弹响消除试验在颞下颌关节可复性关节盘前移位诊断中的信度和效度分析

目的: 分析弹响消除试验在颞下颌关节可复性关节盘前移位诊断中的信度和效度。方法: 选择2019年7月—2019年12月因关节弹响于上海交通大学医学院附属第九人民医院颞下颌关节康复门诊就诊的患者102例。先后接受A、B 2名评估者独立进行弹响问诊与体格检查以及弹响消除试验检查,初步判断患者是否存在可复性关节盘前移位;然后行双侧颞下颌关节磁共振成像;根据磁共振成像诊断关节盘移位的影像学标准,将关节盘位置关系分为正常盘-髁关系、可复性关节盘前移位、不可复性关节盘前移位3类。以磁共振成像诊断结果为金标准,计算弹响消除试验的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比;Kappa检验计算A、B 2名评估者之间弹响消除试验结果的Kappa系数。采用SPSS 13.0软件包对数据进行统计学分析。结果: A、B评估者弹响消除试验的阳性率分别为35%（72/204）、37%（76/204）。评估者A弹响消除试验的敏感度为71%、特异度为91%、阳性预测值为85%、阴性预测值为81%、阳性似然比为7.61、阴性似然比为0.32（P<0.01）;评估者B弹响消除试验的敏感度为76%、特异度为91%、阳性预测值为86%、阴性预测值为84%、阳性似然比为8.11、阴性似然比为0.27（P<0.01）。A、B评估者之间的Kappa系数为0.873±0.036（P<0.01）。结论: 颞下颌关节弹响消除试验简单、易操作,对判断颞下颌关节可复性关节盘前移位有较好的诊断价值。

Analysis of reliability and validity of the elimination test of joint clicking for the diagnosis of temporomandibular anterior disc displacement with reduction

PURPOSE: The aim of this study was to analyze the reliability and validity of the elimination test of joint clicking for the diagnosis of temporomandibular joint(TMJ) anterior disc displacement with reduction(ADDwR). METHODS: From July 2019 to December 2019, 102 patients who visited the Rehabilitation Department of Shanghai Ninth People's Hospital, complaining of joint clicking were recruited. All the patients received clinical examination and the elimination test of joint clicking by two evaluators, A and B independently. Preliminary diagnosis was made that whether the patient had ADDwR. Then magnetic resonance imaging(MRI) of bilateral TMJ was performed. According to the imaging criteria for MRI diagnosis,articular disc position was divided into 3 categories: normal, ADDwR, and anterior disc displacement without reduction. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the test were calculated by using MRI diagnosis results as the gold standard. The Kappa coefficient of the elimination test results between evaluators A and B was calculated. SPSS13.0 software package was used for Chi-square test of cross table. RESULTS: The positive rates of A and B were 35%(72/204) and 37%(76/204),respectively. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of evaluator A were 71%, 91%, 85%, 81%, 7.61 and 0.32,respectively, P<0.01. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of evaluator B were 76%, 91%, 85%, 84%, 8.11 and 0.27,respectively, P<0.01. The Kappa coefficient between evaluators A and B was 0.873±0.036（P<0.01）. CONCLUSIONS: The elimination test of joint clicking is simple and easy to operate, which has a good diagnostic value for the determination of TMJ ADDwR.