Rivera S M, Hatch J P, Dolce C, Bays R A, Van Sickels J E, Rugh J D
Department of Orthodontics, The University of Texas Health Science Center at San Antonio, 78284-7910, USA.
Am J Orthod Dentofacial Orthop. 2000 Aug;118(2):134-41. doi: 10.1067/mod.2000.107010.
In an attempt to learn more about patients' decision-making processes, an analysis was performed to examine patients' reasons for undergoing orthognathic surgery and their understanding of the reasons surgery was recommended. Before surgery, 105 females and 38 males completed an open-ended questionnaire in which they listed their reasons for choosing orthognathic surgery and their perceptions of their orthodontists' recommendations. Three raters classified the responses into 7 categories: esthetics, psychosocial, functional, TMJ/pain, authority, prevention, and other. Rater agreement ranged from a kappa of.55 to 1.00. Patients reported undergoing orthognathic surgery primarily for esthetic, functional, and TMJ improvements, 71%, 47%, and 28%, respectively. Females reported more TMJ-related reasons than males (P <.05). Patients reporting function (P <. 05), TMJ (P <.05), and prevention of future problems (P <.05) were older than patients not reporting these reasons. Mexican American patients indicated more psychosocial reasons (P <.05) than European Americans. Patients understood that orthognathic surgery was recommended primarily for esthetic, functional, and TMJ improvements, 52%, 44%, and 18%, respectively. Males reported receiving more preventative recommendations (23%) than females (10%). Mexican American patients reported receiving more psychosocial recommendations (P <.05) than European Americans. Agreement between each paired patient/patient-perceived reason was highest for TMJ problems (kappa = 0.588). In conclusion, patients underwent orthognathic surgery to improve esthetic, functional and TMJ problems and interpreted orthodontists' recommendations for similar reasons. On a case-to-case basis, agreement between patient and orthodontist-represented reasons was modest, suggesting differences between patients' own reasons and their perceptions of orthodontists' recommendations.
为了更多地了解患者的决策过程，我们进行了一项分析，以研究患者接受正颌手术的原因以及他们对推荐手术原因的理解。手术前，105名女性和38名男性完成了一份开放式问卷，他们在问卷中列出了选择正颌手术的原因以及对正畸医生建议的看法。三名评分者将回答分为7类：美学、心理社会、功能、颞下颌关节/疼痛、权威、预防和其他。评分者之间的一致性系数范围为0.55至1.00。患者报告接受正颌手术主要是为了改善美学、功能和颞下颌关节问题，分别为71%、47%和28%。女性报告的与颞下颌关节相关的原因比男性多（P<.05）。报告功能（P<.05）、颞下颌关节（P<.05）和预防未来问题（P<.05）的患者比未报告这些原因的患者年龄更大。墨西哥裔美国患者表示的心理社会原因比欧裔美国患者多（P<.05）。患者认为正颌手术主要是为了改善美学、功能和颞下颌关节问题，分别为52%、44%和18%。男性报告收到的预防性建议（23%）比女性（10%）多。墨西哥裔美国患者报告收到的心理社会建议比欧裔美国患者多（P<.05）。患者与患者所认为原因之间的一致性在颞下颌关节问题上最高（kappa = 0.588）。总之，患者接受正颌手术是为了改善美学、功能和颞下颌关节问题，并出于类似原因理解正畸医生的建议。在个别情况下，患者与正畸医生所代表原因之间的一致性一般，表明患者自身原因与他们对正畸医生建议的看法之间存在差异。
