膝骨关节炎患者全膝关节置换术后HSS评分最小临床重要差异的研究  

Minimal clinically important difference for HSS of patients with primary osteoarthritis after total knee arthroplasty

作　　者：杨学 江桥 徐驰[2] 付君[2] 李睿[2] 陈继营[2] YANG Xue;JIANG Qiao;XU Chi;FU Jun;LI Rui;CHEN Jiying(Chinese PLA Medical School,Beijing 100853,China;Department of Orthopaedic Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing,100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心骨科,北京100853

出　　处：《解放军医学院学报》2020年第12期1188-1192,共5页Academic Journal of Chinese PLA Medical School

基　　金：国家自然科学基金项目(8167090912)。

摘　　要：目的确定膝骨关节炎患者全膝关节置换后美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)的最小临床重要差异(minimal clinically important difference,MCID)。方法回顾性分析2017年1月-2018年6月解放军总医院第一医学中心关节外科诊断为膝骨关节炎并行单侧全膝关节置换治疗的患者。记录患者术前HSS评分、术后1年的HSS评分及术后1年满意度调查结果。采用锚法(Anchor-based approach)将患者满意度作为分组指标,简单线性回归分析确定HSS评分的MCID。结果413例患者的平均年龄(66.0±7.8)岁,男性93例(22.5%),女性320例(77.5%)。全膝关节置换后1年HSS评分平均提高34.33分(95%CI:33.11~35.54)。术后1年满意度评价极其满意59例,非常满意131例,满意177例,一般34例,不满意/糟糕12例;各组患者术前和术后1年HSS评分均有改变:极其满意组44.96(95%CI:42.51~47.41),非常满意组38.44(95%CI:36.74~40.14),比较满意组32.26(95%CI:30.71~33.81),一般组20.45(95%CI:17.35~23.55),不满意/糟糕组8.08(95%CI:2.83~13.34)。HSS评分的MCID为9.18(95%CI:6.37~11.98)。结论本研究确定了膝骨关节炎患者全膝关节置换后HSS评分的最小临床重要差异为9.18分,建议膝骨关节炎患者全膝关节置换治疗1年后HSS评分变化高于此分数作为有临床意义的评价阈值。Objective To identify the minimal clinically important difference(MCID)for hospital for special surgery knee score(HSS)after total knee arthroplasty(TKA).Methods A retrospective analysis was performed in patients diagnosed with primary knee osteoarthritis and treated with unilateral TKA from January 2017 to June 2018 in the department of orthopaedic surgery of the First Medical Center of Chinese PLA General Hospital.Pre-operative and 1 year postoperative HSS scores and 1 year postoperative satisfaction for 413 patients undergoing a primary TKA for osteoarthritis were collected.Simple linear regression was used to calculate the MCID for improvement HSS score according to the level of patient satisfaction after 1 year.Results The mean age of the 413 subjects was 66±7.8 years.There were 320(77.5%)female and 93(22.5%)male subjects.In average,the HSS improved by 34.33(95%CI:33.11-35.54)points.The level of satisfaction was excellent in 59 cases,very good in 131 cases,good in 177 cases,fair in 34 cases,and poor/terrible in 12 cases.The changes in HSS in excellent group was 44.96(95%CI:42.51-47.41),very good group 38.44(95%CI:36.74-40.14),good group 32.26(95%CI:30.71-33.81),fair group 20.45(95%CI:17.35-23.55),poor/terrible group 8.08(95%CI:2.83-13.34).The MCID identified for HSS was 9.18(95%CI:6.37-11.98).changes in HSS between each group varied significantly;The HSS improved by 34.33(95%CI:33.11-35.54)points.The MCID identified for HSS was 9.18(95%CI:6.37-11.98).Conclusion This study has determined that the MCID for HSS in patients with knee osteoarthritis is 9.18 points at 1 year after total knee arthroplasty.It is recommended 9.18 can be set as the cut-off score to evaluate clinical significance.

关 键 词：骨关节炎 全膝关节置换 最小临床重要差异 美国特种外科医院膝关节评分 患者报告结果评价 

分 类 号：R687.4[医药卫生—骨科学]