股骨头缺血坏死CT和MRI诊断的Meta分析

目的应用循证医学Meta分析来评价CT和MRI对股骨头缺血坏死（ avascular necrosis of the femoral head, ANFH）诊断的应用价值。方法检索cochrane图书馆（2011年第1期）、PubMed（1966～2011）、Embase（1989～2011）、中国生物医学文献数据库（1982～2011）、万方数据库（1982—2011），纳入国内外公开发表的关于股骨头缺血坏死的CT和MRI诊断的文献，按照纳入标准进行筛选，两名调查员独立对文献质量进行严格评价和资料提取，对符合标准的8篇文献在诊断ANFH方面使用软件Review mangager5．0进行Meta分析。结果共纳入8篇研究，共515例患者。Meta分析及其偏倚分歧提示MRI对股骨头缺血坏死阳性率的诊断价值高于CT，两者差别有显著统计学意义[OR=0．12（95％CI，0．04～0．33），P〈0．0001]。MRI对股骨头缺血坏死早期阳性率的诊断价值高于CT，两者差别有统计学意义[OR=0．45（95％CI，0．26～0．78），P=0．005]。结论MRI是首选的股骨头缺血坏死诊断手段，但仍需大样本随机对照试验来验证。

A Comparative Study between CT and MRI in Diagnosing the Avascular Ecrosis of the Femoral Head with Meta -analysis

Objective To evaluate the value of computed tomography （CT）and magnetic resonance imaging （MRI） in diagnosis of avascular ecrosis of the femoral head （ANFH） by meta - analyses. Methods Cochrane Database （Issuel ,2011 ） , PubMed （ 1966 - 2011 ） Embase （ 1989 - 2011 ）, Chinese Biomedical Literature Datebase （ 1982 2011 ）, Wanfang Datebase（ 1982 ~ 2011 ）were searched to identify the literatures. The quality of researches was critically appraised and data were extracted by 2 investigators independently. Eight studies corresponding to the standard with being diagnosed were analysed by Review mangager 5.0. Results Eight cohort studies involving 515 patients were collected. The results of Meta - analyses showed that the difference of ANFH positive rate between CT and MRI had statistical significance [ OR = 0.12 （95% CI, 0.04 - 0. 33 ）, P 〈 0. 0001 ]. And the early stage positive rate had statistical significance [ OR = 0.45 （ 95 % CI,0. 26 - 0.78）, P = 0. 005 ]. Conclusion MRI is the preferred method for diagnosing the avascular ecrosis of the femoral head, but the effectiveness and safety require being proved by the randomized controlled trails of large sample.