背景:桡骨远端骨折(DRF)是常见的骨科损伤。它们可以在许多方面得到治疗,但掌侧锁定板(VLP)更为频繁。目前,关于手术治疗的DRF中最小临床重要差异(MCID)的信息有限.这项研究的目的是在VLP治疗的DRF的设置中计算患者报告的腕部评估(PRWE)的MCID值。
方法:对孤立、用VLP手术治疗的DRF。排除包括腕管松解术以外的任何伴随程序,骨骼不成熟,多发性创伤,开放性骨折,或缺少PRWE数据。MCID是使用PRWE计算的,一个整体健康问题,和基于锚的方法。
结果:共确认131例患者。大约54.2%的人受伤了他们的优势手。AO/OTA分类23C最为常见(n=89,67.9%)。平均基线,6周,12周PRWE分别为71.8±19.6、34.3±20.1和21.2±18.0。这对应于在6周和12周时从基线PRWE的平均变化分别为-37.5±23.4和-50.6±22.3。6周和12周的平均MCID值分别为43.1±18和56.0±20.0(p<0.001)。手部优势与MCID值无关(六周时rs=0.084,12周时rs=0.099)。MCID值另外与性别无关,AO/OTA分类,吸烟状况,ASA得分,或BMI。1级创伤中心的治疗和焦虑和/或抑郁的诊断与较高的6周MCID值相关(分别为rs=0.308和rs=0.410)。年龄增长与较高的12周MCID值弱相关(rs=0.352)。
结论:这项研究证明了使用整体健康锚点的MCID计算。MCID值随随访时间的变化而变化,与年龄的相关性较弱,诊断为焦虑和/或抑郁,和治疗设施,但与惯用手的损伤无关。未来的研究应该分析如何在DRF护理中应用MCID并确定成功的治疗方法。
BACKGROUND: Distal radius fractures (DRFs) are common orthopaedic injuries. They can be treated in many ways, but the volar locking plate (VLP) is more frequent. Currently, there is limited information regarding the minimum clinically important difference (MCID) in surgically treated DRFs. The purpose of this study was to calculate MCID values for the Patient-Reported Wrist Evaluation (PRWE) in the setting of VLP-treated DRFs.
METHODS: A retrospective review was conducted for patients with isolated, surgically-treated DRFs with a VLP. Exclusions included any concomitant procedure other than a carpal tunnel release, skeletal immaturity, polytrauma, open fracture, or missing PRWE data. MCID was calculated using PRWE, an overall health question, and the anchor-based method.
RESULTS: A total of 131 patients were identified. Approximately 54.2% injured their dominant hand. AO/OTA classification 23C was the most common (n=89, 67.9%). Average baseline, 6-week, and 12-week PRWE were 71.8 ± 19.6, 34.3 ± 20.1, and 21.2 ± 18.0 respectively. This corresponds to an average change from baseline PRWE at 6 weeks and 12 weeks of -37.5 ± 23.4 and -50.6 ± 22.3, respectively. Average MCID values for 6 weeks and 12 weeks were 43.1 ± 18 and 56.0 ± 20.0, respectively (p<0.001). Hand dominance did not correlate with MCID value (rs = 0.084 at six weeks, rs = 0.099 at 12 weeks). MCID value additionally did not correlate with sex, AO/OTA classification, smoking status, ASA score, or BMI. Treatment at a level 1 trauma center and diagnosis of anxiety and/or depression correlated with a higher 6-week MCID value (rs = 0.308 and rs = 0.410, respectively). Increasing age weakly correlated with higher 12-week MCID value (rs = 0.352).
CONCLUSIONS: This study demonstrated an MCID calculation using an overall health anchor. MCID value varied with follow-up time and correlated weakly with age, diagnosis of anxiety and/or depression, and treatment facility, but it did not correlate with injury of the dominant hand. Future research should analyze how to apply MCID and identify successful treatment in the setting of DRF care.