患者疼痛绘图是评估运动引起的腿部疼痛原因的一种有价值的工具。
Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain.
作者信息
Rennerfelt Kajsa, Zhang Qiuxia, Karlsson Jón, Styf Jorma
机构信息
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
出版信息
BMJ Open Sport Exerc Med. 2018 Jan 13;4(1):e000262. doi: 10.1136/bmjsem-2017-000262. eCollection 2018.
AIM
We validated patientpain drawing (PPD) in establishing the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain.
METHODS
The study comprised 477 consecutive patients, all suspected of having CACS. The diagnosis was based on the patient's history, a thorough clinical examination and measurements of intramuscular pressure (IMP) following an exercise test. Patients completed a PPD before their hospital visit. Two independent orthopaedic surgeons diagnosed the causes of leg pain based only on the PPD at least 1 year after admission. Based on the results of diagnostic tests, the patients were divided into three groups: CACS (n=79), CACS with comorbidity (n=89) and non-CACS (n=306).
RESULTS
The sensitivity of the PPD to identify CACS correctly was 67% (observer 1) and 75% (observer 2). The specificity was 65% and 54%, respectively. The interobserver agreement (n=477) was 80%, and the kappa value was 0.55. The interobserver agreement was 77%, and the kappa value was 0.48 among 168 CACS patients with or without comorbidity. The interobserver agreement was 85%, and the kappa value was 0.56 in 79 CACS, and CACS was correctly diagnosed in 79% (observer 1) and 82% (observer 2). The test-retest showed the same results for the two observers, with an intraobserver agreement of 84%, while the test-retest reliability coefficient was 0.7. Comorbidity was found in 53% of CACS patients.
CONCLUSION
PPD might be a valuable instrument in diagnosing the causes of exercise-induced leg pain. It is useful in identifying CACS with and without comorbidity.
目的
我们验证了患者疼痛绘图（PPD）在诊断运动性腿痛患者慢性前间隔综合征（CACS）中的作用。
方法
该研究纳入了477例连续的患者，均怀疑患有CACS。诊断基于患者病史、全面的临床检查以及运动试验后肌肉内压力（IMP）的测量。患者在就诊前完成PPD。两名独立的骨科医生在入院至少1年后仅根据PPD诊断腿痛原因。根据诊断测试结果，患者分为三组：CACS组（n = 79）、合并症CACS组（n = 89）和非CACS组（n = 306）。
结果
PPD正确识别CACS的敏感度，观察者1为67%，观察者2为75%。特异度分别为65%和54%。观察者间一致性（n = 477）为80%，kappa值为0.55。在168例有或无合并症的CACS患者中，观察者间一致性为77%，kappa值为0.48。在79例CACS患者中，观察者间一致性为85%，kappa值为0.56，观察者1和观察者2正确诊断CACS的比例分别为79%和82%。重测结果显示两名观察者结果相同，观察者内一致性为84%，重测信度系数为0.7。53%的CACS患者存在合并症。
结论
PPD可能是诊断运动性腿痛原因的一种有价值的工具。它有助于识别有无合并症的CACS。
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