Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Arthroscopy. 2019 Jan;35(1):54-59. doi: 10.1016/j.arthro.2018.08.005.
To determine the minimal clinically important differences (MCIDs) for the Rowe score and the American Shoulder and Elbow Surgeons (ASES) score after arthroscopic stabilization surgery for anterior shoulder instability and to evaluate the effect of various patient- and treatment-related factors on MCIDs.
The study enrolled 216 patients who underwent arthroscopic stabilization surgery for anterior shoulder instability. The patients were categorized into "no-change" and "minimal-change" groups by a 15-item questionnaire at the 1-year postoperative visit. The Rowe and ASES scores were assessed preoperatively and at the 1-year postoperative follow-up visit. MCIDs were calculated using an anchor-based method. Correlations between MCIDs and several factors were evaluated using Spearman correlation analysis and univariate regression analysis.
On the basis of the questionnaires administered at the 1-year postoperative follow-up visit, 10 patients were assigned to the no-change group and 33 patients were placed in the minimal-change group. MCIDs for the Rowe and ASES scores were 9.7 and 8.5, respectively. Body mass index was negatively correlated with the MCID for the Rowe score (P = .01). Number of dislocations, symptom duration, and presence of Hill-Sachs lesions were positively correlated with the MCID for the ASES score (P = .02, P = .04, and P = .02, respectively). Other variables such as age, sex, and arm dominance were not related to the MCIDs for either the Rowe or ASES score.
In patients who underwent arthroscopic stabilization surgery, differences of at least 9.7 in the Rowe score and 8.5 in the ASES score were clinically relevant. Patients with a greater body mass index required a smaller change in the Rowe score and patients with a greater number of dislocations, a longer symptom duration, or a Hill-Sachs lesion required a larger change in the ASES score to feel clinically relevant changes.
Level IV, case series.
确定关节镜下稳定手术后前肩不稳定的 Rowe 评分和美国肩肘外科医生（ASES）评分的最小临床重要差异（MCID），并评估各种患者和治疗相关因素对 MCID 的影响。
本研究纳入了 216 例接受关节镜下稳定手术治疗前肩不稳定的患者。术后 1 年通过 15 项问卷调查将患者分为“无变化”和“最小变化”组。术前和术后 1 年随访时评估 Rowe 和 ASES 评分。采用锚定法计算 MCID。采用 Spearman 相关分析和单变量回归分析评估 MCID 与多个因素的相关性。
根据术后 1 年随访时的问卷，10 例患者被分配到无变化组，33 例患者被分配到最小变化组。Rowe 和 ASES 评分的 MCID 分别为 9.7 和 8.5。体质指数与 Rowe 评分的 MCID 呈负相关（P=0.01）。脱位次数、症状持续时间和 Hill-Sachs 病变的存在与 ASES 评分的 MCID 呈正相关（P=0.02、P=0.04 和 P=0.02）。年龄、性别和手臂优势等其他变量与 Rowe 或 ASES 评分的 MCID 均无关。
在接受关节镜下稳定手术的患者中，Rowe 评分至少增加 9.7 分，ASES 评分至少增加 8.5 分具有临床意义。体质指数较大的患者需要 Rowe 评分的较小变化，而脱位次数较多、症状持续时间较长或存在 Hill-Sachs 病变的患者需要 ASES 评分的较大变化才能感受到临床相关的变化。
IV 级，病例系列。
