改良MESS评分量表的信度和效度
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摘要
[目的]检验改良MESS(mangled extremity severity score)评分量表的信度和效度。[方法] 2008年1月～2018年7月收治的严重髋部软组织损伤患者32例。入院后进行改良MESS评分,分为2次评估,同时进行MESS评分及预见性保肢指数(predictive salvage index, PSI)评分。量表内部一致性使用Cronbachs Alpha系数表示,重测信度的检测使用组内相关系数(intraclass correlation coefficient, ICC),创伤专业专家对量表进行内容效度(content validity index, CVI)的评价,结构效度的检验使用主成分分析法因子分析法,Pearson相关性评估效标效度。[结果]改良MESS评分Cronbachs Alpha值为0.796,说明内部一致性信度比较好。量表两次调查结果得分组内相关系数ICC为0.965,表明该量表重测信度良好。内容效度为0.875,提示该量表具有较好内容效度。结构效度KMO值为0.723,说明结构效度比较好。Spearman相关分析表明该改良量表与MESS评分(r=0.565,P<0.05)和PSI(r=0.832,P<0.05)呈显著正相关。[结论]改良MESS评分具有较好的信度和效度。
[Objective] To test the reliability and validity of the modified mangled extremity severity score(MESS). [Method]From January 2008 to July 2018, 32 patients received surgical treatment for mangled hip injuries in our hospital. The patients were evaluated at admission with modified mangled extremity severity score twice by two surgeons independently, simultaneously assessed with predictive salvage index(PSI). The internal consistency of the scale was expressed by Cronbach's Alpha coefficient, while the test-retest reliability, construct validity and criterion validity were estimated by intraclass correlation coefficient(ICC), The content validity index(CVI) of the score was evaluated by traumatic specialist, while construct-related validation evaluated using principal component analysis and factor analysis, the criterion-related validity assessed with Pearson correlation as well. [Results] The Cronbach's Alpha of modified mangled extremity severity score scale proved 0.796, which expressed fantastic internal consistency. The ICC of twice tests was of 0.965, which presented a high level of test-retest reliability.The CVI was of 0.875, which demonstrated wonderful content validity of the modified MESS. Regarding to the construct-related validation, the KMO proved of 0.723, which meant a good construct validation. This modified MESS proved significantly positively correlated to MESS(r=0.565, P<0.05) and PSI(r=0.832, P<0.05). [Conclusion] The modified mangled extremity severity score scale presents wonderful reliability and validity.
[Objective] To test the reliability and validity of the modified mangled extremity severity score(MESS). [Method]From January 2008 to July 2018, 32 patients received surgical treatment for mangled hip injuries in our hospital. The patients were evaluated at admission with modified mangled extremity severity score twice by two surgeons independently, simultaneously assessed with predictive salvage index(PSI). The internal consistency of the scale was expressed by Cronbach's Alpha coefficient, while the test-retest reliability, construct validity and criterion validity were estimated by intraclass correlation coefficient(ICC), The content validity index(CVI) of the score was evaluated by traumatic specialist, while construct-related validation evaluated using principal component analysis and factor analysis, the criterion-related validity assessed with Pearson correlation as well. [Results] The Cronbach's Alpha of modified mangled extremity severity score scale proved 0.796, which expressed fantastic internal consistency. The ICC of twice tests was of 0.965, which presented a high level of test-retest reliability.The CVI was of 0.875, which demonstrated wonderful content validity of the modified MESS. Regarding to the construct-related validation, the KMO proved of 0.723, which meant a good construct validation. This modified MESS proved significantly positively correlated to MESS(r=0.565, P<0.05) and PSI(r=0.832, P<0.05). [Conclusion] The modified mangled extremity severity score scale presents wonderful reliability and validity.
引文
[1]Smith AC,Flinn DC,Jang Y,et al.Traumatic hemipelvectomy with a contralateral unstable pelvis and acetabular fracture:a case report and review of the literature[J].JBJS Case Connect,2017,7(3):e52.
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[4]Salamon T,Kassis S,Lerner A.Hemipelvectomy images of loss caused by war[J].BMJ Case Rep,2014,9:2014.
[5]Song W,Zhou D,Dong J.Predictors of secondary amputation in patients with grade IIIC lower limb injuries:a retrospective analysis of 35 patients[J].Med(Baltimore),2017,96(22):e7068.
[6]Bain K,Parizh D,Kopatsis A,et al.Mangled extremity:to salvage or not to salvage[J].BMJ Case Rep,2016,30.DOI:10.1136/bcr-2016-218359.
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[9]SchiròGR,Sessa S,Piccioli A,et al.Primary amputation vs limb salvage in mangled extremity:a systematic review of the current scoring system[J].BMC Musculoskelet Dis,2015,2,16:372.
[10]Keeley J,Koopmann M,Yan H,et al.Factors associated with amputation after popliteal vascular injuries[J].Ann Vasc Surg,2016,33:83-87.
[11]Ege T,Unlu A,Tas H,et al.Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries[J].Indian J Orthop,2015,49(6):656-660.
[12]Fochtmann A,Binder H,Rettl G.Third degree open fractures and traumatic sub-/total amputations of the upper extremity:outcome and relevance of the Mangled Extremity Severity Score[J].Orthop Traumatol Surg Res,2016,102(6):785-790.
[13]Venkatadass K,Grandhi TSP,Rajasekaran S,et al.Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children-An analysis of 52 type IIIB open fractures[J].Injury,2017,48(11):2509-2514.
[14]Kumar RS,Singhi PK,Chidambaram M.Are we justified doing Salvage or amputation procedure based on mangled extremity severity score in mangled upper extremity injury[J].J Orthop Case Rep,2017,7(1):3-8.
[15]Loja MN,Sammann A,DuBose J.The mangled extremity score and amputation:time for a revision[J].J Trauma Acute Care Surg,2017,82(3):518-523.
[16]Yeh HK,Fang F,Lin YT,et al.The effect of systemic injury score on the decision making of mangled lower extremities[J].Injury,2016,47(10):2127-2130.
[17]Gustilo RB,Mendoza RM,Williams DN.Problems in the management of type III.(severe)open fractures:a new classification of type III open fractures[J].Trauma,1984,24:742-746.
[18]Ja?a Neto FC,de Paula Canal M,Alves BA,et al.Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III[J].Rev Bras Ortop,2016,51(2):143-149.
[19]?i?li E,Kavala AA,Mavi M,et al.Single centre experience of combat-related vascular injury in victims of Syrian conflict:retrospective evaluation of risk factors associated with amputation[J].Injury,2016,47(9):1945-1950.
[20]唐翔宇,刘玉杰,李春宝,等.臀肌挛缩症功能量化评分表的信效度检验[J].中国矫形外科杂志,2017,25(4):336-339.
[2]Ghimire N,Yan ZK,Fang Y,et al.Management of traumatic hemipelvectomy through ERAS pathway:a case report[J].Med(Baltimore),2018,97(36):e12251.
[3]Haim S,Laufer Y,Leonid K,et al.Hemipelvectomy after severe pelvic injury in Factor VII deficiency toddler[J].Injury,2015,46(6):1178-1182.
[4]Salamon T,Kassis S,Lerner A.Hemipelvectomy images of loss caused by war[J].BMJ Case Rep,2014,9:2014.
[5]Song W,Zhou D,Dong J.Predictors of secondary amputation in patients with grade IIIC lower limb injuries:a retrospective analysis of 35 patients[J].Med(Baltimore),2017,96(22):e7068.
[6]Bain K,Parizh D,Kopatsis A,et al.Mangled extremity:to salvage or not to salvage[J].BMJ Case Rep,2016,30.DOI:10.1136/bcr-2016-218359.
[7]Helfet DL,Howey T,Sanders R,et al.Limb salvage versus amputation.Preliminary results of the Mangled Extremity Severity Score[J].Clin Orthop,1990,256(256):80-86.
[8]Howe HR Jr,Poole GV Jr,Hansen KJ,et al.Salvage of lower extremities following combined orthopedic and vascular trauma.Apredictive salvage index[J].Am Surg,1987,53(4):205-208.
[9]SchiròGR,Sessa S,Piccioli A,et al.Primary amputation vs limb salvage in mangled extremity:a systematic review of the current scoring system[J].BMC Musculoskelet Dis,2015,2,16:372.
[10]Keeley J,Koopmann M,Yan H,et al.Factors associated with amputation after popliteal vascular injuries[J].Ann Vasc Surg,2016,33:83-87.
[11]Ege T,Unlu A,Tas H,et al.Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries[J].Indian J Orthop,2015,49(6):656-660.
[12]Fochtmann A,Binder H,Rettl G.Third degree open fractures and traumatic sub-/total amputations of the upper extremity:outcome and relevance of the Mangled Extremity Severity Score[J].Orthop Traumatol Surg Res,2016,102(6):785-790.
[13]Venkatadass K,Grandhi TSP,Rajasekaran S,et al.Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children-An analysis of 52 type IIIB open fractures[J].Injury,2017,48(11):2509-2514.
[14]Kumar RS,Singhi PK,Chidambaram M.Are we justified doing Salvage or amputation procedure based on mangled extremity severity score in mangled upper extremity injury[J].J Orthop Case Rep,2017,7(1):3-8.
[15]Loja MN,Sammann A,DuBose J.The mangled extremity score and amputation:time for a revision[J].J Trauma Acute Care Surg,2017,82(3):518-523.
[16]Yeh HK,Fang F,Lin YT,et al.The effect of systemic injury score on the decision making of mangled lower extremities[J].Injury,2016,47(10):2127-2130.
[17]Gustilo RB,Mendoza RM,Williams DN.Problems in the management of type III.(severe)open fractures:a new classification of type III open fractures[J].Trauma,1984,24:742-746.
[18]Ja?a Neto FC,de Paula Canal M,Alves BA,et al.Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III[J].Rev Bras Ortop,2016,51(2):143-149.
[19]?i?li E,Kavala AA,Mavi M,et al.Single centre experience of combat-related vascular injury in victims of Syrian conflict:retrospective evaluation of risk factors associated with amputation[J].Injury,2016,47(9):1945-1950.
[20]唐翔宇,刘玉杰,李春宝,等.臀肌挛缩症功能量化评分表的信效度检验[J].中国矫形外科杂志,2017,25(4):336-339.
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