关节镜下肩袖损伤修补术后早期运动和制动对肩关节功能的影响

Effect of motion and immobilization on shoulder function early after arthroscopic rotator cuff repair

目的探讨早期康复被动运动和制动对关节镜下肩袖损伤修补术后肩关节功能的影响。方法采用回顾性病例对照研究分析2016年1月至2017年12月上海交通大学医学院附属新华医院收治的78例肩袖损伤患者临床资料,其中男36例,女42例;年龄35~78岁[(62.7±3.2)岁]。中度撕裂(1~3 cm)36例,小撕裂(<1cm)31例,冈上肌关节面部分撕裂(PASTA)11例。患者均行关节镜下肩袖损伤修补术,43例术后立即开始被动康复运动(活动组);35例术后采用肩关节外展支具固定6周,第7周开始被动活动康复训练(制动组几比较两组术前、术后6周、3个月、12个月的肩关节活动度、视觉模拟评分(VAS)、简明肩关节功能测试(SST)评分.Constant肩关节评分.术后12个月采用超声评估肩袖愈合情况观察两组并发症情况<结果患者均获随访12~16个月[(13.7±1.3)个月]。活动组和制动组分别为7例肩关节活动僵硬(16%.20%)(P>0.05)。活动组与制动组术后6周、3个月、12个月VAS、SST评分及Constant评分差异均无统计学意义(P〉0.05)。与制动组[(124.9±12.9)°、25(20,30)°]比较,术后6周活动组的前屈、体侧外旋活动度[(136.6±16.7)°、30(25,40)°]有明显改善(P<0.05)。活动组与制动组术后3个月、12个月前屈、体侧外旋活动度差异均无统计学意义(P>0.05)°活动组与制动组术后6周、3个月、12个月内旋活动度差异均无统计学意义(P>0.05)。术后12个月患者肩袖损伤均愈合。患者术后均未出现感染、内置物移位等并发症。结论对于中度撕裂、小撕裂和PASTA的关节镜下修补,与制动比较,术后早期被动康复运动对肩关节活动度改善仅在早期有优势。随着时间推移,这种差异消失,而在术后疼痛、肩关节功能改善方面没有明显差异.

Objective To investigate the effect of passive motion and immobilization on shoulder function early after arthroscopic repair of rotator cuff tears.Methods A retrospective case-control study was conducted to analyze the clinical data of 78 patients with rotator cuff tear admitted to Xinhua Hospital,Shanghai Jiaotong University School of Medicine from January 2016 to December 2017.There were 36 males and 42 females,aged 35-78 years[(62.7±3.2)years].There were 36 patients with medium-sized tears(1-3 cm),31 with small tears(<1 cm),and 11 with partial articular supraspinatus tendon avulsion(PASTA).All patients underwent arthroscopic rotator cuff repair.Forty-three patients started rehabilitation exercise immediately after operation(motion group).Thirty-five patients were immobilized with shoulder abduction brace for 6 weeks,and started rehabilitation exercise at week 7(immobilization group).The range of motion,visual analogue pain score(VAS),simplified shoulder joint function test(SST)and Constant shoulder joint score were compared between the two groups before surgery,6 weeks,3 months and 12 months after surgery.The healing results were assessed by ultrasound 12 months after surgery.Complications were observed.Results All the patients were followed up for 12-16 months[(13.7±1.3)months].There were 7 patients with shoulder joint stiffness in each group(motion group:16%,immobilization group:20%)(P<0.05).There were no significant differences between the two groups in VAS,SST or Constant score at postoperative 6 weeks,3 months and 12 months(P>0.05).The forward flexion and external rotation with the arm at the side in immobilization group was(124.9±12.9)°and 25(20,30)°at postoperative 6 weeks,significantly improved in motion group[(136.6±16.7)°,30(25,40)°](P<0.05).There were no significant differences between the two groups in forward flexion and external rotation with the arm at the side at postoperative 3 and 12 months(P>0.05).There were no significant differences between the two groups in internal rotation al postoperative 6 weeks,3 months,and 12 months(P>0.05).All rotator cuffs were healed verified by ultrasound at postoperative 12 months.No infection or implant displacement occurred after operation.Conclusions For arthroscopic repair of medium-sized tears,small tears and PASTA,early postoperative rehabilitation exercises have advantage in improving range of motion only at early stage when compared to immobilization,which disappears with time.Moreover,the two methods have no significant differences in improving postoperative pain and shoulder function.