膝关节骨折快速诊断规则临床应用的循证研究

Meta-analysis of application of Ottawa knee rules in knee injuries

目的 采用循证医学的Meta分析方法研究膝关节骨折快速诊断规则（OKR），明确OKR诊断膝关节骨折的准确性，探讨膝关节外伤X线摄片合理选择的必要性。方法 收集1990年1月～2006年5月国内外公开发表的OKR诊断膝关节骨折的文献，按Cochrane诊断组建议的对Meta分析的质量要求对符合条件的原始文献进行质量评估，提取有效文献的数据进行合并分析，计算OKR的敏感性和特异性，阳性似然比和阴性似然比，并做诊断试验的SROC曲线。同时对文献的异质性和偏倚进行评价。结果 共检索到文献131篇，符合纳入标准的共6篇，均为成人OKR对膝关节骨折的准确性研究，合并敏感性为100％，合并特异性为49％，阳性似然比为1．91，阴性似然比为0．024。结论 OKR在膝关节骨折的诊断方面具有较高的临床应用价值，可以减少30％～40％的不必要X线摄片，节约医疗资源，降低医疗费用，减少患者在急诊处理的等待时间。

Objective To evaluate the accuracy of Ottawa knee rules （OKR） with meta-analysis in screening suspected adult cases of knee fractures for X-ray examination. Methods Pub/Medline and Ovid databases and Chinese databases （1990-2006） were searched for published OKR studies of knee fractures. Standard inclusion and exclusion criteria were used to collect relevant data according to Cochrane Methods Group guidelines. Software SPSS12. 0 and Excel 2000 was used to evaluate sensitivity and specificity, positive likelihood ratio, negative likelihood ratio, heterogeneity, and bias of the data. Results Of the 131 identified studies, 6 involving adult patients were considered appropriate for pooled analysis. The pooled sensitivity was 100% （95%CI, 98.5%-100% ）, the pooled specificity was 49% （95%CI, 47.4%-50. 6% ）, the pooled positive likelihood ratio was 1.91（95% CI, 1. 845-1. 974 ）, and the pooled negative likelihood ratio was 0. 024 （95% CI, 0. 008-0. 074 ）. Conclusions Application of OKR for acute knee injuries is of high value, for it may lead to a reduction of 30% to 40% unnecessary X-ray examinations for the knee injuries.