疼痛和功能障碍在髋关节和膝关节骨关节炎推荐全关节置换决策中的作用：对 1909 例患者的国际横断面研究。骨关节炎研究协会-骨关节炎疗效评价标准任务组关于全关节置换的报告。
The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement.
机构信息
Paris Descartes University, Medicine Faculty, APHP, Rheumatology B Department, Cochin Hospital, Paris, France.
出版信息
Osteoarthritis Cartilage. 2011 Feb;19(2):147-54. doi: 10.1016/j.joca.2010.10.025. Epub 2010 Oct 31.
OBJECTIVE
To assess the pain and functional disability levels corresponding to an indication for total joint replacement (TJR) in hip and knee osteoarthritis (OA).
DESIGN
International cross-sectional study in 10 countries.
PATIENTS
Consecutive outpatients with definite hip or knee OA attending an orthopaedic outpatient clinic. Gold standard measure for recommendation for TJR: Surgeon's decision that TJR is justified.
OUTCOME MEASURES
Pain (ICOAP: intermittent and constant osteoarthritis pain, 0-100) and functional impairment (HOOS-PS/KOOS-PS: Hip/Knee injury and Osteoarthritis Outcome Score Physical function Short-form, 0-100).
ANALYSES
Comparison of patients with vs without surgeons' indication for TJR. Receiver Operating Characteristic (ROC) curve analyses and logistic regression were applied to determine cut points of pain and disability defining recommendation for TJR.
RESULTS
In all, 1909 patients were included (1130 knee/779 hip OA). Mean age was 66.4 [standard deviation (SD) 10.9] years, 58.1% were women; 628/1130 (55.6%) knee OA and 574/779 (73.7%) hip OA patients were recommended for TJR. Although patients recommended for TJR (yes vs no) had worse symptom levels [pain, 55.5 (95% confidence interval 54.2, 56.8) vs. 44.9 (43.2, 46.6), and functional impairment, 59.8 (58.7, 60.9) vs. 50.9 (49.3, 52.4), respectively, both P<0.0001], there was substantial overlap in symptom levels between groups, even when adjusting for radiographic joint status. Thus, it was not possible to determine cut points for pain and function defining 'requirement for TJR'.
CONCLUSION
Although symptom levels were higher in patients recommended for TJR, pain and functional disability alone did not discriminate between those who were and were not considered to need TJR by the orthopaedic surgeon.
目的
评估髋关节和膝关节骨关节炎（OA）全关节置换（TJR）适应证患者的疼痛和功能障碍水平。
设计
国际 10 国横断面研究。
患者
连续就诊于矫形外科门诊的明确髋关节或膝关节 OA 门诊患者。TJR 推荐的金标准测量指标：外科医生认为 TJR 合理。
结局测量指标
疼痛（ICOAP：间歇性和持续性骨关节炎疼痛，0-100）和功能障碍（HOOS-PS/KOOS-PS：髋关节/膝关节损伤和骨关节炎结果评分躯体功能简表，0-100）。
分析
比较有和无外科医生 TJR 适应证的患者。应用受试者工作特征（ROC）曲线分析和逻辑回归确定疼痛和残疾的切点，以定义 TJR 的推荐。
结果
共纳入 1909 例患者（1130 例膝关节/779 例髋关节 OA）。平均年龄 66.4[标准差（SD）10.9]岁，58.1%为女性；628/1130（55.6%）膝关节 OA 和 574/779（73.7%）髋关节 OA 患者被推荐行 TJR。尽管推荐 TJR 的患者（是 vs 否）症状水平更差[疼痛 55.5（95%置信区间 54.2，56.8）vs. 44.9（43.2，46.6），功能障碍 59.8（58.7，60.9）vs. 50.9（49.3，52.4），均 P<0.0001]，但两组之间症状水平存在很大重叠，即使在调整影像学关节状况后也是如此。因此，无法确定定义“需要 TJR”的疼痛和功能切点。
结论
尽管推荐 TJR 的患者症状水平更高，但疼痛和功能障碍本身并不能区分那些被矫形外科医生认为需要和不需要 TJR 的患者。
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