肌肉骨骼超声对软组织损伤诊断价值的Meta分析

Value of musculoskeletal ultrasonography in the diagnosis of soft tissue injury:a Meta⁃analysis

目的分析肌肉骨骼超声对软组织损伤的诊断价值。方法以“肌肉骨骼超声/肌骨超声/musculoskeletal ul⁃trasound/MU/ultrasound/软组织损伤/软组织/皮下组织/肌肉/韧带/肌腱/半月板/soft tissue injury/soft tissue/sub⁃cutaneous tissue/muscle/ligament/tendon/meniscus”等为中、英文检索词,从The Cochrane Library、PubMed、Medline、Em⁃base、Science Citation Index、Scopus、中国生物医学文献数据库、中国知网、万方医学网、中国医院知识仓库等中英文数据库检索2015年1月1日至2020年1月1日的文献,根据纳入和排除标准筛选文献、提取数据,并行文献质量评价。运用STA⁃TA 14.0软件对数据进行Meta分析。结果共纳入12篇文献,共1410例应用肌肉骨骼超声诊断软组织损伤患者。Meta分析结果显示,肌骨超声诊断软组织损伤的敏感性Q值为91.41(P<0.05),I2值为87.97,说明异质性占比较大;特异性Q值为17.05(P>0.05),I2<50%。合并敏感性0.89(95%CI为0.82~0.93),合并特异性0.88(95%CI为0.82~0.92),合并阳性似然比7.3(95%CI为4.6~11.7),合并阴性似然比0.13(95%CI为0.08~0.21),合并诊断比值比58(95%CI为24~141)。sROC曲线下面积(AUG)大小为0.94(95%CI为0.92~0.96)。漏斗图显示纳入文献未见发表偏倚(P=0.59)。亚组分析结果显示纳入文献研究选择的金标准是影响文献异质性的原因。结论肌肉骨骼超声对软组织损伤诊断价值较高,能够为肌骨超声应用于康复治疗、训练伤等临床诊断与治疗提供有力依据。

Objective To analyze the diagnostic value of musculoskeletal ultrasonography in soft tissue injury.Methods Musculoskeletal ultrasound/MU/ultrasound and their Chinese equivalents,and soft tissue injury/soft tissue/subcutaneous tissue/muscle/ligament/tendo/meniscus and their Chinese equivalents were used as key words to search for literature from the following databases:the Cochrane Library,PubMed,MEDLINE,EMBASE,Science Citation Index,Scopus,China Biomedical Literature Database CBM,CNKI,WanFang Data,CHKD,etc.In accordance with the inclusion and exclusion criteria,related documents were screened and evaluated,and data were extracted and the quality of retrieved mocuments were evaluated as well.Then,meta analysis was performed by using STATA14.0 software.Results Included for study was a total of 12 documents,in which 1410 patients were diagnosed as soft tissue injury by musculoskeletal ultrasound.Meta analyses showed that the sensitivity Q value of musculoskeletal ultrasound in the diagnosis of soft tissue injury was 91.41(P<0.05),and the I2 value was 87.97,indicating that heterogeneity accounted for a large proportion.The specific Q value was 17.05(P>0.05),and the I2 value was<50%.The combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio were respecrtively 0.89(95%CI:0.82⁃0.93),0.88(95%CI:0.82⁃0.92),7.3(95%CI:4.6⁃11.7),0.13(95%CI:0.08⁃0.21)and 58(95%CI:24⁃141).The area under the sROC curve(AUG)was 0.94(95%CI:0.92⁃0.96).The funnel plot indicated that there was no publication bias in the included literature(P=0.59).The results of the subgroup analysis showed that the gold standard for literature inclusion was the reason for the heterogeneity of the literature.Conclu⁃sion The musculoskeletal ultrasound is of good value for the diagnosis of soft tissue injury,and it could provide good evidence for clin⁃ical diagnosis and treatment of musculoskeletal injuries.