Kolk Sjoerd, Cox Kevin, Weerdesteyn Vivian, Hannink Gerjon, Bramer Jos, Dijkstra Sander, Jutte Paul, Ploegmakers Joris, van de Sande Michiel, Schreuder Hendrik, Verdonschot Nico, van der Geest Ingrid
Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Sarcoma. 2014;2014:436598. doi: 10.1155/2014/436598. Epub 2014 Nov 18.
Accurate predictions of functional outcome after limb salvage surgery (LSS) in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery) and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS) and the RAND-36 physical functioning subscale (RAND-36 PFS). The orthopedic oncologists made their predictions based on case descriptions (including MRI scans) that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was "very poor" to "poor" on both scores (r (2) values ranged from 0.014 to 0.354). Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a "poor" intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons' ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.
准确预测下肢保肢手术（LSS）后的功能结局具有重要意义，原因有多种，包括术前告知患者，以及在某些情况下决定截肢还是进行保肢手术。本研究旨在阐明荷兰外科医生预测的与患者报告的保肢手术功能结局之间的相关性。23名患者（术后6个月至10年）和5名独立的骨肿瘤学家完成了多伦多肢体 salvage 评分（TESS）和兰德36项健康调查身体功能分量表（RAND - 36 PFS）。骨肿瘤学家根据反映术前状况的病例描述（包括MRI扫描）进行预测。在这两个评分中，患者报告的与外科医生预测的功能结局之间的相关性为“非常差”到“差”（r²值范围为0.014至0.354）。患者报告的功能结局普遍被低估，在TESS上低估了8.7%，在RAND - 36 PFS上低估了8.3%。RAND - 36 PFS上最难和最不难的任务分别也是最难和最不难预测的。大多数问题在外科医生之间的一致性“差”。准确预测保肢手术患者报告的功能结局很困难。通过专注于更准确地预测要求更高的任务，外科医生预测功能评分的能力可以得到最大程度的提高。
