Lesho E P
Fort Richardson, AK, USA.
Mil Med. 1997 Dec;162(12):802-3.
To compare the performance of the tuning fork test (TFT) with nuclear scintigraphy for the identification of tibial stress fractures.
Fifty-two patients with a history and physical examination suggestive of tibial stress fracture underwent a TFT followed by a bone scan. The TFT was performed by applying a 128-Hz tuning fork to the anterior surface of the bared tibia. If the patient reported a marked exacerbation or reproduction of shin pain in a localized area of the tibia, the TFT was considered positive. All patients also underwent a bilateral lower-extremity bone scan.
The sensitivity and specificity of the tuning fork test were 75 and 67%, respectively. The positive and negative predictive values were 77 and 63%, respectively. The positive and negative likelihood ratios with 95% confidence intervals were 2.33 (1.17-4.60) and 0.34 (0.16-0.71), respectively.
The tuning fork test is not sensitive enough to rule out a stress fracture on the basis of a negative test. However, in a setting in which there is a moderate to high pretest likelihood of stress fractures, such as military installations with new basic training recruits, it may be reasonable to avoid the cost and delays associated with nuclear imaging by instituting treatment for tibial stress fractures without obtaining a bone scan when the TFT is positive.
比较音叉试验（TFT）与核素骨显像在诊断胫骨应力性骨折方面的性能。
52例有胫骨应力性骨折病史且体格检查提示该病的患者先接受音叉试验，随后进行骨扫描。音叉试验是将一个128赫兹的音叉置于裸露的胫骨前表面。如果患者报告胫骨局部区域的胫骨疼痛明显加重或再现，则音叉试验被认为是阳性。所有患者还接受了双侧下肢骨扫描。
音叉试验的敏感性和特异性分别为75%和67%。阳性预测值和阴性预测值分别为77%和63%。95%置信区间的阳性似然比和阴性似然比分别为2.33（1.17 - 4.60）和0.34（0.16 - 0.71）。
音叉试验的敏感性不足以基于阴性试验结果排除应力性骨折。然而，在应力性骨折的预测试验可能性为中度至高的情况下，例如在有新兵基础训练的军事设施中，当音叉试验为阳性时，在不进行骨扫描的情况下对胫骨应力性骨折进行治疗，从而避免与核素显像相关的成本和延误，可能是合理的。
