Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Montréal, QC, Canada.
J Shoulder Elbow Surg. 2013 Aug;22(8):1011-8. doi: 10.1016/j.jse.2012.10.042. Epub 2013 Jan 24.
There is a high incidence of retear following surgical repair of rotator cuff tears. Postoperative shoulder immobilization is commonly prescribed to protect the repair; but there is no consensus on the best immobilization postures.
A generic musculoskeletal model of the shoulder was used to simulate postoperative immobilization of full thickness rotator cuff tears involving the supraspinatus only and the supraspinatus concomitantly with the infraspinatus or subscapularis. Optimal immobilization postures, which simultaneously minimized the stresses in the repaired tendons and the angle of humerus elevation, were obtained.
For isolated supraspinatus tears, elevation of the humerus in planes close to the scapular plane was suggested. When the infraspinatus was also involved, planes posterior to the scapular plane were suggested; while, if the subscapularis was also involved, planes anterior to the scapular plane and internal rotation were suggested. The required thoracohumeral elevation angles ranged from 58° to 109°, depending on the tear length and the muscles involved. The optimal postures reduced the stresses in the repaired tendons by between 29% and 90%.
Prescription of immobilization posture for a patient should be based on the conditions of the tear repaired. Appropriate choice of immobilization posture will reduce the stress in the repair, and as such has the potential to reduce retear rates.
肩袖撕裂手术后再撕裂的发生率很高。术后肩部固定常用于保护修复部位，但对于最佳固定姿势尚未达成共识。
使用通用的肩部肌肉骨骼模型模拟仅涉及冈上肌的全层肩袖撕裂以及同时涉及冈下肌或肩胛下肌的冈上肌的术后固定。获得了同时最小化修复肌腱内应力和肱骨抬高角度的最佳固定姿势。
对于孤立的冈上肌撕裂，建议在接近肩胛平面的平面上抬高肱骨。如果同时涉及冈下肌，则建议使用肩胛平面后的平面；而如果肩胛下肌也涉及，则建议使用肩胛平面前和内旋的平面。所需的胸肩抬高角度范围为 58°至 109°，具体取决于撕裂长度和涉及的肌肉。最佳姿势可将修复肌腱内的应力降低 29%至 90%。
应根据修复的撕裂情况为患者开具固定姿势的处方。适当选择固定姿势可以降低修复部位的应力，从而有可能降低再撕裂率。
