Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: Comparison of clinical diagnosis with arthroscopic morphology
Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: Comparison of clinical diagnosis with arthroscopic morphology
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DOI：
10.1016/s0278-2391(98)90246-4
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发表时间：
1998-09-01
影响因子：
1.9
通讯作者：
Ratcliffe, A
中科院分区：
文献类型：
--
作者：
Israel, HA;Diamond, B;Ratcliffe, A
目的：本研究的目的是通过临床诊断标准和关节镜检查来确定骨关节炎和滑膜炎在严重难治性颞下颌关节（TMJ）症状患者中的常见程度，并比较临床和关节镜诊断在特异性和敏感性方面的准确性。患者与方法：对84例严重颞下颌关节症状，保守治疗无效的患者126个关节进行临床及关节镜诊断。所有关节根据临床和关节镜标准分为骨关节炎（OA）或无骨关节炎（非OA）和滑膜炎（syn）或无滑膜炎（非syn）。采用卡方分析来确定临床和关节镜诊断之间是否存在关系。将术前临床诊断与关节镜形态学诊断进行比较，确定滑膜炎和骨关节炎临床诊断标准的特异性和敏感性。结果：126个关节中59个（47%）的术前临床诊断为OA，而126个关节中82个（65%）的关节镜诊断为OA，卡方分析显示OA的临床诊断与关节镜诊断之间存在显著相关性。骨性关节炎的临床诊断具有高特异性。977)，然而，82例假阴性结果中有23例（0.293），敏感性仅为0.707。126个关节中有114个（90%）术前临床诊断为滑膜炎，而126个关节中有112个（89%）经关节镜诊断为滑膜炎。卡方分析没有显示临床和关节镜诊断滑膜炎之间的显著关系。滑膜炎的临床诊断与高敏感性相关（0.920）；然而，14个假阳性结果中有11个（0.786）与低特异性（0.214）相关。结论：OA的临床诊断虽然有很高的特异性，但敏感性很低。临床和关节镜诊断的比较表明，骨关节炎经常逃避临床检测。滑膜炎临床诊断特异性低，症状可能由其他疾病引起。
Purpose: The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity.Patients and Methods: Clinical and arthroscopic diagnoses were established in 126 joints of 84 patients with severe TMJ symptoms recalcitrant to conservative therapy. Ail joints were classified as having osteoarthritis (OA) or no osteoarthritis (non-OA) and synovitis (syn) or no synovitis (non-syn) using clinical and arthroscopic criteria. Chi-squared analysis was used to determine whether there was a relationship between the clinical and arthroscopic diagnoses. Preoperative clinical diagnoses were compared with arthroscopic morphologic diagnoses to determine the specificity and sensitivity of the clinical diagnostic criteria for synovitis and osteoarthritis.Results: A preoperative clinical diagnosis of OA was established in 59 of 126 joints (47%) compared with an arthroscopic diagnoses of OA in 82 of 126 joints (65%), Chi-squared analysis showed a significant relationship between the clinical and arthroscopic diagnosis of OA. A clinical diagnosis of OA was associated with a high specificity (.977), however, there were 23 of 82 (.293) false-negative findings and a sensitivity of only .707. A preoperative clinical diagnosis of synovitis was established in 114 of 126 joints (90%), compared with an arthroscopic diagnosis of synovitis in 112 of 126 (89%). Chi-squared analysis did not show a significant relationship between the clinical and arthroscopic diagnosis of synovitis. A clinical diagnosis of synovitis was associated with a high sensitivity (.920); however, there were 11 of 14 false-positive findings (.786) associated with a low specificity (.214).Conclusions: Although there was high specificity for the clinical diagnosis of OA, the sensitivity was very low. Comparison of clinical and arthroscopic diagnoses showed that osteoarthritis frequently escapes clinical detection. The clinical diagnosis of synovitis showed that low specificity and symptoms may be caused by other pathoses.