Collin Philippe, Matsukawa Tetsuya, Denard Patrick J, Gain Solenn, Lädermann Alexandre
Centre Hospitalier Privé Saint-Grégoire (Vivalto santé), boulevard Boutière 6, 35768, Saint-Grégoire Cedex, France.
Department of Orthopaedic Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Int Orthop. 2017 Oct;41(10):2135-2142. doi: 10.1007/s00264-017-3573-4. Epub 2017 Aug 8.
Recently the use of reverse shoulder arthroplasty (RSA) has increased because of a clinical perception of durable functional outcome. However, some patients unexpectedly have a poor recovery of range of motion (ROM) after surgery. Objective factors such as initial diagnosis, pre- and intra-operative ROM, deltoid impairment or arm lengthening have previously been associated with anterior forward flexion (AFF). This study sought to determine if subjective pre-operative factors influence the rate and timing of ROM recovery after RSA.
Between January 2011 to January 2012, all RSAs performed by a single surgeon were prospectively enrolled in this study. The cohort was divided into two groups based on AFF <90 or ≥90 after surgery. A multivariate analysis was performed to define independent predictive factors of post-operative ROM. Factors assessed included: age, sex, dominant arm, patient activity, body mass index (BMI), pre-operative diagnosis, deltoid status, pain and Constant scores, subjective shoulder value (SSV), simple shoulder test (SST) and radiographic findings. Patients were reviewed at six weeks, and three, six, 12 and 24 months.
One hundred and one RSAs were available for analysis. Poor post-operative AFF at six weeks was significantly related to poor pre-operative deltoid strength. Poor post-operative AFF at one-year follow-up was related to surgery of non-dominant arm, pre-operative poor AFF, pre-operative activity, poor subjective shoulder value (SSV), and a low contralateral Constant score. AFF and Constant score improved until six months and then plateaued. In contrast, both external and internal rotation continued to improve beyond six months after surgery.
AFF and Constant scores after RSA plateau at six months after surgery whereas internal and external rotation continue to improve up to two years post operation. Several pre-operative factors including poor pre-operative AFF, surgery on the non-dominant arm, and lower SSV and Constant scores are correlated with post-operative ROM following RSA. Identification of these factors may be useful for counseling on functional expectations as well as customizing rehabilitation plans.
Level II, Prospective Cohort Study, Treatment Study.
近年来，由于临床上认为反肩关节置换术（RSA）能带来持久的功能预后，其应用有所增加。然而，一些患者术后的活动范围（ROM）恢复却出乎意料地差。诸如初始诊断、术前及术中的ROM、三角肌损伤或手臂延长等客观因素此前已被认为与前向屈曲（AFF）有关。本研究旨在确定术前主观因素是否会影响RSA术后ROM恢复的速度和时间。
2011年1月至2012年1月期间，由同一位外科医生实施的所有RSA手术患者均被前瞻性纳入本研究。根据术后AFF<90或≥90将队列分为两组。进行多变量分析以确定术后ROM的独立预测因素。评估的因素包括：年龄、性别、优势手臂、患者活动情况、体重指数（BMI）、术前诊断、三角肌状态、疼痛和Constant评分、主观肩关节值（SSV）、简单肩关节测试（SST）以及影像学检查结果。在术后六周、三个月、六个月、十二个月和二十四个月对患者进行复查。
共有101例RSA手术患者可供分析。术后六周时AFF较差与术前三角肌力量较差显著相关。一年随访时术后AFF较差与非优势手臂手术、术前AFF较差、术前活动情况、主观肩关节值（SSV）较差以及对侧Constant评分较低有关。AFF和Constant评分在术后六个月时有所改善，之后趋于平稳。相比之下，术后六个月后外旋和内旋均持续改善。
RSA术后的AFF和Constant评分在术后六个月趋于平稳，而内旋和外旋在术后两年内持续改善。包括术前AFF较差、非优势手臂手术以及较低的SSV和Constant评分在内的几个术前因素与RSA术后的ROM相关。识别这些因素可能有助于进行功能预期咨询以及定制康复计划。
二级，前瞻性队列研究，治疗研究。
