体格检查在诊断关节炎前关节内髋关节病理方面的敏感性和特异性是高度可变的：一项系统综述

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-06-01 DOI:10.1016/j.asmr.2025.101117

Jaydeep Dhillon D.O. , Evan J. Hernandez B.S. , Carson Keeter M.S. , Matthew J. Kraeutler M.D.

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引用次数: 0

摘要

目的对各种体格检查诊断髋关节关节炎前病变的准确性进行系统回顾。方法根据PRISMA（系统评价和荟萃分析首选报告项目）指南，通过检索PubMed、Embase和Cochrane图书馆进行系统评价，以确定用于诊断关节内病变（如唇裂、股骨髋臼撞击（FAI）或髋关节微不稳定）的各种体检检查的敏感性和/或特异性的研究。使用的搜索短语是髋关节和（检查或检查）和疼痛和（敏感性或特异性）。共有15项研究（4项I级研究，6项II级研究，5项III级研究）符合纳入标准，共计1,378髋。患者的平均年龄范围为16.0至60.2岁，男性占队列的11%至100%。对于诊断髋关节唇撕裂，基于参考标准比较磁共振成像（MRI）和髋关节镜（HA）时直接可视化，FADIR（屈曲、内缩、内旋）测试的灵敏度最高，为100%，FABER（屈曲、外展、外旋）测试的特异性最高，分别为100%。对于FAI的诊断，基于MRI和HA的参考标准比较，IROP（内旋过压）测试的灵敏度最高，为91%，FADIR测试的特异性最高，分别为47%。对于诊断髋关节微不稳定，AB-HEER（外展-过伸-外旋）试验的灵敏度最高，为80.6%，俯卧不稳定试验的特异性最高，分别为97.6%。结论：本研究发现体格检查在诊断关节炎前关节内髋关节疾病的敏感性和特异性方面存在很大差异。

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Sensitivity and Specificity for Physical Examination Tests in Diagnosing Prearthritic Intra-Articular Hip Pathology Are Highly Variable: A Systematic Review

Purpose

To perform a systematic review of the accuracy of various physical examination tests for diagnosing prearthritic intra-articular hip pathology.

Methods

A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Embase, and the Cochrane Library to identify studies that measured sensitivity and/or specificity of various physical examination tests for diagnosing prearthritic intra-articular hip pathology such as a labral tear, femoroacetabular impingement (FAI), or microinstability of the hip joint. The search phrase used was hip AND (exam OR examination) AND pain AND (sensitivity OR specificity). A total of 15 studies (4 Level I, 6 Level II, and 5 Level III) met the inclusion criteria, including a total of 1,378 hips. The patients had a mean age range of 16.0 to 60.2 years, with males ranging from 11% to 100% of the cohort. For diagnosing hip labral tears, the FADIR (flexion, adduction, internal rotation) test showed the highest sensitivity of 100%, and the FABER (Flexion, Abduction, External Rotation) test showed the highest specificity of 100% based on reference standard comparisons of magnetic resonance imaging (MRI) and direct visualization during hip arthroscopy (HA), respectively. For diagnosing FAI, the IROP (Internal Rotation Over Pressure) test showed the highest sensitivity of 91%, and the FADIR test showed the highest specificity of 47% based on reference standard comparisons of MRI and HA, respectively. For diagnosing hip microinstability, the AB-HEER (abduction–hyperextension–external rotation) test showed the highest sensitivity of 80.6%, and the Prone Instability test showed the highest specificity of 97.6% based on reference standard comparisons of MRI and HA, respectively.

Conclusions

This study found high variability in the sensitivity and specificity of physical examination tests for diagnosing prearthritic intra-articular hip disorders.

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