颌面部创伤严重度评价模型的建立及验证分析

Establishment of evaluation model for severity of maxillofacial trauma and its verification

目的建立口腔颌面部创伤严重度的评价指标体系。方法本研究首先根据层次分析法的要求,通过德尔菲法,收集了26名口腔颌面外科专家的意见,并计算出所构建的概念模型各指标的权重;依据201例病例,通过计算严重度与住院时间的线性相关关系,验证模型的有效性。结果本研究构建的评价模型中,硬组织损伤在评价口腔颌面部创伤时的重要性占到62%;而软组织则占到38%;而在硬组织的损伤中,上颌骨损伤、下颌骨损伤、颧骨/弓损伤的重要性较大,分别占18%、17%和12%;而在软组织损伤中神经损伤的重要性最大,为14%。通过计算收集到的201例临床病例的严重度与住院时间的相关性(r=0.778,P<0.01),本研究验证了所构建的评价模型能比较客观地评价患者的颌面部创伤程度。结论从硬组织和软组织两个方面所构建的颌面部创伤严重程度的评价模型具有一定的合理性。通过层次分析法所计算的模型中各指标的权重具有一定的解释力。该模型对于科学评价患者损伤的严重程度,指导临床治疗,预测医疗资源利用率,监测医疗量和司法机构判定伤情具有重要意义。

Objective To establish an evaluation index system for the severity of oral and maxillofacial trauma.Methods On the basis of the requirements of the analytic hierarchy process（AHP）, this study firstly collected the advices of 26 oral and maxillofacial surgery specialists by Delphi method, and calculated the weights of the indicators of the established conceptual model. According to the 201 cases, the validity of the model was verified by calculating the linear relationship between the severity and length of stay. Results In the evaluation model established in this study, the importance of hard tissue injury and soft tissue injury accounted for 62% and 38%, respectively. In the hard tissue injury, mandibular injury,and cheekbone/arch injury were significantly important, accounting for 18%,17%, and 12%, respectively. In the soft tissue injury, the nerve injury was the most important, accounting for 14%.By calculating the correlation between the ＂severity＂ and ＂length of stay＂ of the included 201 clinical cases（ r=0.778,P〈0.01）, this study verified that the established evaluation model could objectively evaluate the severity of maxillofa-cial trauma. Conclusion The evaluation model of maxillofacial trauma severity established from hard tissue and soft tissue shows certain rationality. The weights of the indicators in the model calculated by AHP have certain explanatory power. The model is of great significance for scientifically evaluating the severity of injury, guiding clinical treatment,predicting the utilization rate of medical resources, monitoring the amount of medical treatment and judging the injuries by judicial institutions.