这位病人有关节炎吗? :理性的临床检查系统审查
David Metcalfe1, Daniel C Perry1, Henry A Claireaux1
1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
JAMA
|December 18, 2019
概括
临床关节检查结果,包括特定运动中的疼痛和有限的运动范围,可以准确地识别关节炎 (OA). 这些简单的测试有助于区分患有关节炎和没有关节炎的患者,
科学领域:
- 整形医学
- 关节病学
- 诊断的准确性
背景情况:
- 关节炎 (OA) 是一种常见的疾病,导致严重的疼痛和功能障碍.
- 精确及早期诊断关节炎对于有效的治疗和治疗至关重要.
研究的目的:
- 系统地识别和评估与关节炎最强相关的临床发现.
- 确定关节炎的各种历史和身体检查组件的诊断准确性.
主要方法:
- 在主要医疗数据库 (MEDLINE,PubMed,EMBASE,CINAHL) 进行了系统的文献搜索,直到2019年11月.
- 如果这些研究使用平面放射图作为参考标准来量化关节骨炎的临床结果,则将其纳入.
- 提取和合成了敏感度,特异性和可能性比率的数据.
主要成果:
- 分析了涉及1110名患者 (1324名部) 的6项研究,其中38%的患者表现为放射性骨关节炎.
- 鉴定关节骨质炎的关键发现包括坐后的背部疼痛 (LR 6.1),被动运动时的沟疼痛 (LR 5.7),带器的软弱 (LR 4. 5),以及被动引的减少 (LR 4. 2) 或内部旋转 (LR 3. 2).
- 正常的被动带是缺少OA的强有力的指标 (负LR0. 25).
结论:
- 评估部运动和疼痛诱发的简单临床试验有效地区分了部骨关节炎患者和没有部骨关节炎患者.
- 结合多个临床发现,可以有效地识别最有可能患有严重关节炎的个体,指导进一步的诊断和治疗决策.
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