关节镜下肩袖修复术后早期主动活动与吊带固定的随机对照试验。
Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.
机构信息
Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, Sturgeon Community Hospital, St. Albert, Alberta, Canada.
Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada.
出版信息
Arthroscopy. 2019 Mar;35(3):749-760.e2. doi: 10.1016/j.arthro.2018.10.139.
PURPOSE
To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24 months following arthroscopic rotator cuff (RC) repair.
METHODS
A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n = 103; self-weaned from sling and performed pain-free active ROM during the first 6 weeks) or SR (n = 103; wore a sling for 6 weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6 weeks and 3, 6, 12, and 24 months postoperatively by a blinded assessor. At 6, 12, and 24 months, strength was reassessed. At 12 months, ultrasound verified RC integrity. Independent t tests assessed 6-week group differences and 2-way repeated measures analysis of variance assessed changes over time between groups.
RESULTS
The groups were similar preoperatively (P > .12). The mean age of participants was 55.9 (minimum, 26; maximum, 79) years, and 131 (64%) were men. A total of 171 (83%) patients were followed to 24 months. At 6 weeks postoperatively, EM participants had significantly better forward flexion and abduction (P < .03) than the SR participants; no other group differences were noted. Over 24 months, there were no group differences in ROM after 6 weeks (P > .08), and pain (P > .06), strength (P = .35), or HRQOL (P > .20) at any time. Fifty-two (25%) subjects (30% EM; 33% SR) had a full-thickness tear present at 12-month postoperative ultrasound testing (P > .8).
CONCLUSIONS
EM did not show significant clinical benefits, but there was no compromise of postoperative ROM, pain, strength, or HRQOL. Repair integrity was similar at 12 months postoperatively between groups. Consideration should be given to allow pain-free active ROM within the first 6 weeks following arthroscopic RC repair.
LEVEL OF EVIDENCE
Level I, high-quality randomized controlled trial.
目的
比较关节镜下肩袖（RC）修复后最初 24 个月内早期活动（EM）与标准康复（SR）的效果。
方法
对术前评估的肩部活动范围（ROM）、疼痛、力量和健康相关生活质量（HRQOL）的全层 RC 撕裂患者进行前瞻性评估后，206 例接受关节镜修复的患者随机分为 EM 组（n=103；在最初 6 周内从吊带中自行解脱，并进行无痛主动 ROM）或 SR 组（n=103；佩戴吊带 6 周，无主动 ROM）。由盲法评估者在术后 6 周和 3、6、12 和 24 个月时重新评估肩部 ROM、疼痛和 HRQOL。在 6、12 和 24 个月时重新评估力量。在 12 个月时，超声检查证实 RC 完整性。独立 t 检验评估 6 周组差异，2 因素重复测量方差分析评估组间随时间的变化。
结果
两组患者术前相似（P>.12）。参与者的平均年龄为 55.9 岁（最小 26 岁，最大 79 岁），131 名（64%）为男性。共有 171 名（83%）患者随访至 24 个月。术后 6 周时，EM 组的前屈和外展明显优于 SR 组（P<.03）；未观察到其他组间差异。在 24 个月内，6 周后 ROM 无组间差异（P>.08），疼痛（P>.06）、力量（P=.35）或 HRQOL（P>.20）在任何时间均无差异。52 名（25%）受试者（30%EM；33%SR）在术后 12 个月的超声检查中发现全层撕裂（P>.8）。
结论
EM 并未显示出显著的临床益处，但并未影响术后 ROM、疼痛、力量或 HRQOL。两组在术后 12 个月时的修复完整性相似。应考虑在关节镜下 RC 修复后最初 6 周内允许无痛主动 ROM。
证据等级
1 级，高质量随机对照试验。
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