Department of Orthopaedic Surgery, Slagelse Hospital, Næstved, Slagelse and Ringsted Hospitals, Ingemannsvej 50, 4200 Slagelse, Denmark; Clinical Orthopaedic Research Hvidovre, Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark; The Harris Orthopaedics Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114-2696 Boston, MA, USA.
Department of Orthopaedic Surgery, Slagelse Hospital, Næstved, Slagelse and Ringsted Hospitals, Ingemannsvej 50, 4200 Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, 5200 Odense, Denmark.
Knee. 2020 Oct;27(5):1310-1324. doi: 10.1016/j.knee.2020.06.006. Epub 2020 Jul 27.
Few studies have described patient-reported outcome measures (PROMs) in knee fracture patients. We reported knee-specific and generic median PROM scores after knee fracture and identified risk factors for poor outcome defined by low median PROM scores.
In a Danish cross-sectional study of 7133 distal femoral, patellar, and proximal tibial fracture patients during 2011-2017, OKS, FJS-12, EQ5D-5L Index, and EQ5D-5L Visual Analogue Scale (VAS), were collected electronically (response rate 53%; median age 60; 63% female). Poor outcome was defined as score lower than median PROM score. Poor outcome risk factors were estimated as odds ratios from binary logistic regression models.
At 0 to one year after knee fracture, median PROM scores were 31 (OKS), 27 (FJS-12), 0.50 (EQ5D-5L Index), and 74 (EQ5D-5L VAS). At >5 years after knee fracture, median OKS score was 40, median FJS-12 score was 54, median EQ5D-5L Index was 0.76, and median EQ5D-5L VAS score was 80. Age > 40 years had higher odds for poor OKS and FJS-12 scores at short- and long-term follow-up after knee fracture. Comorbidity burden, distal femoral fracture, and treatment with external fixation and knee arthroplasty were risk factors for poor outcome at long-term follow-up, for all four PROMs.
Although knee fracture patients have relatively high knee function and quality of life, their ability to forget about the knee joint after knee fracture is compromised. We identified several important risk factors for poor outcome measured by PROMs at different follow-up periods following knee fracture, which will help direct future quality-improvement initiatives.
鲜有研究描述过膝关节骨折患者的患者报告结局测量（PROM）。我们报告了膝关节骨折后膝关节特异性和通用型 PROM 的中位数评分，并确定了以低中位数 PROM 评分定义的不良结局的风险因素。
在 2011-2017 年期间一项针对 7133 例股骨远端、髌骨和胫骨近端骨折患者的丹麦横断面研究中，使用电子方式收集 OKS、FJS-12、EQ5D-5L 指数和 EQ5D-5L 视觉模拟量表（VAS）（应答率为 53%；中位年龄为 60 岁；63%为女性）。不良结局定义为评分低于 PROM 中位数。使用二元逻辑回归模型估计不良结局的风险因素为比值比。
膝关节骨折后 0-1 年时，PROM 的中位数评分为 31（OKS）、27（FJS-12）、0.50（EQ5D-5L 指数）和 74（EQ5D-5L VAS）。膝关节骨折后>5 年时，OKS 的中位数评分为 40，FJS-12 的中位数评分为 54，EQ5D-5L 指数的中位数评分为 0.76，EQ5D-5L VAS 的中位数评分为 80。年龄>40 岁与膝关节骨折后短期和长期随访时较差的 OKS 和 FJS-12 评分有关。合并症负担、股骨远端骨折以及外固定和膝关节置换术治疗是所有四种 PROM 长期随访时不良结局的风险因素。
尽管膝关节骨折患者的膝关节功能和生活质量相对较高，但他们在膝关节骨折后忘记膝关节的能力受到了损害。我们确定了在膝关节骨折后不同随访时间点通过 PROM 测量的不良结局的几个重要风险因素，这将有助于指导未来的质量改进计划。
