关节镜下肩袖修复术后早期与延迟被动运动的疗效比较

The compare of stiffness reduction and functional improvements between early passive motion and delayed passive motion in patients undergoing arthroscopic rotator cuff repair

目的比较关节镜下肩袖修复术后早期被动运动与延迟被动运动对关节活动度、关节功能及肩袖再撕裂的影响,探讨关节镜下肩袖修复术后最佳的康复方案。方法根据随机数字表将我院84例中、大型肩袖损伤患者随机分为早期被动运动组(43例)及延迟被动运动组(41例)。早期组术后第1天即开始进行肩关节康复锻炼,延迟组术后外展枕固定肩关节,6周开始肩关节康复锻炼。分别于术前、术后第3、6、12个月对两组患者进行肩关节活动范围、疼痛程度和肩关节功能评定,并统计末次随访肩袖再撕裂率。结果术后3个月时,早期组前屈上举及外旋、ASES评分及UCLA评分均大于延迟组(P<0.05)。术后6、12个月时,两组关节活动度、疼痛评分及功能评分比较,差异均无统计学意义(P>0.05)。经术后至少12个月的随访,两组再撕裂率比较差异无统计学意义。结论关节镜下肩袖修复术后早期与延迟被动运动均可获得相当的关节活动度及关节功能,而术后早期进行康复锻炼有利于关节活动度及功能的快速恢复,且不增加发生肩袖再撕裂的风险。

Objective To compare the effects of early passive motion（EPM）and delayed passive motion（DPM）on joint range of motion（ROM）,joint function and recurrent tears after arthroscopic rotator cuff repair.Methods A total of 84 cases with middle or large rotator cuff injury were randomly divided into EPM group（43 cases）and DPM group（41 cases）. EPM group began shoulder rehabilitation exercise on the first day post-opera-tion and DPM group began 6 weeks later. ROM,pain and function of shoulder joint were evaluated before and 3,6 and 12 months after operation. Results ASES score and UCLA score in EPM group were significantly higher thanthose in DPM group at 3 months postoperatively（P〈 0.05）. There was no significant difference in joint ROM,painand functional between two groups at 6 months and 12 months postoperatively（P〉0.05）. There was no statisticallysignificant difference in recurrent tears between two groups at least 12 months follow-up. Conclusion There was nosignificant difference in functional outcomes,ROM and relative risks of recurrent tears between EPM and DPM inpatients undergoing arthroscopic rotator cuff repairs. EPM is conducive to joint ROM and function rapid recoverypostoperatively and does not increase the risks of recurrent tears.