Koc University, School of Medicine, Department of Orthopaedics and Traumatology, Koc Universitesi Hastanesi, Davutpasa Cd. No:4 Topkapi-Zeytinburnu, 34010 Istanbul Turkey.
Koc University, School of Medicine, Department of Orthopaedics and Traumatology, Koc Universitesi Hastanesi, Davutpasa Cd. No:4 Topkapi-Zeytinburnu, 34010 Istanbul Turkey.
Orthop Traumatol Surg Res. 2020 Jun;106(4):701-707. doi: 10.1016/j.otsr.2020.03.002. Epub 2020 May 16.
Scapulothoracic arthrodesis (STA) is a well-established surgical technique to provide scapular stabilisation in patients with facioscapulohumeral dystrophy (FSHD). There is no staging or scoring systems available to guide surgical decision. The aim of this study was to develop a staging system to evaluate the shoulder disability in patients with FSHD to guide surgical decision-making and assess its reliability among surgeons.
Fifty-seven shoulders of 29 patients (15 male, 14 female) with an average age of 34.5 years (13-73) were included. Six stages of the disease were defined to create a system consisting of shoulder elevation, deltoid function and scapular winging. Patients were assessed by two independent orthopaedic surgeons who were blind to each other. Statistical analyses included mean and standard deviation for descriptive variables, Pearson's correlation and Cohen's Kappa for inter- and intraobserver agreement.
Measurement of elevation showed excellent correlation in both inter- and intraobserver assessment. There was substantial agreement on deltoid function and moderate agreement on scapular winging. Decisions on stage showed excellent agreement on interobserver and substantial agreement on intraobserver assessment. Surgical decision using the stage showed excellent agreement on both inter- and intraobserver assessment.
This novel staging system has an excellent inter observer agreement on FSHD patients' shoulder disability. This would provide surgeons a beneficial tool to define patient groups that would have negatively or positively affected from STA.
肩胛骨-胸壁融合术（STA）是一种成熟的手术技术，可提供肩胛骨稳定性，用于治疗面肩肱型肌营养不良症（FSHD）患者。目前尚无分期或评分系统可用于指导手术决策。本研究旨在开发一种分期系统，以评估 FSHD 患者的肩部残疾程度，指导手术决策，并评估其在外科医生中的可靠性。
纳入了 29 名患者（15 名男性，14 名女性）的 57 个肩部，平均年龄为 34.5 岁（13-73 岁）。定义了六个疾病阶段，以创建一个由肩部抬高、三角肌功能和肩胛骨翼状形成组成的系统。由两位独立的骨科医生进行评估，他们彼此之间是盲法的。统计分析包括描述性变量的均值和标准差、Pearson 相关系数和 Cohen's Kappa 用于评估观察者间和观察者内的一致性。
在观察者间和观察者内评估中，抬高的测量均显示出极好的相关性。三角肌功能的一致性较高，肩胛骨翼状形成的一致性中等。分期决策在观察者间具有极好的一致性，在观察者内具有较大的一致性。使用分期进行手术决策在观察者间和观察者内评估中均具有极好的一致性。
这种新的分期系统在 FSHD 患者的肩部残疾评估中具有极好的观察者间一致性。这将为外科医生提供一个有益的工具，以确定那些可能会或不会因 STA 而受到负面影响的患者群体。
