全踝关节置换术后患者报告结局与躯体功能的相关性。
Correlation of Patient-Reported Outcomes With Physical Function After Total Ankle Arthroplasty.
机构信息
Baylor University Medical Center, Dallas, TX, USA.
Foot and Ankle Surgery Division, The Orthopedic Institute of North Texas, PA, Frisco, TX, USA.
出版信息
Foot Ankle Int. 2021 May;42(5):646-653. doi: 10.1177/1071100720978428. Epub 2021 Jan 15.
BACKGROUND
Total ankle arthroplasty (TAA) is successful by both subjective patient-reported outcome measures (PROMs) and objective functional improvements of gait. Each is reproducible and valid, but they are entirely distinct methods. This study investigated the correlation between subjective and objective outcomes of TAA.
METHODS
Seventy patients underwent gait analysis preoperatively and 1 year after TAA. The 36-Item Short-Form Health Survey (SF-36) and visual analog score (VAS) for pain and American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded at each interval. A Student test, a multivariate regression, and a Pearson correlation coefficient were used to measure the correlation between parameters of gait and PROMs.
RESULTS
Patients had statistically significant improvements in gait velocity, total range of motion (ROM), maximum plantarflexion, ankle power, and SF-36 Physical, VAS, and AOFAS scores. The SF-36 Physical score had a moderate positive correlation with preoperative walking speed, step length, and ankle power and postoperative walking speed and ankle power. No correlation between VAS score and function was detected. The AOFAS score had a moderate positive correlation with postoperative walking speed, step length, and ankle power, and improvement in walking speed, cadence, and ankle power.
CONCLUSION
Statistically significant correlations were found between numerous preoperative and postoperative comparisons of PROMs and the AOFAS score with the objective biomechanical outcomes of gait. Walking speed and ankle push-off power correlated most with patient perceptions of function and improvement, while pain and ROM did not. Subjective PROMs and objective biomechanical outcomes were complementary in the assessment of surgical outcomes and, combined, helped to address the dilemma of the confounding effect of other lower extremity pathologies on PROMs.
LEVEL OF EVIDENCE
Level III, comparative series.
背景
全踝关节置换术（TAA）在主观患者报告结局测量（PROMs）和步态的客观功能改善方面均取得成功。两者都具有可重复性和有效性，但它们是完全不同的方法。本研究旨在探讨 TAA 的主观和客观结果之间的相关性。
方法
70 例患者分别于术前和 TAA 术后 1 年进行步态分析。记录每个时间点的 36 项简短健康调查（SF-36）和疼痛视觉模拟评分（VAS）以及美国矫形足踝协会（AOFAS）踝关节-后足评分。采用学生 t 检验、多元回归和 Pearson 相关系数来测量步态参数与 PROM 之间的相关性。
结果
患者的步态速度、总活动范围（ROM）、最大跖屈、踝关节力量和 SF-36 身体机能、VAS 和 AOFAS 评分均有统计学显著改善。SF-36 身体机能评分与术前行走速度、步长和踝关节力量以及术后行走速度和踝关节力量呈中度正相关。VAS 评分与功能之间未检测到相关性。AOFAS 评分与术后行走速度、步长和踝关节力量以及行走速度、步频和踝关节力量的改善呈中度正相关。
结论
在 PROM 和 AOFAS 评分与步态客观生物力学结果的众多术前和术后比较中，发现了统计学显著相关性。行走速度和踝关节蹬离力量与患者对功能和改善的感知相关性最强，而疼痛和 ROM 则不然。主观 PROM 和客观生物力学结果在评估手术结果方面是互补的，结合使用有助于解决其他下肢疾病对 PROM 产生混杂影响的难题。
证据等级
III 级，比较系列。
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