Qvist Andreas H, Vaesel Michael T, Moss Carsten, Jakobsen Thomas, Jensen Steen L
Department of Orthopedics, Aarhus University Hospital;
Department of Orthopedics, Viborg Regional Hospital;
Acta Orthop. 2020 Sep 15;91(6):789-793. doi: 10.1080/17453674.2020.1820274.
Background and purpose - Most newer randomized studies examining plate fixation and nonoperative treatment of midshaft clavicular fractures utilize both Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley score (CS) in the evaluation of patient outcomes. Compared with DASH, the use of CS requires on-site trained personnel and patient visits to obtain the score. The use of both DASH and CS should provide extra value compared with the use of a single functional outcome score; if this value is not provided, the combined use is not necessary. We evaluated the agreement between DASH and CS in patients with displaced midshaft clavicular fractures.Patients and methods - We used prospectively collected data from 146 patients enrolled in a randomized study comparing operative and nonoperative treatment of midshaft clavicular fractures. We determined correlation between DASH and CS at all follow-up points and calculated mean bias in the Bland-Altman plot.Results - We found moderate to high correlation (from 0.82 at 6 weeks' follow-up to 0.58 at 1-year follow-up) between DASH and CS score, and a small bias (2.21 [95% CI 0.22-4.20]) in the Bland-Altman plot.Interpretation - In patients with displaced midshaft clavicular fractures DASH and CS measures the same degree of disability. Unless specifically studying strength and range of motion, we recommend the sole use of DASH as it would eliminate potential observer-induced bias along with removing the economic and logistic burden of obtaining CS without compromising the value of the collected data.
背景与目的——大多数较新的关于锁骨中段骨折钢板固定及非手术治疗的随机研究在评估患者预后时，同时使用了上肢、肩部和手部功能障碍评分（DASH）及Constant-Murley评分（CS）。与DASH相比，使用CS需要现场经过培训的人员以及患者前来就诊以获得评分。与使用单一功能预后评分相比，同时使用DASH和CS应该能提供额外价值；如果未提供这种价值，那么联合使用就没有必要。我们评估了移位型锁骨中段骨折患者中DASH与CS之间的一致性。
患者与方法——我们使用了来自一项比较锁骨中段骨折手术与非手术治疗的随机研究中前瞻性收集的146例患者的数据。我们确定了所有随访时间点DASH与CS之间的相关性，并在Bland-Altman图中计算了平均偏差。
结果——我们发现DASH与CS评分之间存在中度到高度相关性（从随访6周时的0.82到随访1年时的0.58），并且在Bland-Altman图中存在较小偏差（2.21[95%CI 0.22 - 4.20]）。
解读——在移位型锁骨中段骨折患者中，DASH和CS测量的残疾程度相同。除非专门研究力量和活动范围，我们建议单独使用DASH，因为这样可以消除潜在的观察者诱导偏差，同时消除获取CS的经济和后勤负担，而不会影响所收集数据的价值。
