Department for Traumatology and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
Clinic for Orthopaedics and Traumatology, St. Josephs-Hospital Wiesbaden, Beethovenstraße 20, 65189, Wiesbaden, Germany.
BMC Musculoskelet Disord. 2019 Sep 4;20(1):403. doi: 10.1186/s12891-019-2795-6.
The Constant score (CS) is one of the most frequently applied tools for the assessment of the shoulder joint. However, evaluation of strength is not standardized leading to potential bias when comparing different studies.
Seventy-six patients with fractures of the proximal humerus undergoing open reduction and internal fixation (ORIF) were assessed using standardized CS strength measurements at the deltoid muscle insertion and at the wrist in three different arm positions. Variation coefficients were evaluated for each patient and position.
Forty women (57%) and 36 men (43%) were examined 96 months in mean after ORIF. We could state a maximum of 105.3 N difference if measurements were performed at the wrist or the insertion of the deltoid muscle in 90° forward flexion on the injured arm (167.9 ± 83.1 N; 62.6 ± 29.4 N). The lowest variation coefficient of the three performed measurements could be stated at the deltoid muscle insertion in a 90° abduction position in the scapula plane (6.94 ± 5.5).
Following our study results, different positions of force measurement can change the total CS by a whole category (e.g. "very good" to "good"). We recommend performing the measurement at the insertion of the deltoid muscle in a 90° abduction position in the scapula plane. Otherwise, even in the non-injured, it is hard to reach a "normal" shoulder function, based on the CS. When using the CS as outcome parameter, authors must give detailed information about the force measuring and use an exact measuring device.
Constant 评分（CS）是评估肩关节最常用的工具之一。然而，由于对力量的评估没有标准化，因此在比较不同研究时可能存在潜在偏差。
对 76 例行切开复位内固定术（ORIF）治疗的肱骨近端骨折患者进行评估，使用标准化的 CS 力量测量仪在三角肌插入点和手腕处测量三种不同的手臂位置。评估每个患者和位置的变异系数。
40 名女性（57%）和 36 名男性（43%）在 ORIF 后平均 96 个月接受了检查。如果在受伤手臂的 90°前屈位上在手腕或三角肌插入处进行测量，则最大差值为 105.3N（167.9±83.1N；62.6±29.4N）。在肩胛骨平面的 90°外展位置的三角肌插入处可获得三个测量值中的最低变异系数（6.94±5.5）。
根据我们的研究结果，不同的力量测量位置可以使整个 CS 评分改变一个等级（例如“非常好”变为“好”）。我们建议在肩胛骨平面的 90°外展位置的三角肌插入处进行测量。否则，即使在未受伤的情况下，根据 CS 评分，也很难达到“正常”的肩部功能。当使用 CS 作为结局参数时，作者必须详细说明力量测量的情况，并使用精确的测量设备。
