肩抬高力量与解剖型全肩关节置换术后患者报告结果的关系。
The relationship of shoulder elevation strength to patient-reported outcome after anatomic total shoulder arthroplasty.
机构信息
Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Lifespan-The Miriam Hospital, Providence, RI, USA.
出版信息
J Shoulder Elbow Surg. 2020 Nov;29(11):2406-2416. doi: 10.1016/j.jse.2020.03.009. Epub 2020 Jun 9.
BACKGROUND
Most patient-reported outcome measures (PROMs) used to assess outcomes after anatomic total shoulder arthroplasty (aTSA) focus on pain and function. Although strength is considered an important component of function, only the Constant-Murley score (CMS) includes an objective measurement of shoulder strength. The purpose of this study was to evaluate the relationship between shoulder elevation strength (SES) and PROMs after aTSA for the treatment of primary glenohumeral osteoarthritis (GHOA).
METHODS
This was a retrospective analysis of 605 patients enrolled in a multicenter clinical database who underwent aTSA to treat primary GHOA. Patients were evaluated preoperatively and at 24 months after surgery. Outcome was assessed with the CMS, American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder score, Single Assessment Numeric Evaluation score, and patient satisfaction. Relationships between SES and outcomes were investigated.
RESULTS
The correlations between SES and the PROMs before and after treatment were very weak and weak, respectively (r ≤ 0.262 for all). The strength of the correlations between the absolute and adjusted CMS and the other PROMs varied from weak to moderate (r = 0.180 to r = 0.455), and the strength of the correlations was greater postoperatively. With the strength component removed from the CMS, the correlations between the CMS and other PROMs were stronger (r = 0.194 to r = 0.495).
CONCLUSIONS
Although measurement of SES provides objective information about shoulder function and outcome related to the treatment of primary GHOA with aTSA, the actual relevance to patients is unclear as the correlations between SES and PROMs were weak. Furthermore, the variable correlations between the CMS and PROMs call into question the exclusive use of the CMS and support the use of other PROMs that may more accurately reflect patient perception of outcome.
背景
大多数用于评估解剖型全肩关节置换术（aTSA）后结果的患者报告结局测量（PROM）都侧重于疼痛和功能。尽管力量被认为是功能的一个重要组成部分，但只有 Constant-Murley 评分（CMS）包括对肩部力量的客观测量。本研究旨在评估 aTSA 治疗原发性肩盂肱关节炎（GHOA）后肩部抬高力量（SES）与 PROM 的关系。
方法
这是一项多中心临床数据库中 605 例患者的回顾性分析，这些患者接受 aTSA 治疗原发性 GHOA。患者在术前和术后 24 个月进行评估。使用 CMS、美国肩肘外科医生评分、西部安大略省肩关节炎评分、单项评估数值评估评分和患者满意度来评估结果。研究了 SES 与结果之间的关系。
结果
SES 与治疗前后 PROM 的相关性分别为非常弱和弱（所有 r 值均≤0.262）。绝对 CMS 与其他 PROM 之间以及调整后 CMS 与其他 PROM 之间的相关性从弱到中度不等（r = 0.180 至 r = 0.455），术后相关性更强。从 CMS 中去除强度成分后，CMS 与其他 PROM 的相关性更强（r = 0.194 至 r = 0.495）。
结论
尽管 SES 的测量提供了有关肩部功能和与 aTSA 治疗原发性 GHOA 相关结果的客观信息，但由于 SES 与 PROM 的相关性较弱，因此其对患者的实际相关性尚不清楚。此外，CMS 与 PROM 之间的可变相关性质疑了 CMS 的排他性使用，并支持使用其他可能更准确反映患者对结果的感知的 PROM。
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