Morris R, Pallister I, Trickett R W
Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK.
Department of Trauma & Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK.
Injury. 2019 Feb;50(2):521-533. doi: 10.1016/j.injury.2018.11.025. Epub 2018 Nov 12.
The aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported outcomes.
A systematic review of publications since 2009 was performed, looking specifically at acute, adult tibial shaft fractures. Ovid Medline, Embase, PubMed and PsycINFO databases were searched for relevant titles which were then screened by two authors with adjudication where necessary by a third. Relevant articles were reviewed in full and data was extracted concerning the study participants, study design and any measures that were used to quantify the results following fracture. The results were collated and patient reported outcome measures were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards.
A total of 943 titles and articles were reviewed, with 117 included for full analysis. A wide range of clinical and radiological "outcomes" were described, along with named clinician- and patient-reported outcome measures. There was considerable heterogeneity and lack of detail in the description of the simplest outcomes, such as union, infection or reoperation. Reported clinician and patient reported outcome measures are variably used. None of the identified patient reported outcome measures have been validated for use following tibial fracture.
We recommend definition of a core outcome set for use following tibial fracture. This will standardise outcome reporting following these injuries. Furthermore, there is need for a validated patient reported outcome measure to better assess patient important outcomes in this patient group.
本研究的目的是确定在功能结局测量和患者报告结局的现代时代，成人胫骨骨折后如何测量结局。
对2009年以来的出版物进行系统综述，特别关注急性成人胫骨干骨折。检索了Ovid Medline、Embase、PubMed和PsycINFO数据库中的相关标题，然后由两位作者进行筛选，必要时由第三位作者进行裁决。对相关文章进行全文审查，并提取有关研究参与者、研究设计以及用于量化骨折后结果的任何测量方法的数据。对结果进行整理，并使用基于共识的健康测量工具选择标准（COSMIN）标准评估患者报告的结局测量方法。
共审查了943个标题和文章，其中117篇纳入全面分析。描述了广泛的临床和放射学“结局”，以及命名的临床医生和患者报告的结局测量方法。在描述最简单的结局时，如骨愈合、感染或再次手术，存在相当大的异质性且缺乏细节。报告的临床医生和患者报告的结局测量方法使用情况各不相同。所确定的患者报告的结局测量方法均未在胫骨骨折后得到验证。
我们建议定义一个胫骨骨折后使用的核心结局集。这将使这些损伤后的结局报告标准化。此外，需要一种经过验证的患者报告结局测量方法，以更好地评估该患者群体中对患者重要的结局。
