Sperling John W, Kaufman Kenton R, Schleck Cathy D, Cofield Robert H
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Int J Shoulder Surg. 2008 Jan;2(1):1-3. doi: 10.4103/0973-6042.39579.
The primary goal of total shoulder arthroplasty (TSA) has traditionally been pain relief and motion improvement. The literature contains multiple studies that have documented the restoration of motion and consistent pain relief following the procedure. However, there has been little attention placed on strength following TSA. Therefore, the purpose of this study was to determine in an objective manner whether strength and motion improve with shoulder arthroplasty and over what time course this may occur.
Between April 2002 and January 2004, 15 patients who underwent TSA for osteoarthritis had biomechanical strength testing preoperatively, at 6 and 12 months postoperatively. The mean age at the time of TSA was 66 years (range, 52-82). None of the patients had full thickness rotator cuff tears at the time of surgery. Peak forces for shoulder flexion, extension, abduction, internal rotation and external rotation strength were recorded. In addition, patients had shoulder range of motion measurements performed.
Range of motion improved significantly with TSA from preoperative to 6 months postoperative: flexion 104° to 147° (P = 0.0034), abduction 86° to 145° (P = 0.0001), internal rotation 43° to 54° (P = 0.0475) and external rotation 25° to 50° (P = 0.0008). There was minimal improvement in range of motion from 6 to 12 months. In contrast, there continued to be improvements in strength from the 6 month to the 12 month postoperative time frame: extension 18.3 kg to 22.4 kg (P = 0.006), abduction 11.3 kg to 12.8 kg (0.0474) and external rotation 8.8 kg to 10.1 kg (P = 0.016). Despite these improvements, compared to normative values, there continued to be relative weakness of the shoulder following TSA.
The data from this study suggest that recovery of strength and motion follow different time frames after TSA. The results of this study may allow the surgeon to more accurately discuss with the patient over what time course strength and motion may return. In addition, this study raises important questions in regard to the current rehabilitation program used after shoulder arthroplasty and whether development of new protocols may improve the functional outcome from surgery.
Level 2.
全肩关节置换术（TSA）的主要目标传统上一直是缓解疼痛和改善活动度。文献中有多项研究记录了该手术后活动度的恢复和持续的疼痛缓解情况。然而，TSA术后的力量情况却很少受到关注。因此，本研究的目的是以客观的方式确定力量和活动度是否会随着肩关节置换术而改善，以及这可能会在什么时间进程中发生。
在2002年4月至2004年1月期间，15例因骨关节炎接受TSA的患者在术前、术后6个月和12个月进行了生物力学力量测试。TSA时的平均年龄为66岁（范围52 - 82岁）。手术时所有患者均无全层肩袖撕裂。记录了肩部前屈、后伸、外展、内旋和外旋力量的峰值。此外，对患者进行了肩关节活动度测量。
从术前到术后6个月，TSA使活动度显著改善：前屈从104°提高到147°（P = 0.0034），外展从86°提高到145°（P = 0.0001），内旋从43°提高到54°（P = 0.0475），外旋从25°提高到50°（P = 0.0008）。从6个月到12个月，活动度改善极小。相比之下，从术后6个月到12个月，力量持续改善：后伸从18.3千克提高到22.4千克（P = 0.006），外展从11.3千克提高到12.8千克（0.0474），外旋从8.8千克提高到10.1千克（P = 0.016）。尽管有这些改善，但与正常数值相比，TSA术后肩部仍存在相对无力的情况。
本研究的数据表明，TSA术后力量和活动度的恢复遵循不同的时间进程。本研究结果可能使外科医生能够更准确地与患者讨论力量和活动度可能在什么时间进程恢复。此外，本研究对目前肩关节置换术后使用的康复方案以及是否制定新的方案可能改善手术功能结果提出了重要问题。
2级。
