Moed Berton R, McMichael Jessica C
Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 7th Floor, Desloge Towers, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2008 Mar;90 Suppl 2 Pt 1:87-107. doi: 10.2106/JBJS.G.01471.
The Musculoskeletal Function Assessment (MFA) is a validated, reliable, self-administered questionnaire that is useful for determining functional status. The Merle d'Aubigné score is a clinical measure of hip function. The purpose of the present study was to evaluate the outcome information provided by these two instruments after operative treatment of elementary posterior wall fractures of the acetabulum.
Forty-six patients who had been followed for a minimum of two years after operative treatment of an elementary posterior wall fracture of the acetabulum were included in the study. Functional outcomes were assessed with use of the ten individual indices and total score of the MFA, and clinical outcomes were evaluated with use of the Merle d'Aubigné score. The MFA scores were compared with previously reported normative values and with previously reported values for similar patients with hip injuries. The duration of follow-up ranged from two to fourteen years (mean, five years).
The mean Merle d'Aubigné score was 17 (standard deviation, 1; range, 14 to 18), indicating overall good-to-excellent clinical results. However, the mean total MFA score was 23.17, which was significantly worse than the normative mean of 9.26 (p < 0.001). All MFA indices except hand/fine motor were similarly significantly worse than expected norms. The mean MFA total score was statistically similar to that reported by others for patients with hip injuries. The emotional category of the MFA score was found to be an important determinant of the total score. The Spearman rho correlation coefficient between the Merle d'Aubigné score and the MFA score was 0.62 (p < 0.001). However, the Merle d'Aubigné score data were asymmetric, demonstrating a ceiling effect (crowding of the scores at the upper end of the scale, limiting the ability of the score to demonstrate differences between patients with supposedly better clinical outcomes).
The total MFA scores for patients with a posterior wall fracture of the acetabulum were significantly worse than normative reference values. Thus, complete recovery after a posterior wall fracture of the acetabulum is uncommon, with residual functional deficits involving wide-ranging aspects of everyday living that do not necessarily have an obvious direct connection to hip function. Although the modified Merle d'Aubigné score may be useful for evaluating isolated hip function in patients who have been treated for an acetabular fracture, its shortcomings limit its usefulness as a method for evaluating functional outcome in these patients. Research efforts should be directed toward the identification of the psychosocial and other underlying determinants of functional outcome and potential related treatment interventions.
肌肉骨骼功能评估（MFA）是一种经过验证的、可靠的、可自行填写的问卷，有助于确定功能状态。Merle d'Aubigné评分是一种髋关节功能的临床测量方法。本研究的目的是评估这两种工具在髋臼后壁基本骨折手术治疗后提供的结果信息。
本研究纳入了46例髋臼后壁基本骨折手术治疗后至少随访两年的患者。使用MFA的十个单项指标和总分评估功能结果，使用Merle d'Aubigné评分评估临床结果。将MFA评分与先前报道的标准值以及先前报道的类似髋关节损伤患者的值进行比较。随访时间为2至14年（平均5年）。
Merle d'Aubigné评分的平均值为17（标准差为1；范围为14至18），表明总体临床结果良好至优秀。然而，MFA总分的平均值为23.17，明显低于标准平均值9.26（p<0.001）。除手/精细运动外，所有MFA指标同样明显低于预期标准。MFA总分在统计学上与其他报道的髋关节损伤患者的总分相似。发现MFA评分的情感类别是总分的一个重要决定因素。Merle d'Aubigné评分与MFA评分之间的Spearman等级相关系数为0.62（p<0.001）。然而，Merle d'Aubigné评分数据不对称，显示出天花板效应（评分在量表上端聚集，限制了评分显示假定临床结果较好的患者之间差异的能力）。
髋臼后壁骨折患者的MFA总分明显低于标准参考值。因此，髋臼后壁骨折后完全恢复并不常见，残留的功能缺陷涉及日常生活的广泛方面，这些方面不一定与髋关节功能有明显的直接联系。虽然改良的Merle d'Aubigné评分可能有助于评估髋臼骨折治疗患者的孤立髋关节功能，但其缺点限制了其作为评估这些患者功能结果方法的实用性。研究工作应致力于确定功能结果的心理社会和其他潜在决定因素以及潜在的相关治疗干预措施。
