Three kind of scoring system for proximal humeral fractures in patients with postoperative functional review of evaluation : a multicenter study

目的 探讨美国肩肘外科医师评分( ASES)、Constant评分、美国特种外科医院肩关节评分(HSS)3种评分系统对肱骨近端骨折患者手术治疗后肩关节功能的评价作用.方法 对来自5家医院2004年9月至2008年9月手术治疗并有完整随访资料的172例单纯肱骨近端骨折术后患者进行ASES、Constant、HSS评分,并由患者本人结合受伤前及术后康复情况对患侧肩关节功能进行自我评价.将上述几种评分结果相互进行Pearson相关性分析,采用Bland-Altman点图分析法对3种评分之间的一致性进行评价.将患者按照年龄和骨折类型进行分组,分析不同年龄组及骨折类型组间评分之间的相关性变化.结果 (1)对于相同年龄组和骨折类型的患者,Constant评分总体低于ASES与HSS评分(F=13.62、4.80,P＜0.05).(2)ASES评分与Constant评分(r=0.754,P=0.0003),ASES评分与HSS评分(r=0.755,P=0.0001),Constant评分和IISS评分(r=0.858,P=0.0002)间均有相关性.ASES评分、Constant评分和HSS评分与患者自身对肩关节功能恢复程度评价的相关系数分别为0.602(P =0.0002)、0.705(P =0.0001)和0.663(P =0.0037).3种评分总体上一致性好.(3 )Constant评分与患者自我肩关节评价的相关性随着年龄的增大和骨折严重性的增加明显降低.结论 ASES、Constant、HSS评分均可应用于肱骨近端骨折术后肩关节功能的评估,三者有较好的相关性及一致性.Constant评分与患者自我肩关节评价相关性最高,作为临床应用,推荐使用Constant评分,但同时应注意其存在的年龄偏倚.ASES评分可以作为远程随访的可靠方法.Objective To evaluate the ASES, Constant and HSS score systems and their significance on postoperative function of thc shoulder. Methods Totally 172 cases of proximal humeral fracture of five affiliated hospital from September 2004 to September 2008 were analyzed.All the functional outcome of the involved shoulder were evaluated by ASES,Constant,HSS score and patient self score.The correlations and agreement of three shoulder scales were analyzed with Pearson corTelation test and BlandAltman plot in different age groups and fracture types.Results ( 1 ) The Constant score were lower than other two scores in the same age group and fracture type ( F =13.62 and 4.80,P ＜ 0.05).(2) The correlations between three shoulder scales:ASES and Constant ( r =0.754,P =0.0003 ),ASES and HSS (r =0.755,P =0.0001 ),Constant and HSS ( r =0.858,P =0.0002).The correlations between three shoulder scales and patient self evaluation:ASES ( r =0.602,P =0.0002 ),Constant ( r =0.705,P =0.0001 ),HSS (r =0.663,P =0.0037).The Bland-Altman plot shows three shoulder scales have good agreement.(3)The correlation between Constant score and patient self evaluation decreased in the elder group and severe fracture type.Conclusions ASES,Constant,HSS shoulder score systems are all fit to evaluate the functional outcome of the shoulder,they have good correlation and agreement.Constant score in recommended for its high correlation cocfficicnt with patient self cvaluation score.However,its age bias must be paid attention in clinical practice.ASES shoulder score can be used in remote follow-up.国家科技部十一五科技支撑计划资助项目中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)04318-3225