图示化自主髋关节功能评分系统的应用研究

doi:10.3877/cma.j.issn.1674-134X.2024.03.004

目的

以Harris评分量表为标准，设计以图片、视频的多媒体呈现的图示化髋关节功能评分，应用于患者自我测评，验证其可行性及准确性。

方法

选取2020年1月至2023年12月于中山大学孙逸仙纪念医院行单侧髋关节置换术或髓芯减压术的出院患者进行观察性的随机交叉设计研究，排除严重老年痴呆或其他精神疾病、资料不全等。通过方差分析、Kendall秩相关分析、Bland-Altman图评估Harris评分、简版Harris评分和图示化髋关节评分的一致性，并通过评估过程耗时及应答率分析图示化患者自我测评的可行性。

结果

同为患者自主测评，较之简版Harris评分相比，图示化髋关节评分值更集中地分布在95%一致性界限（-4.25，9.47）；基于图示化髋关节评分进行的等级评定较简版Harris评分，误判率更低（38% vs. 23%，χ²=4.309，P=0.038）；评估耗时显示图示化评分操作耗时较Harris评分量表法缩短（F=19.753，P<0.001）；满意度问卷调查显示图示化评分法最高（F=20.659，P<0.001）。

结论

患者自我测评的图示化髋关节评分与Harris评分存在一致性及高度相关性，且其等级评定较既往患者自我测评使用的简版Harris评分更准确，且具良好可及性，能满足精确便利的患者自我评估而更好促进远程随访的开展。

关键词: 髋关节, 疗效比较研究, 数据相关性, 患者报告结局评价

Objective

To design a visual hip joint function rating system presented through pictures and videos for self-evaluation by patients based on the Harris score, and to verify its feasibility and accuracy.

Methods

An observational randomized crossover design study was conducted on patients discharged from hospital after unilateral hip replacement or core decompression at Sun Yat-sen Memorial Hospital from January 2020 to December 2023. Severe senile dementia or other psychological diseases, and incompleted data were excluded. The consistency of the Harris score, simplified Harris score, and visual hip joint score were evaluated by analysis of variance, Kendall rank correlation analysis, and Bland-Altman plot. The feasibility of visual hip joint sore by patients was assessed through analysis of evaluation process time and response rate.

Results

Compared to the simplified Harris score, the visual hip joint score had a more concentrated distribution of scores within the 95% consistency limits (-4.25, 9.47). The visual hip joint score had lower misjudgment rate compared to the simplified Harris score (38% vs. 23%, χ²=4.309, P=0.038) in terms of grade assessment. The evaluation process time for the visual hip joint score was shorter than that for the Harris score(F=19.753, P<0.001). The satisfaction survey showed the highest satisfaction with the visual hip joint score(F=20.659, P<0.001).

Conclusions

The visual hip joint score for self-evaluation by patients is consistent and highly correlated with the Harris score. It provides more accurate grade assessment compared to the simplified Harris score previously used for self-evaluation by patients, and has good accessibility. It can meet the needs of accurate and convenient self-assessment by patients and better promote the development of remote follow-up.

Key words: Hip joint, Comparative study of curative effect, Data correlation, Patients reported outcome evaluations

图1 三种髋关节功能评估所含项目及呈现形式对比

Figure 1 Comparison of items and presentation forms in three hip joint function assessments

图2　轻度跛行　图3　中度跛行　图4　重度跛行

Figure 2　Mild claudication　Figure 3　Moderate claudication　Figure 4　Severe claudication

图5 髋屈曲畸形程度评估注：利用生活物品（如矿泉水瓶）估测仰卧位时床面与腘窝间距离，显示髋屈曲畸形程度（约30°）

Figure 5 Assessment of the degree of flexion deformity of the hip Note: Estimate the distance between the bed and the popliteal fossa in the supine position using daily objects (such as mineral water bottles), indicating the degree of flexion deformity of the hip (about 30°)

图6 肢体缩短畸形评估注：以仰卧中立状态两足跟距离差评估肢体缩短畸形（三指约3.2 cm）

Figure 6 Assessment of limb shortening deformity Note: The difference in heel distance between two legs in supine neutral state was used to evaluate limb shortening deformity (three fingers about 3.2 cm)

图7 以侧观坐姿判定髋屈曲程度

Figure 7 Hip flexion was determined by lateral sitting posture

图8 髋外展程度评估注：以仰卧髋外展状态下，两膝间距离差评估髋外展程度（膝间可容纳A4纸长度为外展约30°）

Figure 8 Assessment of hip abduction degree Note: In supine hip abduction, the distance difference between the knees is used to assess the degree of hip abduction (the length of A4 paper between the knees is about 30°)

图9 髋内收活动度评估注：仰卧位，下肢交叉评估髋内收活动度（交叉及膝约为内收15°）

Figure 9 Assessment of hip adduction range of motion Note: Supine position, lower limb cross assessment of hip adduction motion (cross and knee about 15° adduction)

图10 以端坐位小腿可交叉情况评估髋内旋角度

Figure 10 Assessing the internal rotation angle of the hip in the position of calf cross-overability

图11 Harris评分与简版Harris评分的Bland-Altman图注：A-Harris评分；B-简版Harris评分

Figure 11 Bland-Altman plot of Harris score and simplified Harris score Note: A - Harris score; B - Simplified Harris score

图12 Harris评分与图示化髋关节评分的Bland-Altman图注：A-Harris评分；C-图示化髋关节评分

Figure 12 Bland-Altman plot of Harris score and visual hip joint score Note: A - Harris score; C - visual hip joint score

图13 三种评分间患者等级差异桑基图

Figure 13 Sankey diagram of patient grade differences between three evaluation scores

表1 三种评分的等级评定的相关性

Table 1 Correlation of grade assessment for three types of scores

量表 Evaluation methods	Harris评分Harris score		简版Harris评分Simplified Harris score		图示化髋关节评分Visual hip joint score
量表 Evaluation methods	r值	P值	r值	P值	r值	P值
Harris评分 Harris score	1.000	<0.001	0.805	<0.001	0.862	<0.001
简版Harris评分 Simplified Harris score	0.805	<0.001	1.000	<0.001	0.884	<0.001
图示化髋关节评分 Visual hip joint score	0.862	<0.001	0.884	<0.001	1.000	<0.001

表1 三种评分的等级评定的相关性

Table 1 Correlation of grade assessment for three types of scores

量表 Evaluation methods	Harris评分Harris score		简版Harris评分Simplified Harris score		图示化髋关节评分Visual hip joint score
量表 Evaluation methods	r值	P值	r值	P值	r值	P值
Harris评分 Harris score	1.000	<0.001	0.805	<0.001	0.862	<0.001
简版Harris评分 Simplified Harris score	0.805	<0.001	1.000	<0.001	0.884	<0.001
图示化髋关节评分 Visual hip joint score	0.862	<0.001	0.884	<0.001	1.000	<0.001

表2 满意度调查（n=79）

Table 2 Satisfaction survey

量表 Evaluation methods	满意度 Satisfaction	题干可理解度 Question comprehensibility	选项可理解度 Option comprehensibility	填表时间 Filling time
Harris评分 Harris score	4.4± 1.3	-	-	6.2±1.5
简版Harris评分 Simplified Harris score	4.3 ± 1.3	4.4 ± 1.1	3.8 ± 1.4	2.1±0.8
图示化髋关节评分 Visual hip joint score	4.7 ± 1.5	4.4 ± 1.7	4.8 ± 1.5	3.2±1.8
统计值 Statistical values	F=20.659	t=0.232	t=4.699	F=19.753
P值	<0.001	>0.05	<0.001	<0.001

表2 满意度调查（n=79）

Table 2 Satisfaction survey

量表 Evaluation methods	满意度 Satisfaction	题干可理解度 Question comprehensibility	选项可理解度 Option comprehensibility	填表时间 Filling time
Harris评分 Harris score	4.4± 1.3	-	-	6.2±1.5
简版Harris评分 Simplified Harris score	4.3 ± 1.3	4.4 ± 1.1	3.8 ± 1.4	2.1±0.8
图示化髋关节评分 Visual hip joint score	4.7 ± 1.5	4.4 ± 1.7	4.8 ± 1.5	3.2±1.8
统计值 Statistical values	F=20.659	t=0.232	t=4.699	F=19.753
P值	<0.001	>0.05	<0.001	<0.001

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Application research of visual self-rating system for hip joint function evaluation

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Application research of visual self-rating system for hip joint function evaluation