Costantino Cosimo, Verdano Michele Arcangelo, Jacopetti Marco, Romiti Davide, Lunini Enricomaria, Pellegrini Andrea, Ceccarelli Francesco
Rehabilitation Medicine, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Via Gramsci, 14, 43126, Parma, Italy,
J Orthop Sci. 2014 Sep;19(5):776-85. doi: 10.1007/s00776-014-0603-6. Epub 2014 Jul 5.
Despite the use of many shoulder outcome scales in subjects with rotator cuff pathology or instability symptoms, it can be problematic to select an instrumental evaluation in the shoulder trauma population. In this study we evaluated patients with proximal humeral fractures treated with internal fixation with a locking plate, analyzing the recovery of strength with an isokinetic test and its correlation with clinical and functional outcomes.
We enrolled 46 individuals (17 men, 29 women). The evaluation included a structured interview, measurement of ROM, isokinetic strength test and Constant-Murley and QuickDASH scores. The isokinetic test was performed in flexion/extension and external/internal rotation of the operated shoulder in comparison with the contralateral side and concentric contractions in all movements. The parameter tested was peak torque.
In the operated shoulder values we noticed a statistically significant correlation between the QuickDASH and Constant-Murley score. QuickDASH showed a significant correlation with flexion isokinetic strength, partial correlation with extension isokinetic values and no correlation with external/internal rotation values. In addition, we found a correlation between the Constant-Murley score and all the isokinetic strength parameters. Comparing the operated shoulder and the contralateral, in Neer type 2 fractures there was no significant difference in all the isokinetic peak torque values; in Neer type 3 and type 4, there was a significant statistical difference in both flexion peak torque values and no significant difference in the other movements.
The isokinetic test can give objective data on strength recovery and could help the surgeon's clinical evaluation to assess the functional recovery of the operated shoulder over time. We believe that the isokinetic test and Constant-Murley score could act as a reference in the evaluation of post-surgical outcome of proximal humeral fractures. Furthermore, the type of fracture could be a post-surgical limb recovery predictor and the shoulder flexion force could be the best functionality recovery indicator.
尽管在肩袖病变或不稳定症状的患者中使用了多种肩部结局量表，但在肩部创伤人群中选择一种器械评估方法可能存在问题。在本研究中，我们评估了采用锁定钢板内固定治疗的肱骨近端骨折患者，通过等速测试分析力量恢复情况及其与临床和功能结局的相关性。
我们纳入了46例个体（17例男性，29例女性）。评估包括结构化访谈、活动度测量、等速力量测试以及Constant-Murley和QuickDASH评分。等速测试在患侧肩部的屈伸和内外旋动作中与对侧进行比较，且所有动作均采用向心收缩。测试参数为峰值扭矩。
在患侧肩部的数值中，我们注意到QuickDASH和Constant-Murley评分之间存在统计学显著相关性。QuickDASH与屈曲等速力量显著相关，与伸展等速值部分相关，与内外旋值无相关性。此外，我们发现Constant-Murley评分与所有等速力量参数之间存在相关性。比较患侧肩部和对侧，在Neer 2型骨折中，所有等速峰值扭矩值均无显著差异；在Neer 3型和4型骨折中，屈曲峰值扭矩值均存在显著统计学差异，而其他动作中无显著差异。
等速测试可以提供关于力量恢复的客观数据，并有助于外科医生进行临床评估，以长期评估患侧肩部的功能恢复情况。我们认为等速测试和Constant-Murley评分可作为评估肱骨近端骨折术后结局的参考。此外，骨折类型可能是术后肢体恢复的预测指标，而肩部屈曲力量可能是最佳的功能恢复指标。
