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首页> 外文期刊>Archives of Iranian medicine >Arthroscopic evaluation of the accuracy of clinical examination versus MRI in diagnosing meniscus tears and cruciate ligament ruptures
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Arthroscopic evaluation of the accuracy of clinical examination versus MRI in diagnosing meniscus tears and cruciate ligament ruptures

机译：关节镜检查与MRI在半月板撕裂和交叉韧带破裂诊断中的临床检查准确性

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Background: Magnetic resonance imaging (MRI) of the knee joint has often been regarded as a noninvasive alternative to diagnostic arthroscopy. In day-to-day clinical practice, the MRI scan is routinely used to support the diagnosis for meniscus or ligamentous injuries prior to recommending arthroscopic examination and surgery. On the other hand, rapidly progressing medical technology sometimes obscures the importance of history and physical examination. This study aims to evaluate the accuracy of physical examination and MRI scanning in the diagnosis of knee injury, including meniscus tears and cruciate ligament ruptures. Methods: In a cross-sectional, descriptive analytical study, 120 patients with knee injury who were candidates for arthroscopy were referred to Tabriz Shohada Hospital during a one-year period. Prior history of arthroscopy or knee surgery was considered as exclusion criteria. Before ordering an MRI and arthroscopy, a thorough physical examination of the affected knee was performed and a preliminary diagnosis made. The results of arthroscopy were considered as the definitive diagnosis, therefore the results of the physical examination and MRI were judged accordingly. Results: Of the 120 evaluated patients with knee injuries, there were 108 males and 12 females with a mean age of 29.13 ± 7.37 (16-54) years. For medial meniscus injuries, clinical examination had an accuracy of 85%, sensitivity of 94.8%, and specificity of 75.8%. Lateral meniscus injuries had the following results: accuracy (85%), sensitivity (70.8%) and specificity (88.5%). Clinical examination of anterior cruciate injuries had an accuracy of 95.8%, sensitivity of 98.6% and specificity of 91.7%. According to MRI results, for medial meniscus injuries there was an accuracy of 77.5%, sensitivity of 84.2%, and specificity of 71.4%. In lateral meniscus injuries, MRI had an accuracy of 85.8%, sensitivity of 56.5% and 92.8% specificity. MRI evaluation of anterior cruciate injuries was 92.5% for accuracy, 98.6% for sensitivity, and 83.3% for specificity. Both clinical examination and MRI were 100% for posterior cruciate injuries. Overall, in isolated injuries, the accuracy of clinical examination was relatively better than with complicated cases. The opposite results were seen for MRI findings in this regard. Conclusion: According to our results, both physical examination and MRI scans are very sensitive and accurate in the diagnosis of knee injuries, with a mild preference for physical examination. MRI should be reserved for doubtful cases or complicated injuries.
机译：背景：膝关节磁共振成像（MRI）通常被认为是诊断性关节镜的一种非侵入性替代方法。在日常临床实践中，在建议进行关节镜检查和手术之前，通常使用MRI扫描来支持对半月板或韧带损伤的诊断。另一方面，快速发展的医疗技术有时会掩盖病史和体格检查的重要性。这项研究的目的是评估体格检查和MRI扫描在诊断包括半月板撕裂和交叉韧带断裂的膝关节损伤中的准确性。方法：在一项横断面描述性分析研究中，将120例膝关节损伤患者进行关节镜检查，并在一年期间转诊至大不里士Shohada医院。关节镜检查或膝关节手术的既往史被视为排除标准。在进行MRI和关节镜检查之前，对患膝进行了全面的身体检查并做出了初步诊断。关节镜检查的结果被认为是明确的诊断，因此对身体检查和MRI的结果进行相应的判断。结果：在120位评估过的膝关节损伤患者中，男性108例，女性12例，平均年龄为29.13±7.37（16-54）岁。对于内侧半月板损伤，临床检查的准确性为85％，敏感性为94.8％，特异性为75.8％。半月板外侧损伤具有以下结果：准确性（85％），敏感性（70.8％）和特异性（88.5％）。前交叉损伤的临床检查准确率为95.8％，敏感性为98.6％，特异性为91.7％。根据MRI结果，对于半月板内侧损伤，准确度为77.5％，敏感性为84.2％，特异性为71.4％。在外侧半月板损伤中，MRI的准确度为85.8％，敏感性为56.5％，特异性为92.8％。 MRI对前交叉损伤的准确度为92.5％，敏感性为98.6％，特异性为83.3％。临床检查和MRI均显示100％后十字交叉受伤。总体而言，在孤立的伤害中，临床检查的准确性相对于复杂病例要好。在这方面，MRI发现的结果相反。结论：根据我们的结果，体格检查和MRI扫描对膝关节损伤的诊断非常敏感和准确，对体格检查的偏爱程度较高。对于可疑病例或复杂损伤，应保留MRI。

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