, Australia.
BMC Musculoskelet Disord. 2013 Aug 30;14:257. doi: 10.1186/1471-2474-14-257.
Previous reviews of the diagnostic performances of physical tests of the hip in orthopedics have drawn limited conclusions because of the low to moderate quality of primary studies published in the literature. This systematic review aims to build on these reviews by assessing a broad range of hip pathologies, and employing a more selective approach to the inclusion of studies in order to accurately gauge diagnostic performance for the purposes of making recommendations for clinical practice and future research. It specifically identifies tests which demonstrate strong and moderate diagnostic performance.
A systematic search of Medline, Embase, Embase Classic and CINAHL was conducted to identify studies of hip tests. Our selection criteria included an analysis of internal and external validity. We reported diagnostic performance in terms of sensitivity, specificity, predictive values and likelihood ratios. Likelihood ratios were used to identify tests with strong and moderate diagnostic utility.
Only a small proportion of tests reported in the literature have been assessed in methodologically valid primary studies. 16 studies were included in our review, producing 56 independent test-pathology combinations. Two tests demonstrated strong clinical utility, the patellar-pubic percussion test for excluding radiologically occult hip fractures (negative LR 0.05, 95% Confidence Interval [CI] 0.03-0.08) and the hip abduction sign for diagnosing sarcoglycanopathies in patients with known muscular dystrophies (positive LR 34.29, 95% CI 10.97-122.30). Fifteen tests demonstrated moderate diagnostic utility for diagnosing and/or excluding hip fractures, symptomatic osteoarthritis and loosening of components post-total hip arthroplasty.
We have identified a number of tests demonstrating strong and moderate diagnostic performance. These findings must be viewed with caution as there are concerns over the methodological quality of the primary studies from which we have extracted our data. Future studies should recruit larger, representative populations and allow for the construction of complete 2×2 contingency tables.
之前对骨科髋关节体格检查的诊断性能的综述由于文献中发表的初级研究质量较低，得出的结论有限。本系统综述旨在在此基础上进行扩展，评估更广泛的髋关节病变，并采用更具选择性的研究纳入方法，以准确评估诊断性能，为临床实践和未来研究提供建议。它特别确定了具有较强和中等诊断性能的测试。
系统检索了 Medline、Embase、Embase Classic 和 CINAHL，以确定髋关节测试的研究。我们的选择标准包括内部和外部有效性分析。我们报告了以敏感性、特异性、预测值和似然比表示的诊断性能。似然比用于确定具有较强和中等诊断效用的测试。
文献中报道的测试只有一小部分在方法学上有效的初级研究中进行了评估。我们的综述纳入了 16 项研究，产生了 56 个独立的测试-病理组合。有两项测试显示出较强的临床实用性，即髌骨-耻骨敲击试验排除影像学隐匿性髋部骨折（阴性似然比 0.05，95%置信区间 [CI] 0.03-0.08）和髋关节外展征用于诊断已知肌营养不良症患者的肌聚糖病（阳性似然比 34.29，95%CI 10.97-122.30）。有 15 项测试显示出较强的中等诊断效用，用于诊断和/或排除髋部骨折、症状性骨关节炎和全髋关节置换术后组件松动。
我们已经确定了一些具有较强和中等诊断性能的测试。必须谨慎看待这些发现，因为我们从中提取数据的初级研究的方法学质量存在问题。未来的研究应招募更大、更具代表性的人群，并允许构建完整的 2×2 四格表。
