Clinical Rehabilitation Sciences Research Group, Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, PO Box 170, East Street, Lidcombe, New South Wales 1825, Australia.
Phys Ther. 2010 May;90(5):679-92. doi: 10.2522/ptj.20090104. Epub 2010 Mar 11.
Shoulder movement impairment is a commonly reported consequence of surgery for breast cancer.
The aim of this study was to determine whether shoulder girdle kinematics, including those of the scapula, spine, and upper limb, in women who have undergone a unilateral mastectomy for breast cancer are different from those demonstrated by an age-matched control group.
An observational study using 3-dimensional kinematic analysis was performed.
Women who had a unilateral mastectomy on their dominant-arm side (n=29, mean [+/-SD] age=62.4+/-8.9 years) or nondominant-arm side (n=24, mean [+/-SD] age=59.8+/-9.9 years), as well as a control group of age-matched women without upper-limb, shoulder, or spinal problems (n=22, mean [+/-SD] age=58.1+/-11.5 years), were measured while performing bilateral arm movements in the sagittal, scapular, and coronal planes. All of the women were free of shoulder pain at the time of testing. Data were collected from the glenohumeral joint, the scapulothoracic articulation, and the spine (upper and lower thoracic and lumbar regions) using an electromagnetic tracking system.
Women following mastectomy displayed altered patterns of scapular rotation compared with controls in all planes of movement. In particular, the scapula on the mastectomy side rotated upward to a markedly greater extent than that on the nonmastectomy side, and women following mastectomy displayed greater scapular excursion than controls.
The findings suggest that altered motor patterns of the scapula are associated with mastectomy on the same side. Whether these changes are harmful or not is unclear. Investigation of interventions designed to restore normal scapulohumeral relationships on the affected side following unilateral mastectomy for breast cancer is warranted.
肩部运动障碍是乳腺癌手术后常见的一种后果。
本研究旨在确定接受单侧乳腺癌乳房切除术的女性的肩带运动学（包括肩胛骨、脊柱和上肢）是否与年龄匹配的对照组不同。
采用三维运动学分析的观察性研究。
对接受单侧乳腺癌乳房切除术的女性（患侧组，n=29，平均[+/-SD]年龄=62.4+/-8.9 岁；非患侧组，n=24，平均[+/-SD]年龄=59.8+/-9.9 岁）以及无上肢、肩部或脊柱问题的年龄匹配对照组女性（n=22，平均[+/-SD]年龄=58.1+/-11.5 岁）进行双侧手臂运动的矢状面、肩胛骨和冠状面的 3 维运动学测量。所有女性在测试时均无肩部疼痛。使用电磁跟踪系统从盂肱关节、肩胛胸关节和脊柱（胸上和胸腰区）收集数据。
与对照组相比，接受乳房切除术的女性在所有运动平面上的肩胛骨旋转模式均发生改变。特别是，手术侧的肩胛骨向上旋转的幅度明显大于非手术侧，并且接受乳房切除术的女性的肩胛骨活动范围大于对照组。
这些发现表明，肩胛骨的运动模式改变与同侧乳房切除术有关。这些变化是否有害尚不清楚。需要对旨在恢复乳腺癌单侧乳房切除术后患侧正常肩胛盂肱关系的干预措施进行研究。
