软骨病变征象对膝骨关节炎诊断的价值

Cartilage degeneration sign and diognosis of knee osteoarthritis

目的 从骨关节炎临床特征中寻找出提示软骨病变最敏感的指标 ,将其结合到原有的美国风湿病学会 (ARA)膝骨关节炎分类标准中 ,探讨增加新标准后对膝骨关节炎诊断敏感性及特异性的影响。方法 先回顾 115例行膝关节置换或关节镜检查确诊的膝骨关节炎病人 ,比较其临床表现、影像学及手术所见 ,发掘提示软骨退变最敏感指标 ,并将它们添加到ARA分类标准中而视之为新标准。再分别用原ARA膝骨关节炎分类标准和我们提出的新标准对 112例行膝关节置换或关节镜检查的成年病人进行诊断 ,对不同标准的敏感性和特异性进行比较。结果 临床特征的比较得出膝关节广泛压痛与膝软骨退变、交锁的症状或研磨试验阳性与半月板损伤高度相关。用现有ARA临床分类标准诊断膝骨关节炎敏感度为 39 7% ,加入新项目后临床诊断的敏感度提高至 70 6 % (P <0 0 0 5 ) ;现有ARA临床与临床加放射学结合的总的分类标准诊断敏感度为 70 6 % ,包含新增项目的总的分类标准敏感度达 83 8% (P <0 0 0 5 )。四者特异度分别为 88 6 % ,79 5 % ,84 1%和 77 3% (P>0 0 5 )。结论 将关节广泛压痛和交锁的症状或研磨试验阳性两项增加到膝骨关节炎ARA分类标准中后 ,可提高膝骨关节炎诊断敏感性 。

Objective To get new more sensitive signs reflecting cartilage degeneration,which were added to the present ARA differential criteria of knee osteoarthritis and to compare the sensitivity and specificity before and after new items.Methods Through review analysis of the clinical feature,radiography and operative presentation of 115 adult patients,the new signs reflecting cartilage degeneration as items were found,which were added to the present ARA differential criteria of knee osteoarthritis as new criteria.Then the 112 patients who have received either knee joint replacement or arthroscopy were re diagnosed with both the present ARA criteria and the new criteria.Sensitivity and specificity were calculated and compared.Results 'Extensive knee joint tenderness' with cartilage degradation and 'lockage on motion or a positive Apler test' were significantly related to the meniscus degradation.A 39 7% sensitivity of these patients was obtained using the present ARA clinical criteria,while it reached 70 6% using the new clinical criteria ( P <0 005).The sensitivity of the ARA clinical and radiographic criteria was 70 6%,while it reached 83 8% after new items were added ( P <0 005),When specificity was compared,the difference was of no statistic significance( P >0 05).Conclusion The two new items added to the present ARA criteria help to increase the sensitivity for diagnosis of knee osteoarthritis without influence on the specificity.