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关节镜下肩袖修复术后标准康复方案对疼痛、功能及健康认知的影响

The Effects of a Standard Postoperative Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair on Pain, Function, and Health Perception.

作者信息

Monesi Roberta, Benedetti Maria Grazia, Zati Alessandro, Vigna Daniela, Romanello Domenico, Monello Alberto, Rotini Roberto

机构信息

Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy.

Division of Shoulder and Elbow Orthopedic, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy.

出版信息

Joints. 2018 Oct 31;6(3):145-152. doi: 10.1055/s-0038-1673701. eCollection 2018 Sep.

Abstract

There is still conflicting evidence to support postoperative rehabilitation protocols using immobilization following rotator cuff repair over early motion. The objective of the study was to evaluate the evolution of pain, shoulder function, and patients' perception of their health status up to 1 year after cuff rotator repair and a standard postoperative rehabilitation protocol consisting of 4 weeks of immobilization followed by a 2-week assisted controlled rehabilitation.  Descriptive, longitudinal, uncontrolled case-series study was performed on 49 patients who underwent arthroscopic rotator cuff repair following traumatic or degenerative lesions. VAS scale for pain, Constant-Murley score for function, and SF-12 score for quality of life were used as outcome measures and were administered before the rehabilitation treatment, at the end of the 2-week rehabilitation, 3 months, and 1 year after surgery.  VAS pain score decreased significantly along the follow-up reaching almost a nil value after 1 year (0.2). Function as measured by Constant-Murley score had a significant improvement during follow-up, reaching a mean value of 84.6. The short form (SF)-12 score increased over time reaching 46.3 for the physical and 43.8 for the psychological dimension, respectively, at 1 year.  The present study confirmed an excellent outcome at 1 year after rotator cuff repair using a traditional 4-week immobilization followed by a 2-week rehabilitation protocol without evidence of tendon un-healing or re-tearing.  This is a level IV, therapeutic case series.

摘要

对于肩袖修复术后采用固定术还是早期活动的康复方案,目前仍存在相互矛盾的证据。本研究的目的是评估肩袖修复术后长达1年的疼痛演变、肩部功能以及患者对自身健康状况的感知,并评估一种标准的术后康复方案,该方案包括4周的固定期,随后是2周的辅助控制性康复。

对49例因创伤性或退行性病变接受关节镜下肩袖修复术的患者进行了描述性、纵向、非对照病例系列研究。采用视觉模拟评分法(VAS)评估疼痛,采用Constant-Murley评分法评估功能,采用SF-12评分法评估生活质量,在康复治疗前、2周康复结束时、术后3个月和1年进行测量。

随访期间VAS疼痛评分显著降低,1年后几乎降至零值(0.2)。Constant-Murley评分所衡量的功能在随访期间有显著改善,平均值达到84.6。简短形式(SF)-12评分随时间增加,1年时身体维度达到46.3,心理维度达到43.8。

本研究证实,采用传统的4周固定加2周康复方案进行肩袖修复术后1年,效果良好,且无肌腱不愈合或再次撕裂的迹象。

这是一个IV级治疗性病例系列。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a6c/6301846/b2f10a40106a/10-1055-s-0038-1673701-i1700044-1.jpg

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