关节镜肩袖修复术后两种康复方案对活动范围和愈合率的影响：积极与有限的早期被动运动。

Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises.

机构信息

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea.

出版信息

Arthroscopy. 2012 Jan;28(1):34-42. doi: 10.1016/j.arthro.2011.07.012. Epub 2011 Oct 20.

DOI:10.1016/j.arthro.2011.07.012

PMID:22014477

Abstract

PURPOSE

To compare range of motion and healing rates between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tear.

METHODS

Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI) evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive early passive rehabilitation (manual therapy [2 times per day] and unlimited self-passive stretching exercise) was performed in 30 shoulders (group A) and limited early passive rehabilitation (limited continuous passive motion exercise and limited self-passive exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean of 7.6 months (range, 6 to 12 months) after surgery.

RESULTS

Regarding range of motion, group A improved more rapidly in forward flexion, external rotation at the side, internal and external rotation at 90° of abduction, and abduction than group B until 3 months postoperatively with significant differences. However, there were no statistically significant differences between the 2 groups at 1-year follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30 cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the difference was not statistically significant (P = .106).

CONCLUSIONS

Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks.

LEVEL OF EVIDENCE

Level II, randomized controlled trial.

摘要

目的

比较关节镜下单排修复全层肩袖撕裂后两种不同康复方案的活动范围和愈合率。

方法

本研究共纳入 64 例关节镜肩袖修复术后可进行术后磁共振成像（MRI）评估的肩关节。30 例（A 组）接受积极的早期被动康复（手法治疗[每天 2 次]和无限制的自我被动拉伸运动），34 例（B 组）接受有限的早期被动康复（有限的连续被动运动和有限的自我被动运动）。术后平均 7.6 个月（6 至 12 个月）进行术后 MRI 扫描。

结果

在活动范围方面，A 组在术后前屈、侧方外旋、外展 90°时内、外旋和外展方面的改善速度比 B 组更快，直到术后 3 个月时差异有统计学意义。然而，两组在 1 年随访时差异无统计学意义（前屈时 P =.827，侧方外旋时 P =.132，外展 90°时外旋 P =.661，外展时 P =.252），除了外展 90°时的内旋（P =.021）。通过术后 MRI 评估修复完整性，A 组 30 例中有 7 例（23.3%）和 B 组 34 例中有 3 例（8.8%）发生再撕裂，但差异无统计学意义（P =.106）。