单光子发射计算机断层成像术/CT对关节置换术后无菌性假体松动诊断价值的Meta分析

摘要

背景 近年来,单光子发射计算机断层成像术(SPECT)/CT逐步应用于关节置换术后并发症的诊断.但文献报道的灵敏度、特异度各不相同.目的 评价SPECT/CT诊断关节置换术后无菌性假体松动(AL)的临床价值.方法 计算机检索PubMed、Cochrane Library、Elsevier、中国知网、维普网、万方数据知识服务平台等数据库.检索日期截至2016年12月.并手工检索《中华骨科杂志》《中华放射学杂志》和部分相关英文杂志.评价SPECT/CT对关节置换术后AL的诊断价值.采用Meta-Disc 1.4软件进行Meta分析,计算合并灵敏度、特异度、阳性似然比、阴性似然比,并描绘综合受试者工作特征(SROC)曲线.结果 最终纳入5篇文献,合并灵敏度为0.94〔95%CI(0.87,0.98)〕、合并特异度为0.92〔95%CI(0.86,0.96)〕、合并阳性似然比为9.80〔95%CI(2.02,47.61)〕、合并阴性似然比为0.09〔95%CI(0.04,0.20)〕.SROC曲线下面积(AUC)为0.973,Q=0.925.结论 SPECT/CT对于诊断关节置换术后AL有较好的灵敏度和特异度,可作为关节置换术后AL诊断的优先选择.%Background In recent years,SPECT/CT has been applied to the diagnosis of complications after joint replacement.However,its sensitivity and specificity reported in the published articles are different.Objective To evaluate the diagnostic value of SPECT/CT for aseptic loosening (AL) after joint replacement.Methods We did a literature review of PubMed,Cochrane Library,Elsevier Science Direct,CNKI,CQVIP,Wanfang Data,and printed Chinese Journal of Orthopaedics,Chinese Journal of Radiology and some relative printed English journals to identify studies published as of December 2016 in which the diagnostic value of SPECT/CT for AL after joint replacement was investigated.Meta-Dics(version 1.4) was used to analyze the data.The pooled sensitivity,specificity,positive likelihood ratio and negative likelihood ratio were calculated,and the summary receiver operating characteristic (SROC) of SPECT/CT for the diagnosis of AL after joint replacement was drawn.Results Five studies were included,in which the reported pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and AUC of SPECT/CT for the diagnosis of AL after joint replacement were 0.94〔95%CI (0.87,0.98)〕,0.92〔95%CI(0.86,0.96)〕,9.80〔95%CI(2.02,47.61)〕,0.09〔95%CI(0.04,0.20)〕and 0.973, Q=0.925,respectively.Conclusion SPECT/CT has good sensitivity and specificity for the diagnosis of AL,so it can be used as the preferred choice for AL diagnosis.