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目的:评价高分辨率超声(HR-US)对颞下颌关节盘前移位(anteriordiscdisplacement,ADD)的诊断价值。方法:计算机检索PubMed(1966~2013.9)、CNKI(1994~2013.9)、CBM(1978~2013.9)、Embase(1974~2013.9)、VIP(1994~2013.9)数据库,辅助手工检索及其他检索,查找关于高分辨率超声用于诊断ADD的文献。由2名评价者按照QUADAS(qualityassessmentofdiagnosticaccuracystudies)质量评价标准评价纳入研究的质量,进行资料提取,交叉核对,采用分层综合受试者操作特征曲线(HSROC)分析模型进行meta分析,根据贝叶斯理论Fagan’sNomogram统计评价该方法的临床应用价值,利用Stata12.0软件包对纳入数据进行分析。结果:共纳入研究12篇,1137例受试者。Meta分析结果显示,HR-US诊断可复性盘前移位(ADDWR)的合并Sen=0.84(95%CI=0.76~0.90),合并Spe=0.87(95%CI=0.77~0.93),Beta=0.33(95%CI=-0.15~0.81),Z=0.135,P=0.179>0.1,Lambda=3.65(95%CI=2.53~4.77),fagan验前概率=58%,+LR=6.7,阳性验后概率=90%,-LR=0.17,阴性验后概率=20%;HR-US诊断不可复性盘前移位(ADDWoR)的合并Sen=0.76(95%CI=0.61~0.86),合并Spe=0.92(95%CI=0.87~0.95),Beta=-0.41(95%CI=-1.17~0.35),Z=-1.05,P=0.294>0.1,Lambda=3.99(95%CI=2.71~5.27),fagan验前概率=38%,+LR=9.8,阳性验后概率=83%,-LR=0.25,阴性验后概率=16%。结论:HR-US诊断ADD具有较高的准确性,对ADDWR的诊断效能高于ADDWoR,适合用于口腔门诊对ADD的快速筛选。
Objective: To evaluate the diagnostic value of high resolution ultrasound (HR-US) in the anterior segment of temporomandibular joint (anteriordiscisplacement, ADD). Methods: The databases of PubMed (1966 ~ 2013.9), CNKI (1994 ~ 2013.9), CBM (1978 ~ 2013.9), Embase (1974 ~ 2013.9) and VIP (1994 ~ 2013.9) databases were searched by computer. Resolution ultrasound for the diagnosis of ADD literature. Two reviewers evaluated the quality of the included studies according to QUADAS (qualityassessment of diagnostic quality tests), extracted data and cross-checked the data. The data were analyzed by the hierarchical comprehensive receiver operating characteristic curve (HSROC) analysis model. According to Bayesian theory Fagan’sNomogram statistical evaluation of the clinical value of the method, the use of Stata12.0 package data included in the analysis. Results: A total of 12 studies and 1137 subjects were enrolled. Meta-analysis showed that the HR-US diagnosis of rewirable ADDWR combined Sen = 0.84 (95% CI = 0.76-0.90), combined Spe = 0.87 (95% CI = 0.77-0.93), Beta = 0.33 (95% CI = -0.15-0.81), Z = 0.135, P = 0.179> 0.1, Lambda = 3.65 (95% CI = 2.53-4.77), fagan a priori probability = 58%, + LR = 6.7, Post-morbidity = 90%, LR = 0.17, post-negative posterior probability = 20%, HR-US combined with Senile Propagation Sentences = 0.76 for ADDWoR (95% CI = 0.61-0.86) = 0.92 (95% CI = 0.87-0.95), Beta = -0.41 (95% CI = -1.17-0.35), Z = -1.05, P = 0.294> 0.1 and Lambda = 3.99 , the pre-test probability of fagan = 38%, + LR = 9.8, post-posterior probability = 83%, - LR = 0.25, negative post-test probability = 16%. Conclusion: The diagnosis of ADD with HR-US has high accuracy and the diagnostic efficiency of ADDWR is higher than that of ADDWoR. It is suitable for rapid screening of ADD in oral clinic.