腰椎关节突关节疼痛的诊断
发布于 2009-01-18 · 浏览 890 · IP 陕西陕西
这个帖子发布于 16 年零 142 天前，其中的信息可能已发生改变或有所发展。
Diagnosing Lumbar Zygapophysial Joint Pain
腰椎关节突关节疼痛的诊断
In their review of the literature on lumbar radiofrequency neurotomy and zygapophysial joint blocks, Hooten, Martin, and Huntoon [1] make
several salient points. They indicate that systematic reviews of lumbar radiofrequency neurotomy have focused on conventional aspects of methodology, such as randomization, sample size, and outcomes, but that these reviews did not address two seminal, clinical matters:diagnosis and operative technique.
在他们关于腰椎射频神经毁损和关节突关节阻滞的文献中，Hooten, Martin, 和Huntoon做出几个突出重点。他们指出关于腰椎射频神经毁损的系统性回顾集中于传统的方法论方面，如随机化，样本大小，结果，但是这些综述并未涉及关于临床的两个方面：诊断和手术技巧。
On operative technique, Hooten, Martin, andHuntoon correctly point out that for lumbar radiofrequency neurotomy to be credible and effective, electrodes need to be placed parallel to the target nerve. This very point is elaborated in another recent study [2]. None of the controlled studies covered by the systematic reviews used such a technique. Therefore, none of the studies and none of the reviews constitutes an evaluation of the procedure is it should be correctly performed. As Hooten, Martin, and Huntoon state, only Dreyfuss et al. used the correct technique, and their study provides the benchmark for expectable outcomes.
对于手术技巧，Hooten, Martin, 和Huntoon正确指出腰椎射频神经毁损是可靠的也是有效的，需要将电极平行放置到靶神经。这一点在最近在其它文献中有详细说明。无系统性综述报道使用这项技术的对照研究。因此，无研究和综述继续评估这一过程应该正确操作。Hooten, Martin, 和Huntoon声明只有Dreyfuss等人正确使用了该技术，并且他们的研究为预期结果提供基准。
On the matter of diagnosis, Hooten, Martin, and Huntoon [1] reveal that none of the controlled trials properly established a diagnosis of lumbar zygapophysial joint pain before venturing to test a treatment for that condition. The criterion standard for the diagnosis are controlled, diagnostic blocks, but no study used controlled blocks. Therefore, the samples recruited are very likely to have included false-positive cases, which would have confounded the outcomes of the studies, by reducing the apparent success rates. For this reason,none of the controlled studies and none of the systematic reviews constitutes proper evidence of the efficacy of lumbar radiofrequency neurotomy. Again, only Dreyfuss et al. [3] used controlled blocks to select their patients.
关于诊断，Hooten, Martin, 和Huntoon认为在这种情况下冒险去检验一种治疗之前，无合理的对照试验确立腰椎关节突关节疼痛的诊断。诊断标准是对照，诊断性阻滞，但是无使用对照性阻滞的研究。因此，招集的样本很可能包括假阳性病例，这些假阳性通过减少成功率来混淆治疗结果，正是这个原因，无对照研究和无系统性综述制定合适的腰椎射频神经毁损有效的证据。此外，只有Dreyfuss等人使用对照阻滞来选择病人。
Hooten, Martin, and Huntoon [1] proceed to elaborate an algorithm, which they submit could be used to select patients more efficiently, for controlled trials and, by implication, perhaps for treatment in conventional practice. They argue that patients should first be screened using the clinical tests of Revel [4].
Hooten, Martin, 和Huntoon进行推测此作用机制，他们认为它对于选择病人更有效，对于对照试验，通过适应指征，也许对常规治疗也有效。他们认为应该使用Revel临床试验筛选病人。
What Hooten, Martin, and Huntoon [1] propose is sensible in principle. The argument that they use, however, may be somewhat esoteric to many readers. The argument is based on Bayesian statistics. In essence, this method is based on the relationship that diagnostic confidence is the product of the likelihood ratio of the diagnostic test and the pretest prevalence of the condition in question. Accordingly, a series of tests can be used to increase progressively the pretest prevalence of the condition, and thereby improve diagnostic confidence.
Hooten, Martin, 和Huntoon的推理在原则上是合理。然而，他们所使用的论点或许对于大多数读者来讲是点深奥难懂。这些论点基于贝叶斯统计学。实质上，这种方法基于诊断一致性的关系，是诊断试验似然比与预测这种情况患病率的结果。相应地，一系列试验逐步被用来增加预测这种疾病的患病率，因而提高诊断可信度。
In particular, the argument is that, if the likelihood of zygapophysial joint pain can be increased by clinical examination, the yield of subsequent diagnostic blocks will be greater. Thereby, the diagnostic process can be rendered more efficient, that is, by reducing the number of diagnostic blocks required.
这个论点是，尤其是当关节突关节疼痛的可能性由于临床检查而加重时，随后的诊断性阻滞效果会更好。因此，报告的诊断过程更有效，也就是，通过减少所需诊断性阻滞的次数。
Whereas this argument is correct in principle, certain steps outlined by Hooten, Martin, and Huntoon [1] are either incorrect or ambiguous. By correcting the information and revisiting their argument, the actual efficiency of the algorithm proposed by Hooten, Martin, and Huntoon [1] can be determined in terms that are perhaps of more transparent relevance to practitioners.
由于这个证点在原则上是合理的，Hooten, Martin, 和Huntoon所描绘的具体步骤是不正确的或不确定的。通过更正这些资料并且重新回顾他们的论点，他们假想法则的实际有效性可以确定。由于它对临床工作者更明确关联性。
For the sake of argument, let us assume that the prevalence of lumbar zygapophysial joint pain in the population is 27%, which is the representative figure selected by Hooten, Martin, and Huntoon [1]. Let us then consider what would happen if this diagnosis were pursued and established using double-blind, controlled diagnostic blocks in 1,000 patients with low back pain.
这个论点使我们认为人群中腰椎关节突关节疼痛的发病率是27%,这是Hooten, Martin, 和Huntoon选择的代表性数字。然后，让我们考虑到如果在1000个下腰痛病例中使用双盲，对照诊断性阻滞,将会出现的结果。
The data of Dreyfuss et al. [3] show that controlled blocks have a sensitivity of 88% and a specificity of 71%. The false-negative rate, as estimated by Hooten, Martin, and Huntoon [1], is 12%. If the observed prevalence of zygapophysial joint pain is 27%, 1,000 patients would be distributed as shown in Table 1. The actual prevalence of zygapophysial joint pain is 30.6% (306/1,000),but 36 patients fail to be detected because of the false-negative rate, leaving only 270 (27%) to constitute the observed prevalence.
Dreyfuss等人的数据资料显示对照性阻滞的敏感度为88%，特异度为71%。Hooten等所估计的假阴性率是12%。若所观察的关节突关节疼痛的发病率是27%，1000个患者的分布情况如表1。关节突关节疼痛的发病率是30.6% (306/1,000),但由于假阳性率有36个患者未能检测到，继续观察剩下的270个病例。
The data in Table 1 also show the properties of single diagnostic blocks. Single blocks have a falsepositive rate of 29% (202/694). Consequently, only 270 of 472 positive blocks (57%) are truepositive.
表1中的数据也显示出单纯诊断性阻滞的特征。单纯性阻滞有29%的假阳性率。结果，真阳性率仅有57%。
If controlled blocks were used to determine the diagnosis, the cost would be 1,472 blocks. One thousand blocks would be needed to screen the patients for an initial response, and a further 472 control blocks would be needed to check the responses in those who were positive after the first block. The yield of this approach would be 270 true-positive cases, but no false-positive cases, and 36 false-negative cases. The latter would be patients who, indeed, did have zygapophysial joint pain but were missed by the first block and therefore
did not proceed to a second block.
如果使用对照性阻滞来明确诊断，代价是1472个阻滞。需要一千个阻滞来筛选病例，在第一次阻滞结果阳性的病菌例中，还需472例对照阻滞来检测反应。这种方法的结果是270个真阳性病例，但无假阳性，有36个假阴性。实际上，假阴性是指患者有关节突关节疼痛而第一次阻滞失败，因此未进行第二次阻滞治疗。
If controlled blocks were not used, and the diagnosis was based on relief after only single blocks, the process would appear more efficient. Only 1,000 blocks would be required. The yield, however, would be 270 true-positive responses,but also 202 false-positive responses, with no way of determining which was which. There would also be 36 false-negative cases, as for controlled blocks.
如果不用对照性阻滞，其诊断依赖于单纯阻滞后症状的缓减，其过程式显得更加有效。样本仅需1000例。然而，有270真阳性，但同时也有202例假阳性，对照性阻滞中产生36个假阴性。
Hooten, Martin, and Huntoon [1] argue that the diagnostic process can be made more efficient if the sample were first subjected to Revel’s tests.These tests are said to have a sensitivity of 92% and a specificity of 80%, with a resultant likelihood ratio of 4.6. Although these figures appear impressive, they were not based on controlled blocks; they were based on single blocks. Therefore, the sensitivity and specificity apply to samples of patients who are positive and negative to single blocks. In terms of the example being developed, in a sample of 1,000 patients, 472 would be positive to single blocks, and 528 would be negative (Table 2). With a sensitivity of 92%, Revel’stests would be positive in 434 of those 472 positive patients. With a specificity of 80%, the tests would be false-positive in 106 of the 528 negative patients (Table 2).
Hooten, Martin, 和Huntoon认为如果首次按Revel检验选择样本，诊断过程会更有效。这些检验的敏感性为92%，特异性为80%，结论性似然比为4.6。尽管这些数据给人的印象深刻，但它们并不是在对照阻滞的基础上得出的；它们基于单纯阻滞。因此，敏感性和特异性应用于单纯阻滞阳性和阴性的病人。按照显像的病例，一个1000人的样本中，472例单纯阻滞阳性，528例为阴性。敏感性为92%，472个阳性病例中有434个Revel检验阳性。特异性为80%，528个阴性病例中106假阳性。
The group of 472 patients, who are positive to single blocks, contains the 270 patients who would be true-positive if subjected to controlled blocks. Proportionally, these 270 patients would be distributed as 248 among the 434 patients positive to Revel’s tests, and 22 among the 38 patients negative to Revel’s tests (Table 2).
这组有472个病人单纯阻滞阳性，如果符合对照阻滞，包括270例病人为真阳性。按比例这270位病人的分布符合Revel检验，38个阴性病人中有22个符合Revel检验。
If Revel’s tests are used as a screening test, to preselect patients for diagnostic blocks, only those who are positive to the tests proceed to blocks. They would number 540, and consist of 434 true positive and 106 false-positive responders to Revel’s tests. The remaining 460 patients do not proceed to blocks, which include the 422 truenegative cases, but also the 38 false-negative cases.
如果应用Revel检验来作为筛选试验，来预选诊断性阻滞病人，仅仅是阻滞性试验阳性的病人。共540人进行Revel检验，其中真阳性为434例，106例假阳性。460例患者未进行阻滞，包括422个真阴性病例，38个假阴性。
The latter include 22 patients with true zygapophysial joint pain who slip through the screening test, because of the false-negative rate of Revel’s tests. Of those who proceed to blocks, only 248 truly have zygapophysial joint pain that might be confirmed by controlled blocks. At this stage in the algorithm, the sample size is 540, and the number of true-positive cases hidden within it is 248. Revel’s tests have increased the prevalence of zygapophysial joint pain from 27% to 46% (248/540). When this sample is subjected to blocks the distribution will be as shown in Table 3.
后者包括22个真正腰椎关节突关节疼痛筛检结果阴性，因为Revel检验的假阴性率。这些进行阻滞的样本中，仅有248例真正关节突关节疼痛的病人可通过对照阻滞来确诊。在这个规则中，样本大小为540，真阳性病例为隐藏在248个病例中，Revel检验增加了关节突性关节疼痛的发病率，从27%到46%(248/540)。当这些样本进行阻滞时，其情况分布如图3。
The figures are based on the properties of diagnostic blocks (Table 1). Although there should be 248 patients with zygapophysial joint pain, only 218 are correctly detected because of the falsenegative rate of controlled blocks. Meanwhile, because of the false-positive rate of single diagnostic blocks, 31 of the 106 patients who were negative to Revel’s tests appear positive to single blocks, leaving 75 as true-negative; and 54 of the 186 patients who were false-positive to Revel’s tests emerge as positive to single blocks, leaving 132 as true-negative. The 31 plus 54 patients have false-positive responses to single blocks, but will prove negative to controlled blocks. From these figures the efficiency of applying Revel’s tests as a screening test can be derived.
这些数据资料基于诊断性阻滞的特性。尽管应该出现248例关节突关节疼痛的患者，由于对照阻滞的假阴性率导致仅有218例可正确确诊。同时，由于单纯性阻滞的假阳性率，106个病人中有31例的Revel检验阴性而单纯阻滞阳性，剩下75例是真阴性，186例中有54例Revel检验假阳性而单纯阻滞阳性，剩下132例真阴性。85例病人单纯阻滞假阳性，但是对照阻滞为阴性。从这些资料可得，Revel检验的有效地运用于筛选。
腰椎关节突关节疼痛的诊断
In their review of the literature on lumbar radiofrequency neurotomy and zygapophysial joint blocks, Hooten, Martin, and Huntoon [1] make
several salient points. They indicate that systematic reviews of lumbar radiofrequency neurotomy have focused on conventional aspects of methodology, such as randomization, sample size, and outcomes, but that these reviews did not address two seminal, clinical matters:diagnosis and operative technique.
在他们关于腰椎射频神经毁损和关节突关节阻滞的文献中，Hooten, Martin, 和Huntoon做出几个突出重点。他们指出关于腰椎射频神经毁损的系统性回顾集中于传统的方法论方面，如随机化，样本大小，结果，但是这些综述并未涉及关于临床的两个方面：诊断和手术技巧。
On operative technique, Hooten, Martin, andHuntoon correctly point out that for lumbar radiofrequency neurotomy to be credible and effective, electrodes need to be placed parallel to the target nerve. This very point is elaborated in another recent study [2]. None of the controlled studies covered by the systematic reviews used such a technique. Therefore, none of the studies and none of the reviews constitutes an evaluation of the procedure is it should be correctly performed. As Hooten, Martin, and Huntoon state, only Dreyfuss et al. used the correct technique, and their study provides the benchmark for expectable outcomes.
对于手术技巧，Hooten, Martin, 和Huntoon正确指出腰椎射频神经毁损是可靠的也是有效的，需要将电极平行放置到靶神经。这一点在最近在其它文献中有详细说明。无系统性综述报道使用这项技术的对照研究。因此，无研究和综述继续评估这一过程应该正确操作。Hooten, Martin, 和Huntoon声明只有Dreyfuss等人正确使用了该技术，并且他们的研究为预期结果提供基准。
On the matter of diagnosis, Hooten, Martin, and Huntoon [1] reveal that none of the controlled trials properly established a diagnosis of lumbar zygapophysial joint pain before venturing to test a treatment for that condition. The criterion standard for the diagnosis are controlled, diagnostic blocks, but no study used controlled blocks. Therefore, the samples recruited are very likely to have included false-positive cases, which would have confounded the outcomes of the studies, by reducing the apparent success rates. For this reason,none of the controlled studies and none of the systematic reviews constitutes proper evidence of the efficacy of lumbar radiofrequency neurotomy. Again, only Dreyfuss et al. [3] used controlled blocks to select their patients.
关于诊断，Hooten, Martin, 和Huntoon认为在这种情况下冒险去检验一种治疗之前，无合理的对照试验确立腰椎关节突关节疼痛的诊断。诊断标准是对照，诊断性阻滞，但是无使用对照性阻滞的研究。因此，招集的样本很可能包括假阳性病例，这些假阳性通过减少成功率来混淆治疗结果，正是这个原因，无对照研究和无系统性综述制定合适的腰椎射频神经毁损有效的证据。此外，只有Dreyfuss等人使用对照阻滞来选择病人。
Hooten, Martin, and Huntoon [1] proceed to elaborate an algorithm, which they submit could be used to select patients more efficiently, for controlled trials and, by implication, perhaps for treatment in conventional practice. They argue that patients should first be screened using the clinical tests of Revel [4].
Hooten, Martin, 和Huntoon进行推测此作用机制，他们认为它对于选择病人更有效，对于对照试验，通过适应指征，也许对常规治疗也有效。他们认为应该使用Revel临床试验筛选病人。
What Hooten, Martin, and Huntoon [1] propose is sensible in principle. The argument that they use, however, may be somewhat esoteric to many readers. The argument is based on Bayesian statistics. In essence, this method is based on the relationship that diagnostic confidence is the product of the likelihood ratio of the diagnostic test and the pretest prevalence of the condition in question. Accordingly, a series of tests can be used to increase progressively the pretest prevalence of the condition, and thereby improve diagnostic confidence.
Hooten, Martin, 和Huntoon的推理在原则上是合理。然而，他们所使用的论点或许对于大多数读者来讲是点深奥难懂。这些论点基于贝叶斯统计学。实质上，这种方法基于诊断一致性的关系，是诊断试验似然比与预测这种情况患病率的结果。相应地，一系列试验逐步被用来增加预测这种疾病的患病率，因而提高诊断可信度。
In particular, the argument is that, if the likelihood of zygapophysial joint pain can be increased by clinical examination, the yield of subsequent diagnostic blocks will be greater. Thereby, the diagnostic process can be rendered more efficient, that is, by reducing the number of diagnostic blocks required.
这个论点是，尤其是当关节突关节疼痛的可能性由于临床检查而加重时，随后的诊断性阻滞效果会更好。因此，报告的诊断过程更有效，也就是，通过减少所需诊断性阻滞的次数。
Whereas this argument is correct in principle, certain steps outlined by Hooten, Martin, and Huntoon [1] are either incorrect or ambiguous. By correcting the information and revisiting their argument, the actual efficiency of the algorithm proposed by Hooten, Martin, and Huntoon [1] can be determined in terms that are perhaps of more transparent relevance to practitioners.
由于这个证点在原则上是合理的，Hooten, Martin, 和Huntoon所描绘的具体步骤是不正确的或不确定的。通过更正这些资料并且重新回顾他们的论点，他们假想法则的实际有效性可以确定。由于它对临床工作者更明确关联性。
For the sake of argument, let us assume that the prevalence of lumbar zygapophysial joint pain in the population is 27%, which is the representative figure selected by Hooten, Martin, and Huntoon [1]. Let us then consider what would happen if this diagnosis were pursued and established using double-blind, controlled diagnostic blocks in 1,000 patients with low back pain.
这个论点使我们认为人群中腰椎关节突关节疼痛的发病率是27%,这是Hooten, Martin, 和Huntoon选择的代表性数字。然后，让我们考虑到如果在1000个下腰痛病例中使用双盲，对照诊断性阻滞,将会出现的结果。
The data of Dreyfuss et al. [3] show that controlled blocks have a sensitivity of 88% and a specificity of 71%. The false-negative rate, as estimated by Hooten, Martin, and Huntoon [1], is 12%. If the observed prevalence of zygapophysial joint pain is 27%, 1,000 patients would be distributed as shown in Table 1. The actual prevalence of zygapophysial joint pain is 30.6% (306/1,000),but 36 patients fail to be detected because of the false-negative rate, leaving only 270 (27%) to constitute the observed prevalence.
Dreyfuss等人的数据资料显示对照性阻滞的敏感度为88%，特异度为71%。Hooten等所估计的假阴性率是12%。若所观察的关节突关节疼痛的发病率是27%，1000个患者的分布情况如表1。关节突关节疼痛的发病率是30.6% (306/1,000),但由于假阳性率有36个患者未能检测到，继续观察剩下的270个病例。
The data in Table 1 also show the properties of single diagnostic blocks. Single blocks have a falsepositive rate of 29% (202/694). Consequently, only 270 of 472 positive blocks (57%) are truepositive.
表1中的数据也显示出单纯诊断性阻滞的特征。单纯性阻滞有29%的假阳性率。结果，真阳性率仅有57%。
If controlled blocks were used to determine the diagnosis, the cost would be 1,472 blocks. One thousand blocks would be needed to screen the patients for an initial response, and a further 472 control blocks would be needed to check the responses in those who were positive after the first block. The yield of this approach would be 270 true-positive cases, but no false-positive cases, and 36 false-negative cases. The latter would be patients who, indeed, did have zygapophysial joint pain but were missed by the first block and therefore
did not proceed to a second block.
如果使用对照性阻滞来明确诊断，代价是1472个阻滞。需要一千个阻滞来筛选病例，在第一次阻滞结果阳性的病菌例中，还需472例对照阻滞来检测反应。这种方法的结果是270个真阳性病例，但无假阳性，有36个假阴性。实际上，假阴性是指患者有关节突关节疼痛而第一次阻滞失败，因此未进行第二次阻滞治疗。
If controlled blocks were not used, and the diagnosis was based on relief after only single blocks, the process would appear more efficient. Only 1,000 blocks would be required. The yield, however, would be 270 true-positive responses,but also 202 false-positive responses, with no way of determining which was which. There would also be 36 false-negative cases, as for controlled blocks.
如果不用对照性阻滞，其诊断依赖于单纯阻滞后症状的缓减，其过程式显得更加有效。样本仅需1000例。然而，有270真阳性，但同时也有202例假阳性，对照性阻滞中产生36个假阴性。
Hooten, Martin, and Huntoon [1] argue that the diagnostic process can be made more efficient if the sample were first subjected to Revel’s tests.These tests are said to have a sensitivity of 92% and a specificity of 80%, with a resultant likelihood ratio of 4.6. Although these figures appear impressive, they were not based on controlled blocks; they were based on single blocks. Therefore, the sensitivity and specificity apply to samples of patients who are positive and negative to single blocks. In terms of the example being developed, in a sample of 1,000 patients, 472 would be positive to single blocks, and 528 would be negative (Table 2). With a sensitivity of 92%, Revel’stests would be positive in 434 of those 472 positive patients. With a specificity of 80%, the tests would be false-positive in 106 of the 528 negative patients (Table 2).
Hooten, Martin, 和Huntoon认为如果首次按Revel检验选择样本，诊断过程会更有效。这些检验的敏感性为92%，特异性为80%，结论性似然比为4.6。尽管这些数据给人的印象深刻，但它们并不是在对照阻滞的基础上得出的；它们基于单纯阻滞。因此，敏感性和特异性应用于单纯阻滞阳性和阴性的病人。按照显像的病例，一个1000人的样本中，472例单纯阻滞阳性，528例为阴性。敏感性为92%，472个阳性病例中有434个Revel检验阳性。特异性为80%，528个阴性病例中106假阳性。
The group of 472 patients, who are positive to single blocks, contains the 270 patients who would be true-positive if subjected to controlled blocks. Proportionally, these 270 patients would be distributed as 248 among the 434 patients positive to Revel’s tests, and 22 among the 38 patients negative to Revel’s tests (Table 2).
这组有472个病人单纯阻滞阳性，如果符合对照阻滞，包括270例病人为真阳性。按比例这270位病人的分布符合Revel检验，38个阴性病人中有22个符合Revel检验。
If Revel’s tests are used as a screening test, to preselect patients for diagnostic blocks, only those who are positive to the tests proceed to blocks. They would number 540, and consist of 434 true positive and 106 false-positive responders to Revel’s tests. The remaining 460 patients do not proceed to blocks, which include the 422 truenegative cases, but also the 38 false-negative cases.
如果应用Revel检验来作为筛选试验，来预选诊断性阻滞病人，仅仅是阻滞性试验阳性的病人。共540人进行Revel检验，其中真阳性为434例，106例假阳性。460例患者未进行阻滞，包括422个真阴性病例，38个假阴性。
The latter include 22 patients with true zygapophysial joint pain who slip through the screening test, because of the false-negative rate of Revel’s tests. Of those who proceed to blocks, only 248 truly have zygapophysial joint pain that might be confirmed by controlled blocks. At this stage in the algorithm, the sample size is 540, and the number of true-positive cases hidden within it is 248. Revel’s tests have increased the prevalence of zygapophysial joint pain from 27% to 46% (248/540). When this sample is subjected to blocks the distribution will be as shown in Table 3.
后者包括22个真正腰椎关节突关节疼痛筛检结果阴性，因为Revel检验的假阴性率。这些进行阻滞的样本中，仅有248例真正关节突关节疼痛的病人可通过对照阻滞来确诊。在这个规则中，样本大小为540，真阳性病例为隐藏在248个病例中，Revel检验增加了关节突性关节疼痛的发病率，从27%到46%(248/540)。当这些样本进行阻滞时，其情况分布如图3。
The figures are based on the properties of diagnostic blocks (Table 1). Although there should be 248 patients with zygapophysial joint pain, only 218 are correctly detected because of the falsenegative rate of controlled blocks. Meanwhile, because of the false-positive rate of single diagnostic blocks, 31 of the 106 patients who were negative to Revel’s tests appear positive to single blocks, leaving 75 as true-negative; and 54 of the 186 patients who were false-positive to Revel’s tests emerge as positive to single blocks, leaving 132 as true-negative. The 31 plus 54 patients have false-positive responses to single blocks, but will prove negative to controlled blocks. From these figures the efficiency of applying Revel’s tests as a screening test can be derived.
这些数据资料基于诊断性阻滞的特性。尽管应该出现248例关节突关节疼痛的患者，由于对照阻滞的假阴性率导致仅有218例可正确确诊。同时，由于单纯性阻滞的假阳性率，106个病人中有31例的Revel检验阴性而单纯阻滞阳性，剩下75例是真阴性，186例中有54例Revel检验假阳性而单纯阻滞阳性，剩下132例真阴性。85例病人单纯阻滞假阳性，但是对照阻滞为阴性。从这些资料可得，Revel检验的有效地运用于筛选。
最后编辑于 2009-01-18 · 浏览 890
回复6 点赞
