新版膝关节评分系统在评价单髁关节置换术的应用分析
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摘要
目的使用单髁关节置换的患者样本验证新版膝关节评分系统(New-KSS)评分系统的效应性以及内部一致性。方法采用2012年由美国膝关节协会设计推出的New-KSS评价单髁关节置换治疗膝前内侧单间室骨关节炎患者疗效,在行初次单髁关节置换的住院患者中对参与本研究的患者按照符合膝内侧单间室骨关节炎的纳入标准进行筛选,并排除双侧、多间室、炎症性关节炎及近期感染的患者,并且要求患者在术前、术后3个月及术后12个月完成New-KSS评分量表以及膝关节损伤和骨关节炎评分(KOOS)量表。利用克隆巴赫信度系数(Cronbach’s alpha)分析新版膝关节评分系统NewKSS的信度,同时通过Spearman相关系数分析其效度。验证New-KSS评分在评价单髁关节置换疗效的效应性以及内部一致性。结果 65名符合入组标准的患者参加了研究,根据New-KSS各亚维度的Cronbach’sα在0. 70～0. 91变化,反映其具有较高的内在信度。术前、术后次评分各维度效应值Cohen’d系数范围在1. 83～4. 43,提示其具有较好的效应性。New-KSS与KOOS量表相应维度之间的结构效度理想,说明New-KSS与KOOS在评价同一对象时具有较好的一致性。结论通过分析相关数据发现,New-KSS在评价单髁关节置换疗效具有较好的效应性和内部一致性;且New-KSS量表具有较好的跨时间差异适应性。
Objective To verify the responsiveness,and internal consistency of the New Knee Society knee scoring system( New-KSS) in the patients treated with unicompartment knee arthroplasty.Methods New-KSS proposed by the American Knee Association in 2012 was used to evaluate the efficacy of unicompartment knee arthroplasty in treating knee anteromedial osteoarthritis. The inpatients who received primary unicompartment knee arthroplasty were screened for trial participants according to the knee anteromedial osteoarthritis inclusion criteria; the bilateral,multi-compartment,inflammatory or recently infected patients were excluded. The selected participants were evaluated with New-KSS and knee injury and osteoarthritis outcome score( KOOS) before the operation, three and 12 months after the surgery.Responsiveness,and internal consistency of the New-KSS scoring system in the patients treated with unicompartment knee arthroplasty were varified by analyzing the acquired data using Cronbach's alpha and Spearman correlation coefficient. Results A total of 65 patients were included in this research according to the enrollment criteria. Cronbach's alpha of different subscale varied from 0. 70 to 0. 91,reflecting that there existed high degree of internal consistency. Cohen 'd of different subscale ranged from 1. 83 to 4. 43,indicating that there existed high degree of responsiveness. Corresponding subscales between New-KSS and KOOS had ideal correlation,indicating that New-KSS and KOOS showed better consistency in evaluating the same object. Conclusion Relating data analysis supports the responsiveness of New-KSS in the evaluation of medial unicompartment osteoarthritis of the knee treated with UKA,the internal consistency is acceptable as well; New-KSS also has favorable adaptability at different time points.
Objective To verify the responsiveness,and internal consistency of the New Knee Society knee scoring system( New-KSS) in the patients treated with unicompartment knee arthroplasty.Methods New-KSS proposed by the American Knee Association in 2012 was used to evaluate the efficacy of unicompartment knee arthroplasty in treating knee anteromedial osteoarthritis. The inpatients who received primary unicompartment knee arthroplasty were screened for trial participants according to the knee anteromedial osteoarthritis inclusion criteria; the bilateral,multi-compartment,inflammatory or recently infected patients were excluded. The selected participants were evaluated with New-KSS and knee injury and osteoarthritis outcome score( KOOS) before the operation, three and 12 months after the surgery.Responsiveness,and internal consistency of the New-KSS scoring system in the patients treated with unicompartment knee arthroplasty were varified by analyzing the acquired data using Cronbach's alpha and Spearman correlation coefficient. Results A total of 65 patients were included in this research according to the enrollment criteria. Cronbach's alpha of different subscale varied from 0. 70 to 0. 91,reflecting that there existed high degree of internal consistency. Cohen 'd of different subscale ranged from 1. 83 to 4. 43,indicating that there existed high degree of responsiveness. Corresponding subscales between New-KSS and KOOS had ideal correlation,indicating that New-KSS and KOOS showed better consistency in evaluating the same object. Conclusion Relating data analysis supports the responsiveness of New-KSS in the evaluation of medial unicompartment osteoarthritis of the knee treated with UKA,the internal consistency is acceptable as well; New-KSS also has favorable adaptability at different time points.
引文
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[12] Callahan CM,Drake BG,Heck DA,et al. Patient outcomes following tricompartmental total knee replacement. A meta-analysis[J]. JAMA,1994,271(17):1349-1357.
[13] Bach CM,Nogler M,Steingruber IE,et al. Scoring systems in total knee arthroplasty[J]. Clin Orthop Relat Res,2002,399:184-196.
[14] Davies AP. Rating systems for total knee replacement[J]. Knee,2002,9(4):261-266.
[15] Scuderi GR,Bourne RB,Noble PC,et al. The new Knee Society Knee Scoring System[J]. Clin Orthop Relat Res,2012,470(1):3-19.
[16] Bremner-Smith AT,Ewings P,Weale AE. Knee scores in a’normal’elderly population[J]. Knee,2004,11(4):279-282.
[17] Kluczynski MA,Marzo JM,Wind WM,et al. The effect of body mass index on clinical outcomes in patients without radiographic evidence of degenerative joint disease after arthroscopic partial meniscectomy[J]. Arthroscopy,2017,33(11):2054-2063,e10.
[18] Tamura LS,Cazzo E,Chaim EA. Influence of morbid obesity on physical capacity,knee-related symptoms and overall quality of Life:a cross-sectional study[J]. Rev Assoc Med Bras,2017,63(2):142-147.
[19] Ware J,Kosinski M,Keller SD. A 12-Item Short-Form health survey:construction of scales and preliminary tests of reliability and validity[J]. Med Care,1996,34(3):220-233.
[20] Jette AM,Haley SM,Coster WJ,et al. Late life function and disability instrument:I. Development and evaluation of the disability component[J]. J Gerontol A Biol Sci Med Sci,2002,57(4):M209-M216.
[21] Tubach F,Ravaud P,Baron G,et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis:the minimal clinically important improvement[J].Ann Rheum Dis,2005,64(1):29-33.
[2] Insall JN,Dorr LD,Scott RD,et al. Rationale of the knee society clinical rating system[J]. Clin Orthop Relat Res,1989,248:13-14.
[3]王一鸣,王琦,张先龙.膝关节单髁置换术的适应证及远期疗效综述[J/CD].中华关节外科杂志(电子版),2016,10(3):341-346.
[4]王春生,靳振岭,张子琦,等.新版KSS评分系统的试应用及分析[J].中国矫形外科杂志,2017,(1):33-37.
[5] Roos EM,Roos HP,Lohmander LS,et al. Knee injury and osteoarthritis outcome score(KOOS)--development of a selfadministered outcome measure[J]. J Orthop Sports Phys Ther,1998,28(2):88-96.
[6] Fillingim RS. Sex,gender,and pain:women and men really are different[J]. Curr Rev Pain,2000,4(1):24-30.
[7] Escobar A,Quintana JM,Bilbao A,et al. Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis. Western Ontario and Mc Master Universities Osteoarthritis Index[J]. Clin Rheumatol,2002,21(6):466-471.
[8] Garratt AM,Brealey S,Gillespie WJ,et al. Patient-assessed health instruments for the knee:a structured review[J].Rheumatology,2004,43(11):1414-1423.
[9] Bottomley N,Jones LD,Rout R,et al. A survival analysis of1084 knees of the Oxford unicompartmental knee arthroplasty:a comparison between consultant and trainee surgeons[J]. Bone Joint J,2016,98B(B):22-27.
[10] Luscombe KL,Lim J,Jones PW,et al. Minimally invasive Oxford medial unicompartmental knee arthroplasty-A note of caution![J]. Int Orthop,2007,31(3):321-324.
[11] Price AJ,Rees JL,Beard DJ,et al. Sagittal plane kinematics of a mobile-bearing unicompartmental knee arthroplasty at 10 years:a comparative in vivo fluoroscopic analysis[J]. J Arthroplasty,2004,19(5):590-597.
[12] Callahan CM,Drake BG,Heck DA,et al. Patient outcomes following tricompartmental total knee replacement. A meta-analysis[J]. JAMA,1994,271(17):1349-1357.
[13] Bach CM,Nogler M,Steingruber IE,et al. Scoring systems in total knee arthroplasty[J]. Clin Orthop Relat Res,2002,399:184-196.
[14] Davies AP. Rating systems for total knee replacement[J]. Knee,2002,9(4):261-266.
[15] Scuderi GR,Bourne RB,Noble PC,et al. The new Knee Society Knee Scoring System[J]. Clin Orthop Relat Res,2012,470(1):3-19.
[16] Bremner-Smith AT,Ewings P,Weale AE. Knee scores in a’normal’elderly population[J]. Knee,2004,11(4):279-282.
[17] Kluczynski MA,Marzo JM,Wind WM,et al. The effect of body mass index on clinical outcomes in patients without radiographic evidence of degenerative joint disease after arthroscopic partial meniscectomy[J]. Arthroscopy,2017,33(11):2054-2063,e10.
[18] Tamura LS,Cazzo E,Chaim EA. Influence of morbid obesity on physical capacity,knee-related symptoms and overall quality of Life:a cross-sectional study[J]. Rev Assoc Med Bras,2017,63(2):142-147.
[19] Ware J,Kosinski M,Keller SD. A 12-Item Short-Form health survey:construction of scales and preliminary tests of reliability and validity[J]. Med Care,1996,34(3):220-233.
[20] Jette AM,Haley SM,Coster WJ,et al. Late life function and disability instrument:I. Development and evaluation of the disability component[J]. J Gerontol A Biol Sci Med Sci,2002,57(4):M209-M216.
[21] Tubach F,Ravaud P,Baron G,et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis:the minimal clinically important improvement[J].Ann Rheum Dis,2005,64(1):29-33.