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这位肩部疼痛的患者是否患有旋转手套疾病? : 理性临床检查系统审查
Job Hermans1, Jolanda J Luime, Duncan E Meuffels
1Department of Orthopaedic Surgery, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands. j.hermans@erasmusmc.nl
JAMA
|August 29, 2013
概括
疼痛弧测试是诊断旋转手套疾病 (RCD) 的最准确方法. 阳性滞后测试可以准确诊断全厚旋转手套撕裂,有助于为肩部疼痛做出临床决策.
科学领域:
- 整形外科 整形外科 整形外科
- 诊断的准确性 诊断的准确性
- 肌肉骨疾病 肌肉骨疾病
背景情况:
- 旋转手套疾病 (RCD) 是导致肩部疼痛的主要原因.
- 准确的临床检查结果对于及时诊断和治疗至关重要.
研究的目的:
- 进行元分析,确定RCD.最准确的临床检查结果.
- 为了评估各种身体检查操作的诊断准确性,以检查旋转手套病理.
主要方法:
- 在2013年5月之前,在MEDLINE,EMBASE和CINAHL进行了系统的文献搜索.
- 如果这些研究描述了RCD检查,报告了灵敏度和特异性,使用了参考标准,并提出了原始数据,则这些研究被纳入.
- 概率比率 (LRs) 被计算出来,以评估症状和征兆的诊断准确性,研究质量使用理性临床检查得分进行评估.
主要成果:
- 分析了28项研究,只有5项符合高质量标准 (1-2级).
- 一个阳性疼痛弧测试 (LR,3.7) 和一个正常疼痛弧测试 (LR,0.36) 显示在诊断RCD时有用.
- 积极的外部旋转延迟 (LR,7.2) 和内部旋转延迟 (LR,5.6) 测试对全厚撕裂最准确;积极的落臂测试 (LR,3.3) 也表明了RCD.
结论:
- 疼痛弧测试是RCD检测的一个关键发现.
- 滞后测试 (外部或内部旋转) 对于诊断全厚旋转手套撕裂非常准确.
- 由于研究方法,对非参考人群的概括性是有限的.
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