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关节镜下肩袖修复术后使用肩部外展支具:关于步态表现和跌倒的研究

Use of a shoulder abduction brace after arthroscopic rotator cuff repair: A study on gait performance and falls.

作者信息

Sonoda Yuma, Nishioka Takashi, Nakajima Ryo, Imai Shinji, Vigers Piers, Kawasaki Taku

机构信息

1 Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu, Japan.

2 Department of Orthopedic Surgery, Shiga University of Medical Science, Otsu, Japan.

出版信息

Prosthet Orthot Int. 2018 Apr;42(2):136-143. doi: 10.1177/0309364617695882. Epub 2017 Mar 20.

Abstract

BACKGROUND

Fall prevention is essential in patients after arthroscopic rotator cuff repair because of the high risk of re-rupture. However, there are no reports related to falls that occur during the early postoperative period, while the affected limb is immobilized.

OBJECTIVES

This study assessed gait performance and falls in patients using a shoulder abduction brace after arthroscopic rotator cuff repair.

STUDY DESIGN

Prospective cohort and postoperative repeated measures.

METHODS

This study included 29 patients (mean age, 67.1 ± 7.4 years) who underwent arthroscopic rotator cuff repair followed by rehabilitation. The timed up and go test, Geriatric Depression Scale, and Falls Efficacy Scale were measured, and the numbers of falls were compared between those shoulder abduction brace users and patients who had undergone total hip or knee arthroplasty.

RESULTS

In arthroscopic rotator cuff repair patients, there were significant improvements in timed up and go test and Geriatric Depression Scale, but no significant differences in Falls Efficacy Scale, between the second and fifth postoperative weeks ( p < 0.05). Additionally, arthroscopic rotator cuff repair patients fell more often than patients with total hip arthroplasty or total knee arthroplasty during the same period.

CONCLUSION

The findings suggest that rehabilitation in arthroscopic rotator cuff repair patients is beneficial, but decreased gait performance due to the immobilizing shoulder abduction brace can lead to falls. Clinical relevance Although rehabilitation helps motor function and mental health after arthroscopic rotator cuff repair, shoulder abduction brace use is associated with impaired gait performance, high Falls Efficacy Scale scores, and risk of falls, so awareness of risk factors including medications and lower limb dysfunctions is especially important after arthroscopic rotator cuff repair.

摘要

背景

由于再次破裂风险高,预防跌倒对于关节镜下肩袖修复术后的患者至关重要。然而,尚无关于术后早期患侧肢体固定期间发生跌倒的相关报道。

目的

本研究评估关节镜下肩袖修复术后使用肩外展支具患者的步态表现和跌倒情况。

研究设计

前瞻性队列研究和术后重复测量。

方法

本研究纳入29例(平均年龄67.1±7.4岁)接受关节镜下肩袖修复并随后进行康复治疗的患者。测量了计时起立行走测试、老年抑郁量表和跌倒效能量表,并比较了肩外展支具使用者与接受全髋关节或膝关节置换术患者的跌倒次数。

结果

在关节镜下肩袖修复患者中,术后第二周和第五周之间,计时起立行走测试和老年抑郁量表有显著改善,但跌倒效能量表无显著差异(p<0.05)。此外,在同一时期,关节镜下肩袖修复患者比全髋关节置换术或全膝关节置换术患者跌倒更频繁。

结论

研究结果表明,关节镜下肩袖修复患者的康复是有益的,但由于固定的肩外展支具导致步态表现下降可导致跌倒。临床相关性:尽管康复有助于关节镜下肩袖修复术后的运动功能和心理健康,但使用肩外展支具与步态表现受损、跌倒效能量表得分高和跌倒风险相关,因此在关节镜下肩袖修复术后,认识包括药物和下肢功能障碍在内的风险因素尤为重要。

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