基于德尔菲法探究影响股骨头坏死预后的主要因素

Exploration on the Main Factors Affecting the Prognosis of Osteonecrosis of Femoral Head Based on the Delphi Method

目的对影响股骨头坏死预后因素条目研究讨论,以确定优化统一的预后影响因素。方法通过文献预检索与临床调研,设计调查问卷,基于德尔菲法遴选专家并进行两轮问卷调查。问卷通过线上发送,回收后应用Excel2016、SPSS26.0软件进行数据处理,计算专家积极系数、专家权威程度、专家意见协调程度、专家意见集中程度、条目的权重系数并进行重要性评价。结果最终纳入文献116篇,根据原始文献提取影响预后因素指标清单。第一轮、第二轮咨询专家分别为30、40位,回收问卷均为有效问卷。最终确定10个主要影响股骨头坏死的预后因素,包括是否严格拄拐、是否疼痛(疼痛时间)、髋关节活动度、确认骨坏死时间、国际骨微循环研究协会(ARCO)分期、日本骨坏死研究会(JIC)分型、前外侧柱是否保留、坏死面积、电子计算机断层扫描上软骨下骨断裂带、中药口服。结论总结影响股骨头坏死进展的相关因素,可进一步增强临床医师对股骨头坏死预后的认识,并能通过对重要因素进行有效干预以延缓股骨头坏死进展。

Objective To discuss the entries of prognostic factors affecting osteonecrosis of the femoral head(ONFH);To determine optimized and uniform prognostic influences.Methods Through literature pre-search and clinical research,the questionnaire was designed.Experts were selected based on the Delphi method and the questionnaire was distributed to the experts online,and after the questionnaire was recovered,Excel 2016 and SPSS 26.0 software were applied to process the data.The positive coefficients of experts,the degree of authority of experts,the degree of coordination of experts’opinions,the degree of concentration of experts’opinions,and the weight coefficients of the entries were calculated for the evaluation of the importance.Results Totally 116 articles were included.A list of prognostic factors indicators based on original literature was extracted.The first and second rounds of consultation had 30 and 40 experts respectively,and the collected questionnaires were all valid.Finally,10 major prognostic factors affecting ONFH were identified,including whether strictly on crutches,whether in pain(duration of pain),hip mobility,time to confirmation of osteonecrosis,ARCO staging,JIC staging,whether the anterolateral column is preserved,necrotic area,CT supracondylar subchondral fracture zone,and oral administration of traditional Chinese medicine.Conclusion This article summarizes the relevant factors that affect the progression of ONFH,which can further enhance clinical physicians’understanding of the prognosis of ONFH,and can delay the progression of ONFH by effectively intervening in important factors.