Terry G C, Tagert B E, Young M J
Hughston Clinic, P.C., Columbus, Georgia 31908, USA.
Arthroscopy. 1995 Oct;11(5):568-76. doi: 10.1016/0749-8063(95)90134-5.
The reliability of the clinical assessment, which comprised history, physical examination, and plain radiographs, was determined by comparing the initial preoperative diagnosis with the postoperative diagnosis as determined arthroscopically, and by comparing the results of the clinical evaluation with published reports of arthrography, computed tomography (CT), and magnetic resonance imaging (MRI). The study group included 206 patients (216 knees) scheduled for arthroscopic surgery for suspected internal derangements. The primary preoperative clinical diagnosis was correct in 175 knees (81%), with an overall accuracy of 93%, sensitivity of 89%, and specificity of 94%. The most common preoperative diagnoses were medial and lateral meniscal tears. Results of the clinical assessment were comparable or superior to published reports of arthrography, CT, and MRI. Thus, it may be unnecessary to routinely use these costly special studies to determine the need for arthroscopic surgery. We conclude that a thorough clinical assessment can provide sufficient information for the surgeon to make a definitive primary preoperative diagnosis, and that arthroscopy should not be performed without first completing a complete preoperative examination.
将术前初步诊断结果与关节镜检查确定的术后诊断结果进行比较，以及将临床评估结果与已发表的关节造影、计算机断层扫描（CT）和磁共振成像（MRI）报告进行比较。临床评估包括病史、体格检查和普通X线片。研究组包括206例（216个膝关节）因怀疑存在内部紊乱而计划进行关节镜手术的患者。术前主要临床诊断在175个膝关节中正确（81%），总体准确率为93%，敏感性为89%，特异性为94%。最常见的术前诊断是内侧和外侧半月板撕裂。临床评估结果与已发表的关节造影、CT和MRI报告相当或更优。因此，可能无需常规使用这些昂贵的特殊检查来确定是否需要进行关节镜手术。我们得出结论，全面的临床评估可为外科医生做出明确的术前初步诊断提供足够信息，并且在未首先完成完整的术前检查之前不应进行关节镜检查。
