应力性骨折的诊断试验评价

作者以核素骨扫描为金标准，用随机抽样、盲法检测、四格表法评价了Ｘ线摄影、红外线热成像、超声波诱痛试验和临床诊断检出应力性骨折的结果。Ｘ线检查了１３４个应力性骨折部位和１７９个对照部位，红外线热成像分别检查了１４６个和１６１个部位，超声波诱痛试验分别检查了７８个和６９个部位，临床诊断分别检查了２１７个和２４８３个部位。Ｘ线的灵敏度、特异度和符合率分别为１０％、１００％和６１％，红外线热成像分别为５６％、６７％和６２％，超声波诱痛试验分别７３％、４１％和６０％，临床诊断分别为７４％、９８％和９６％。作者认为针对新兵这一特殊的应力性骨折高发人群，临床医生只要对该损伤有足够的重视和认识，熟练掌握临床诊断标准，则可大大地提高对临床型应力性骨折诊断的正确性。所评价的３种非核素骨扫描诊断方法均不能替代核素骨扫描，为了寻找有效且简单易行的替代方法，尚需做进一步的研究。

EvaluationoftheDiagnosticTestsofStresFractures

Usingbonescintigraphyasthegoldenstandard,theauthorsevaluatedthediagnosticre-sultsofradiography,thermography,ultrasoundinducedpaintestandclinicalfeaturesinthediagnosisofstressfractures.Randomsampling,blindmeasurementandfourfoldtablewereusedinthisstudy.134sitesofstressfracturesand179sitesofcontrolswereexaminedbyradiography,146stressfracturesand161sitesbythermogrophy,78stressfracturesand69sitesbyultrasoundinducedpaintestand217stressfracturesand2483sitesbyclinicalfeatures.thesensitivity(Se),specificity(Sp)andaccuracy(Ac)ofradiographywererespectively10%,100%,and61%;theSe,Sp,andAcofthermographywererespectively56%,67%,and62%;theSe,Sp,andAcofultrasoundinducedpaintestwerere-spectively73%,41%,and60%,andthoseofclinicaldiagnosiswere74%,93%and96%.Amongtherecruits,whichisaspecialgroupwithahighincidenceofstressfracture,themedicalpersonnelshouldpayenoughatentionforaccuracyofthediagnosisofstressfractures.Theevaluationofthethreeauxil-larydiagnosticmethodscouldnotreplacebonescintigraphyforthediagnosisofstressfractures.Newefortshouldbedonetomaketheauxilaryexaminationsimpleandeffective.