Courpied J P, Caton J, Bouee S, Charpak Y, Thomine J M
Secrétaire général de la SO.F.C.O.T., 56, rue Boissonade, 75014 Paris.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Sep;87(5):424-36.
Seeking for a global epidemiology data on bone and joint disease in adults in France, we analyzed the problems related to bone and joint disease in a sample population to determine healthcare needs. We also examined patient referral and demand for surgical care for bone and joint disease and the degree of patient satisfaction.
A telephone interview was conducted in a randomly sampled population of adults living in France to determine their demographic characteristics and bone and joint conditions and surgical care reported by the interviewees. Before standardizing, the sample population in the 60-year and older group was increased in order to obtain more precise information concerning degenerative joint disease. The sample included 1000 persons aged under 60 years and another 1000 persons aged over 60 years. The sample populations were matched to the French population for sex and age distribution. One hundred personal face-to-face interviews were also conducted with 100 persons residing in a nursing home. The two surveys were conducted in June and July 1999.
Extrapolation of the data obtained to the French population yielded a total of 12 million adults affected by a bone and joint condition during the year preceding the survey. Considering both study samples, the most frequent localizations concerned the spine and the knees. The distribution of the other localizations was age and sex dependent. The percentage of trauma-induced conditions was 31%, predominantly in men under the age of 60 years and in institutionalized individuals. Extrapolation yielded a total of 5.4 million persons who had (or expected to have) a surgical intervention due to a bone and joint condition. The percentage of surgical treatment was highest for fractures (41%) and extravertebral osteoarthritis (18%). Extrapolation to the French population yielded 0.55 million persons aged over 60 years with a hip prosthesis and 0.27 million with a knee prosthesis. Seventy-six percent of the individuals who had undergone surgery for a conditions unrelated to trauma felt their quality of life had been improved. For those who had surgery for a trauma-induced condition, 85% considered they had minimal or no sequelae. Information provided by the surgeon concerning surgical care was thought to be insufficient by 23% of the operated individuals and 43% of those who had a joint prosthesis stated they had not been informed that their implant might be changed. Management of postoperative pain was thought to be insufficient by 36% of the operated individuals.
Due to the wide field of investigation and the methodology used to collect these data, our findings cannot be easily compared with other epidemiological data. They must be considered with caution due to the sampling bias of a telephone interview and also to the bias introduced by the simplified nosology scheme used for the questionnaire and the fact that no medical validation was performed. These data do however show that a large number of adults are concerned, notwithstanding conditions occurring before the age of 18 years with the frequency of accidents during childhood and adolescence. The data collected confirm the priorities set within the framework of the Bone and Joint Decade 2000-2010.
为获取法国成年人骨与关节疾病的全球流行病学数据，我们分析了样本人群中与骨与关节疾病相关的问题，以确定医疗保健需求。我们还研究了患者转诊情况、对骨与关节疾病手术治疗的需求以及患者满意度。
对居住在法国的成年人进行随机抽样电话访谈，以确定受访者的人口统计学特征、骨与关节状况以及所报告的手术治疗情况。在进行标准化之前，增加了60岁及以上年龄组的样本人数，以便获取有关退行性关节疾病的更精确信息。样本包括1000名60岁以下的人和另外1000名60岁以上的人。样本人群在性别和年龄分布上与法国人口相匹配。还对100名住在养老院的人进行了100次个人面对面访谈。两项调查均于1999年6月和7月进行。
将所获数据外推至法国人口，得出在调查前一年共有1200万成年人患有骨与关节疾病。综合两个研究样本来看，最常见的发病部位是脊柱和膝盖。其他发病部位的分布取决于年龄和性别。创伤所致疾病的比例为31%，主要发生在60岁以下的男性和机构化居住的人群中。外推得出共有540万人因骨与关节疾病接受了（或预计将接受）手术干预。手术治疗比例最高的是骨折（41%）和椎体外骨关节炎（18%）。外推至法国人口得出，60岁以上有髋关节假体的人数为55万，有膝关节假体的人数为27万。接受与创伤无关疾病手术的个体中，76%认为其生活质量得到了改善。对于因创伤性疾病接受手术的个体，85%认为他们有轻微后遗症或没有后遗症。23%接受手术的个体认为外科医生提供的有关手术治疗的信息不足，43%有关节假体的个体表示他们未被告知其植入物可能会被更换。36%接受手术的个体认为术后疼痛管理不足。
由于调查范围广泛以及收集这些数据所采用的方法，我们的研究结果不易与其他流行病学数据进行比较。由于电话访谈的抽样偏差、问卷所使用的简化疾病分类方案引入的偏差以及未进行医学验证这一事实，必须谨慎看待这些结果。然而，这些数据确实表明，尽管18岁之前就存在疾病情况，且童年和青少年时期事故频发，但仍有大量成年人受到影响。所收集的数据证实了2000 - 2010年骨与关节十年框架内设定的优先事项。
