Establishment of a topographic map assessment system for facial and cervical wounds and scars of burn patients based on the Delphi method
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摘要:
目的 构建一套适用于烧伤患者面颈部创面和瘢痕的针对性精准评估系统。 方法 采用文献分析和调查研究相结合的方法，遵循条目体系构建的基本原则。2020年6—8月，以面颈部整形美学标准为基础，患者烧伤后面颈部创面与瘢痕评估为中心，初步形成烧伤患者面颈部创面与瘢痕地形图评估系统。于2020年9月对38名相关领域专家行预函询，并根据专家意见修改问卷。2020年12月—2021年3月，运用德尔菲法对符合入选标准的35名来自广州、深圳、上海、北京等地相关领域专家开展函询，筛选并确立条目。计算函询问卷有效回收率，判断专家积极程度；计算所有条目的权威系数均值，判断专家权威程度；计算所有三级条目的重要性专家评分均值、变异系数均值和满分率均值，判断专家意见集中程度；计算所有三级条目的重要性、敏感性和可操作性专家评分变异系数均值、肯德尔和谐系数，判断专家意见协调程度。对函询中所有三级条目的重要性、敏感性和可操作性专家评分的肯德尔和谐系数行 χ 2检验。 结果 经德尔菲法函询的35名专家以男性居多，年龄为（48±10）岁，工作年限8~38年，副高及以上职称者为主，均为本科及以上学历，烧伤科专家11人、创面修复科专家7人、整形美容科专家4人、康复医学科专家13人。最后形成包含4个一级条目、21个二级条目、40个三级条目和1个面谱的烧伤患者面颈部创面与瘢痕地形图评估系统。函询问卷有效回收率为100%（35/35）。所有条目的权威系数均值为0.89。所有三级条目的重要性专家评分均值为4.67分，重要性专家评分变异系数均值为0.01，满分率均值为86.3%。所有三级条目的重要性、敏感性、可操作性专家评分的变异系数均值分别为0.01、0.01、0.02。所有三级条目的重要性、敏感性、可操作性专家评分的肯德尔和谐系数检验，结果均有统计学意义（ χ 2值分别为1 201.53、745.67、707.07， P<0.05）。 结论 构建的烧伤患者面颈部创面与瘢痕地形图评估系统具有较高的科学性、可靠性，可用于烧伤患者面颈部创面或瘢痕的评估。 Abstract:Objective To construct a targeted and accurate evaluation system for facial and cervical wounds and scars of burn patients. Methods The method combining literature analysis and survey research was adopted, and the basic principles of item system construction were followed. From June to August 2020, based on the aesthetic standards of facial and cervical plastic surgery, the topographic map assessment system for facial and cervical wounds and scars of burn patients was preliminarily formed, focusing on the assessment of wounds and scars in the necks and faces of patients after burns. In September 2020, 38 experts in the relevant fields were consulted in advance and the questionnaire was revised according to the experts' opinions. From December 2020 to March 2021, the Delphi method was applied to conduct inquiry by correspondence with 35 experts in relevant fields from Guangzhou, Shenzhen, Shanghai, Beijing, and other cities, who met the inclusion criteria, and the items were screened and established. The effective recovery rate of inquiry questionnaire was calculated to determine the level of enthusiasm of experts, the average authority coefficient of all items was calculated to determine the level of expert authority, the average importance expert score, the average coefficient of variation, and the average full score rate of all the third-level items were calculated to determine the concentration of expert opinions, the average coefficients of variation and Kendall's harmony coefficients of the importance, sensitivity, and operability expert scores of all the third-level items were calculated to determine the degree of coordination of expert opinions. The Kendall's harmony coefficients for the importance, sensitivity, and operability expert scores of all the third-level items were statistically analyzed with chi-square test. Results Among the 35 experts consulted by Delphi method, mainly were male, aged (48±10) years, with 8-38 years of working experience, mainly with associate senior titles and above, all with a bachelor's degree or above education background, and of whom 11 were burn experts, 7 were wound repair experts, 4 were plastic surgery experts, and 13 were rehabilitation medicine experts. Finally, a topographic map assessment system for facial and cervical wounds and scars of burn patients was formed, including 4 first-level items, 21 second-level items, 40 third-level items, and 1 mask. The effective recovery rate of inquiry questionnaire was 100% (35/35). The average authority coefficient of all items was 0.89. The average importance expert score was 4.67, the average coefficient of variation of importance expert score was 0.01, and the average full score rate of all the third-level items was 86.3%. The average coefficients of variation of the importance, sensitivity, and operability expert scores of all the third-level items were 0.01, 0.01, and 0.02, respectively. The Kendall's harmony coefficients for the importance, sensitivity, and operability expert scores of all the third-level items were statistically significant (with χ 2 values of 1 201.53, 745.67, and 707.07, respectively , P<0.05). Conclusions The established topographic map assessment system for facial and cervical wounds and scars of burn patients has high scientificity and reliability, which can be used for the evaluation of facial and neck wounds or scars in burn patients. -
Key words:
- Burns /
- Cicatrix /
- Face /
- Neck /
- Delphi technique /
- Wound /
- Assessment system
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1 烧伤患者面颈部创面与瘢痕地形图评估系统面谱
注：面颈部由解剖标志线和水平线、矢状线共同分割为各格区；格区标记由红色大写字母与红色数字表示，A、B、C、D、E、F、G、H、I、J分别代表额、眉、眼（角膜以O标记）、鼻、口、耳、颞、颊、颏下、颈区，字母后第1位数字代表格区在所属区的行数；字母后第2个数字代表格区在所属区的横向位置，越靠近中线数字越小，正中用“0”表示；各格区中绿色数字代表该格区权重；眉区中B11~B14格区权重均为1.0；眼区中C11~C16、C21~C26格区权重均为2.0，O18、O20格区权重均为8.0
表1 烧伤患者面颈部创面与瘢痕地形图评估系统各级条目
表1. The items at all levels of the topographic map assessment system for facial and cervical wounds and scars of burn patients
一级条目 二级条目 三级条目 面谱分区 额（A） 发际线以内，眉弓水平线以上为额区 以经过内外眦的矢状线分为5个格区 眉（B） 眉弓为眉区 以矢状线平均分为2个格区，左右共4个格区 眼（C和O） 以眼眶外缘为界 上下眼睑各以矢状线平均分为3个格区，左右角膜各1个格区，左右共14个格区 鼻（D） 上界与额区下界重叠，下界为经过鼻尖的水平线，左右以鼻梁和鼻翼轮廓为界 鼻翼以矢状线平均分为左右2个格区，余下部位以水平线平均分为上下2个格区，共4个格区 口（E） 上界与鼻区下界重叠，下界为下颌骨下缘，左右以两侧法令纹及其延长线为界 经过唇柱下缘的水平线以上部分按口裂分隔后，以矢状线平均分为上下各4个格区，余下部位以矢状线平均分为左右2个格区，共10个格区 耳（F） 以整个外耳郭根部为界 以外耳轮为界，分为内外2个格区，左右共4个格区 颞（G） 眼区下界和额区下界之间，眼区外侧的区域 左右共2个格区 颊（H） 眼区和颞区下界以下，除去鼻区、口区的部分 以经过鼻尖的水平线和外眦的矢状线把左右颊区各分为4个格区，共8个格区 颏下（I） 上界与颊区下界、口区下界重叠，以颏颈交界为下界 以水平线平均分为上下等宽的2个部分。上面部分与口区相接为单独的1个格区，下面部分以矢状线平均分为2个格区，共3个格区 颈（J） 上界为颏颈交界，下界为锁骨上缘，左右以肩峰乳突连线为界 左右颈前三角各为1个格区，余下部位以矢状线平均分为左右各3个格区，共8个格区 面谱格区权重 格区标记 由1个大写字母和2个数字组成。字母代表区，第1位数字代表在所属区的行数，第2个数字代表在所属区的横向位置，越靠近中线数字越小，正中用“0”表示 各格区权重 额区中间3个格区权重均为1.0，两侧格区权重均为0.5，总权重为4.0 眉区各格区权重均为1.0，左右眉区总权重为4.0 左右眼区角膜格区权重均为8.0，余下格区权重均为2.0，左右眼区总权重为40.0 鼻区各格区权重均为1.0，总权重为4.0 口区唇部各格区权重均为1.5，余下格区权重均为1.0，总权重为14.0 耳区各格区权重均为1.0，左右耳区总权重为4.0 颞区各格区权重均为1.0，左右颞区总权重为2.0 颊区各格区权重均为2.0，左右颊区总权重为16.0 颏下区I10格区权重为1.0，I21、I22格区权重均为1.5，总权重为4.0 颈区J11、J12、J13、J14格区权重均为1.0，J15、J16格区权重均为1.5，J17、J18格区权重均为0.5，总权重为8.0 格区总权重 100.0 评分方法 面谱参照和记录法 参照面谱对各格区相应部位的皮肤创面或瘢痕情况分别进行评估，并把得分记录在相应格区里 面积系数和连续性系数 面积系数：创面或瘢痕面积占格区面积的百分比≥50%为1.0，30%~49%为0.5，<30%为0。连续性系数：相邻格区有创面或瘢痕相连，则连续性系数为2.0；若无，则连续性系数为1.0 格区创面分值 创面评分：Ⅰ度0分、浅Ⅱ度1分、深Ⅱ度3分、Ⅲ度4分、Ⅳ度5分，合并感染者加1分，最高为6分 格区瘢痕分值 对各格区的瘢痕按温哥华瘢痕量表从色素沉着、血供、柔软性和瘢痕厚度方面进行评分，并计算总分，最高为15分 总分计算方法 创面总粗分计算方法 各格区创面分值、权重、面积系数、连续性系数四者乘积的总和，范围为0~1 200分 创面总标准分计算方法 创面总粗分÷12，范围为0~100分 瘢痕总粗分计算方法 各格区瘢痕分值、权重、面积系数、连续性系数四者乘积的总和，范围为0~3 000分 瘢痕总标准分计算方法 瘢痕总粗分÷30，范围为0~100分 注：二级条目旁字母表示各区在面谱里的位置代号 
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表2 35名专家对烧伤患者面颈部创面与瘢痕地形图评估系统的40个三级条目的专家意见协调程度
表2. The degree of coordination of 35 experts' opinions on the 40 third-level items in topographic map assessment system for facial and cervical wounds and scars of burn patients
类别 评分（分， 肯德尔和谐系数 χ 2值 P值 重要性 4.934±0.024 0.88 1 201.53 <0.001 敏感性 4.771±0.028 0.55 745.67 <0.001 可操作性 4.933±0.070 0.52 707.07 <0.001
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