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[膝关节韧带损伤评估的现状。新的国际膝关节文献委员会(IKDC)膝关节评估表]

[Current state of evaluation of knee ligament lesions. The new IKDC knee evaluation form ].

作者信息

Hefti F, Müller W

机构信息

Orthopädische Universitätsklinik Basel.

出版信息

Orthopade. 1993 Nov;22(6):351-62.

PMID:8309693
Abstract

Various scoring systems have been proposed for quantification of the disability caused by knee ligament injuries and to evaluation of the results of their treatment. None of them was found worldwide acceptance, mainly because all scoring systems attribute numerical values to factors that are not quantifiable, after which the arbitrary scores for parameters that are not comparable with each other are added together. For these reasons a group of knee surgeons from Europe and America met in 1987 and founded the International Knee Documentation Committee. A common terminology and an evaluation form were created. This form is the standard form for use in all publications on results of treatment of knee ligament injuries. It is a concise one-page form and includes a documentation section, a qualification section and a evaluation section. For evaluation there are four problem areas (subjective assessment, symptoms, range of motion and ligament examination). These are supplemented by four additional areas that are documented but are not included in the evaluation (compartmental findings, donor site pathology, X-ray findings and functional tests). The form can be used pre- and postoperatively and at follow-up. The Committee also laid down that in a publication the minimum follow-up time for short-term results should be 2 years, for medium-term results, 5 years, and for long-term results, 10 years. Most of the sheet is devoted to the qualification section. It is called "qualification" and not "scoring" section because no scores are given. Each parameter is qualified as "normal", "nearly normal", "abnormal" or "severely abnormal". This qualification is less subjective and emotional than "very good", "good", "fair" and "poor". No knee and no knee function can be better than normal, and it is rather doubtful whether any knee that has been operated on can ever be "normal" again. For evaluation, the parameters of the four problem areas "subjective assessment", "symptoms", "range of motion" and "ligament examination" are qualified for the group qualification. The worst qualification within the group is taken as the group qualification. The worst group qualification is taken as the final evaluation. If the knee is abnormal in any of the problem areas it cannot be entered as normal knee. For knees with chronic pathology it is also possible to evaluate the sum of levels of improvement or deterioration of all groups compared with the preoperative evaluation. The committee also recommends that terms describing knee ligament problems should be used according to the definitions published by Noyes et al.(ABSTRACT TRUNCATED AT 400 WORDS)

摘要

已经提出了各种评分系统,用于量化膝关节韧带损伤所导致的功能障碍以及评估其治疗结果。但这些评分系统均未在全球范围内得到认可,主要原因是所有评分系统都将数值赋予了不可量化的因素,然后将彼此不可比参数的任意分数相加。出于这些原因,一群来自欧美的膝关节外科医生于1987年会面并成立了国际膝关节文献委员会。该委员会创建了通用术语和一份评估表。这份表格是膝关节韧带损伤治疗结果所有出版物中使用的标准表格。它是一份简洁的单页表格,包括记录部分、评定部分和评估部分。评估有四个问题领域(主观评估、症状、活动范围和韧带检查)。另外还有四个领域虽有记录但不纳入评估(关节间 findings、供区病理、X线检查结果和功能测试)。该表格可在术前、术后及随访时使用。委员会还规定,在一篇出版物中,短期结果的最短随访时间应为2年,中期结果为5年,长期结果为10年。表格的大部分篇幅用于评定部分。它被称为“评定”部分而非“评分”部分,因为不给出分数。每个参数被评定为“正常”“近乎正常”“异常”或“严重异常”。这种评定比“非常好”“好”“一般”和“差”主观性和情绪化程度更低。没有哪个膝关节及膝关节功能能比正常更好,而且接受过手术的膝关节是否还能再次“正常”相当值得怀疑。为进行评估,对“主观评估”“症状”“活动范围”和“韧带检查”这四个问题领域的参数进行组评定。组内最差的评定结果作为组评定结果。最差的组评定结果作为最终评估结果。如果膝关节在任何一个问题领域异常,就不能将其评定为正常膝关节。对于患有慢性病理状况的膝关节,也可以评估与术前评估相比所有组改善或恶化水平的总和。委员会还建议应根据诺伊斯等人公布的定义使用描述膝关节韧带问题的术语。

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