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论文摘要

其他疾病误诊为颞下颌关节紊乱病及有关此类文献命名术语的探讨

Diseases misdiagnosed as temporomandibular disorders and the appropriateness of terminology for classification of such literatures Yang

作者:杨娴睿1 李春洁2 史宗道3 苏乃川4

Author:Yang Xianrui1,Li Chunjie2,Shi Zongdao3,Su Naichuan4.

收稿日期:2012-03-23          年卷(期)页码:2013,40(1):28-32

期刊名称:国际口腔医学杂志

Journal Name:International Journal of Stomatology

关键字:颞下颌关节紊乱病,误诊,病例报道,文献综述,系统评价,

Key words:temporomandibular disorders,misdiagnosis,case reports,review,systematic review,

基金项目:

2010—2011年全国“大学生创新性实验计划” 基金资助项目(101061001)

中文摘要

目的 总结其他疾病误诊为颞下颌关节紊乱病(TMD)的情况,分析其原因,同时探讨描述此类文献术语的合理性。方法 电子检索Medline(via OVID)和EMBASE 数据库,中国生物医学文献数据库网络版(CBM)、中国期刊全文数据库(CNKI)和中文科技期刊全文数据库(维普),终止检索时间为2011 年12 月。收集相关文献总结误诊为颞下颌关节紊乱病的其他疾病情况,资料提取由两名检阅者独立分开完成。同时,搜索名为“系统评价” 的总结病例报道或病案系列的“文献综述” 类文章,探讨对此类文章命名为“系统评价”的合理性。结果 共检索到国内外文献315篇,最终纳入21篇(57例),均为病例报道或临床综述。该57 例被误诊为颞下颌关节紊乱病的病例分别有上颌第三磨牙慢性冠周炎(43.86%)、鼻咽癌(15.79%)、颌面部肿瘤(15.97%)等20种疾病,误诊的原因主要有:临床表现类似(33.96%)、主诉相混淆(26.43%)及认识上不足(22.64%)等。同时,检索到标为“系统评价”的病例报道类“文献综述”文章35 篇,中文27 篇,英文8 篇, 均缺乏对病例报道真实性的评价,也没有方法学质量评价。结论 其他疾病被误诊为颞下颌关节紊乱病主要发生在其临床表现极为相似的一些疾病,患者的主诉容易造成混淆, 医务人员专业素质欠缺,工作责任心不够强亦有一定关系。在命名此类总结病例报道或病案系列文章时,最好使用“文献综述”,而不用“系统评价”。

英文摘要

ObjectiveTo summarize all the related reports to explore causes of the misdiagnoses of other diseases as temporomandibular disorder(TMD) and develop strategies in reducing the misdiagnosis, and to assess appropriateness of using“systematic review” in replace of“review” for this kind of literatures.MethodsMedline (via OVID), EMBASE, Chinese BioMedical Literature Database(CBM), China National Knowledge Infrastructure (CNKI) and VIP Database for Chinese Technical Periodicals(VIP) were searched electronically till December, 2011 for identifying the case reports, case series or “systematic reviews” of misdiagnoses of other diseases as TMD. The eligible studies were selected and extracted by two independent reviewers. All the data were summarized to show distributions of other diseases and classifications of the possible causes of the misdiagnoses. For second aim of the study, some so-called systematic reviews on misdiagnosis in which only case reports or case series being included were also collected, to explore appropriateness of the term “systematic review” for such literatures.ResultsA total of 21 case r eports or case series involving 57 patients met the inclusive criteria, of which 10 being in Chinese and 11 in English. The 57 patients being misdiagnosed as TMD were suffering from 20 sorts of diseases, such as pericoronitis of the maxillary third molar(43.86%), nasopharyngeal carcinoma(15.79%), different kinds of tumors(15.97%) in the orofacial region, etc.. Suspected causes of the misdiagnoses could be classified into 7 categories, such as similar clinical manifestations(33.96%), confused chief complaints (26.43%), insufficient understanding of the clinicians(22.64%), etc.. Thirty five articles naming as systematic review in which case reports or case series on misdiagnoses being included were found through intensive searching, 8 in English and 27 in Chinese. They were narrative reviews in light of congeries of same facts without appraising quality of methodology or validity of the case reports or case series.“Review” should be appropriate term for such literatures and it is no need to use a modern term “systematic review” instead. The later term did not raise any new value to the term“review”.ConclusionThe misdiagnoses of other diseases as TMD were mainly caused by similarities in symptoms and clinical signs of the diseases with TMD, and insufficient understandings of the clinicians. It is better to use“review” instead of“systematic review” to describe same type of the literatures.

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