Establishment Of Grading Model Of Knee Osteoarthritis Based On Clinical Research Sharing System

BackgroundKnee osteoarthritis is a common diseases in orthopedic,the main clinical manifestations is pain,weakness and limitation with varying degrees,or even deformed.Global surveys show that about 250 million people suffer from KOA,and it is also the main cause of disability in the elderly.In China,85%population in over 65 years old with KOA.The diagnosis of KOA mostly requires X-ray indications.This study searched the influencing factors of KOA in different classification grade,and provided reference for clinical diagnosis of KOA grade.ObjectiveBased on clinical research sharing system,getting comprehensive acquisition of knee osteoarthritis factors.Including symptoms,signs and elements of the data of Chinese and Western medicine.ordinal Logistic regression analysis is the screen method used by us.Finding factors and establishing knee osteoarthritis ordinal Logistic regression classification model.The Ordinal Logistic model judged by area under the receiver operating characteristic curve(ROC).This model will provide a reliable evaluation tool for the clinical diagnosis of knee osteoarthritis level.MethodCases criterionInclude the 776 KOA people from department of bone and joint one,two,three,four and orthopedic specialist outpatient and hospital system in Wangjing Hospital,China Academy of Chinese Medical Science during September 18,2014 to April 26,with the study of Chinese and Western medicine diagnosis,imaging classification,inclusion,exclusion,removal criteria.Each patient was only involved in this study and was not followed up.Factors47 factors including age,sex,BMI index,pain side,pain range,pain nature,pain duration(months),concomitant synptoms,concomitant symptoms duration(months),whether recurrent,whether increased,aggravated duration(months),Incentive,trauma,history of smoking,history of drinking,heavy physical labor,sports,family history of KOA,morning stiffness,gait,TCM rating scale,VAS score,WOMAC scale,soreness and weakness of waist and knees,lower limb weakness,Lower limb weakness,lower extremity chills,season,sweating,swelling,aversion to cold and fever,lower extremity deformity,quadriceps atrophy,lower swelling,skin temperature,pain location,knee movement,knee joint friction,knee friction,floating patellar test,Patella grinding test,mcmurray ' s test,anterior drawer test,posterior drawer test,Bohler sign,Lachman sign.Statistical method47 factors of 776 cases were analyzed by using SPSS24.0.OR value,95%CI and the regression coefficient of the influential factors of 753 cases are figured up by using single factor and multiple factors ordinal Logistic regression analysis.753 cases can be divided into training set and test set,through the training set to determine the influence factors of KOA classification,and build the model equation.To evaluate model test using the test set.In addition,for the correlation of TCM symptom scale and WOMAC scale test using Pearson correlation coefficient calculation.ResultIn 776 cases of knee osteoarthritis,K-L I is 79 cases,10.2%of the total number of cases.II is 250 cases,32.2%of the total number of cases.? is 262 cases,accounted for 33.8%of the total number of cases.IV is 185 cases,23.8%of the total number of cases.The average age of the overall is 61.26±11.53,male and female sex ratio of 1:3.67.General description by SPSS24.0 analysis found that the influence factors of statistically differences between groups are:age,gender,BMI range,don't by the side of pain,pain,pain symptoms,pain duration(month),with nature,along with the duration of symptoms(month),whether or not break out repeatedly,aggravating,increase the duration(year)and knee injury history,smoking history,heavy physical labor work,morning stiffness situation description,gait,TCM symptoms scale score,VAS score,WOMAC scale,lumbar debility,lower limb weakness,lower limb sour,lower limb chills,good hair season,evil cold fever,lower limb deformity,quadriceps atrophy,swelling and tenderness,joint activities,knee joint,knee joint rubs.By using single factor and multiple factors Logistic regression analysis,found that the influence 13 factors of KOA classification The risk factors are 10,protective factor are 3.Risk factors include old,obesity,and long duration of pain,break out repeatedly,lower limb deformities,quadriceps atrophy.WOMAC scale,TCM symptoms scale,VAS score were positively correlated with KOA grade.Protective factors include one knee pain,single site pain or more pain.Beside,the scope of activities were negatively correlated with KOA grade.Knee osteoarthritis classification of ordinal Logistic regression model was constructed.P(?I?)=1-exp[Z-3.644]/1+exp[Z-3.644]P(??)=exp[Z-3.644]/1+exp[Z-3.644]-exp[Z-6.448]/1+exp[(Z-6.448]P(??)exp[Z-6.448]/1+exp[Z-6.448]-exp[Z-6.448]/1+exp[Z-8.891]p(??)=1-[P(??)+ P(??)+P(??)]Z = 0.052 × age + 0.104 × BMI + 0.004 × course(month)+ 0.599 × recurrent + 0.426 ×morning stiffness + 0.115 × TCM syndrome score + 0.006 × WOMAC index + 0.205 × VAS score + 0.902 × lower limb Deformity + 0.263 × quadriceps muscle atrophy-0.017 × joint activity+ pain side + pain range.There are recurrent episodes into 1,no into the 0;there are morning stiffness into 1,no into the 0;with lower limb deformity into 1,without into the 0;there are quadriceps atrophy into 1,Into the 0;pain side of the left knee into the-0.366,pain side of the right knee into the-0.056,knee pain into 0;single range of pain into the-0.118,multi-range pain into the-1.017,Pain into 0.Efficiency of model found that the total prediction rate is above 67%,sensitivity is above 50%,specificity is above 75%.Area under the ROC curve,the training set is 0.828,test set is 0.879.ConclusionBased on the clinical research sharing system,the grading model of knee osteoarthritis was established by using sequential Logistic regression analysis,and the ability of predicting knee osteoarthritis was found under the preliminary evaluation.Risk factors include old,obesity,and long duration of pain,break out repeatedly,lower limb deformities,quadriceps atrophy.WOMAC scale,TCM symptoms scale,VAS score were positively correlated with KOA grade.Protective factors include one knee pain,single site pain or more pain.Beside,the scope of activities were negatively correlated with KOA grade.InnovationBased on the clinical research sharing system,the Logistic regression method was used to construct the grading model of knee osteoarthritis.The model contains traditional medicine,modern medical-related disease factors,symptoms,signs,physical examination and various scales.