Fattal Charles, Coulet Bertrand, Gelis Anthony, Rouays-Mabit Hélène, Verollet Christine, Mauri Cécile, Ducros Jean-Luc, Teissier Jacques
Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Euromove Department, M2H Laboratory, Montpellier, France.
Physical Medicine and Rehabilitation Department, Centre Mutualiste Neurologique PROPARA, Montpellier, France; Hand and Upper Limb Surgery Department, CHRU Lapeyronie, Montpellier, France.
J Shoulder Elbow Surg. 2014 Sep;23(9):1263-71. doi: 10.1016/j.jse.2014.01.011. Epub 2014 Apr 13.
This article is a prospective review of patients with spinal cord injury who underwent multidisciplinary consultation from January 2005 to September 2013 for pain in one or both shoulders.
We performed clinical, functional, and lesion evaluations of 38 patients with paraplegia and quadriplegia presenting with rotator cuff pathologies.
Surgery was indicated and performed on 38 shoulders in 28 patients. The lesion assessment during surgery showed injuries that were more severe than one would have thought based on imaging data. The mean pain intensity rating in the operative and nonoperative groups was 0 and 1.6, respectively, at rest and 2 and 4.9, respectively, during paroxysmal peaks. On average, for patients who had surgery, the Functional Independence Measure score decreased by 2.3. The mean satisfaction index in operated patients was 8.5 of 10.
When the surgical indication was based on a multidisciplinary decision, no negative results were reported that could have challenged the validity of this decision. Pain relief was the primary benefit reported after surgery. The functional status was modified because of the technical aids needed to prevent shoulder overuse. There are several arguments in favor of rotator cuff surgery for wheelchair-bound patients with spinal cord injury. Because of their functional impairments, wheelchair-bound patients will continue to overburden their shoulders after rotator cuff surgery. A multidisciplinary approach emerges as the solution to inform and educate patients to limit the risk of recurrence.
本文是一项前瞻性综述，研究对象为2005年1月至2013年9月因单肩或双肩疼痛接受多学科会诊的脊髓损伤患者。
我们对38例患有肩袖病变的截瘫和四肢瘫患者进行了临床、功能和损伤评估。
28例患者的38个肩部接受了手术治疗。手术中的损伤评估显示，实际损伤比根据影像学数据所预期的更为严重。手术组和非手术组在休息时的平均疼痛强度评分分别为0和1.6，发作高峰期分别为2和4.9。平均而言，接受手术的患者的功能独立性测量得分下降了2.3。接受手术患者的平均满意度指数为8.5（满分10分）。
当手术指征基于多学科决策时，未报告任何可能对该决策的有效性构成挑战的负面结果。术后疼痛缓解是主要益处。由于需要技术辅助来防止肩部过度使用，功能状态发生了改变。对于脊髓损伤的轮椅使用者，有几个理由支持进行肩袖手术。由于功能障碍，轮椅使用者在肩袖手术后肩部仍会继续负担过重。多学科方法成为告知和教育患者以限制复发风险的解决方案。
