唇腭裂患者侧貌协调性医患主观评价的比较

目的比较医患对唇腭裂患者侧貌协调性主观评价的一致程度及影响评价敏感部位的异同。方法10名唇腭裂患者对150张唇腭裂患者侧位标准照的鼻尖突度、鼻上唇协调性、上下唇协调性和侧貌整体行主观等级评分。计算医患主观评价一致性、差异性及局部在整体评价中的敏感性。结果医患主观评价一致性加权Kappa值为0．408-0．508。对于鼻尖突度和侧貌整体，医生评分较患者高（P〈0．01）；对于鼻上唇协调性，患者评分较医生高（P〈0．01）。唇间角在患者整体评价三等级各组间有显著性差异。结论医患对唇腭裂患者侧貌协调性主观评价中度一致。对于鼻尖突度和侧貌整体，医生比患者认可度高；对于鼻上唇协调性，患者比医生认可度高。影响整体评价的敏感部位是上下唇协调性。

A comparative study of profile assessments between professionals and patients with cleft lip and palate

Objective To investigate the agreement of the subjective assessments on the profile of cleft lip and palate （CLP） patients between the professionals and CLP patients and the parts that influence the evaluation. Methods A total of 150 standard lateral profile photographs of CLP patients were randomly selected. Ten CLP patient assessors were selected to rate the nasal tip projection, nasolabial harmony, interlips harmony and profile based on a 3-point ordinal scale. The agreement was analyzed by Weighted Kappa. The difference was analyzed by Wilcoxon rank sum test. Results The agreement between the patients and doctors was Weighted Kappa O. 408-0. 508. The scores obtained by the professionals in nasal tip projection and profile were higher than those by CLP patients （ P 〈 0. 01 ）. The scores obtained by the CLP patients in nasolabial harmony were higher than those by professionals （ P 〈 0. 01 ）. Interlips angle showed significantly different among the three ordinal groups of profile evaluation. Condusion The agreement of the subjective assessment between professionals and CLP patients was moderate. Professionals were more likely to accept nasal tip projection and profile while CLP patients were more likely to accept nasolabial harmony. The interlips harmony was the parts that most influenced the evaluation.