From the School of Kinesiology, the Department of Biostatistics, School of Public Health, and the Department of Biomedical Engineering, University of Michigan; the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and The Curtis National Hand Center, MedStar Union Memorial Hospital.
Plast Reconstr Surg. 2021 Jan 1;147(1):181-192. doi: 10.1097/PRS.0000000000007486.
Postmastectomy breast reconstruction techniques differentially influence patient-reported physical and psychosocial well-being. Objective measures of shoulder biomechanics, which are uniquely influenced by reconstruction technique, may provide insight into the influence of reconstruction technique on patient-reported outcomes.
Robot-assisted measures of shoulder strength and stiffness, and five validated patient-reported outcomes surveys were obtained from 46 women who had undergone mastectomy and a combined latissimus dorsi flap plus subpectoral implant, subpectoral implant, or DIEP flap breast reconstruction. Mediation analyses examined the role of functional shoulder biomechanics as a mediator between reconstruction technique and patient-reported outcomes.
Reconstruction technique affected shoulder biomechanics, with latissimus dorsi flap plus subpectoral implant patients exhibiting reduced shoulder strength and stiffness compared with subpectoral implant and DIEP flap patients. Increasing external rotation strength was predictive of improved upper extremity function (p = 0.04). Increasing shoulder stiffness while at rest was predictive of worsened upper extremity function (p = 0.03). Increasing shoulder stiffness at rest and during contraction was indicative of worsened psychosocial well-being (all p ≤ 0.02). Reconstruction technique did not predict survey scores of function directly, or when mediated by functional shoulder biomechanics.
In the current cohort, latissimus dorsi plus subpectoral implant breast reconstructions significantly reduced shoulder strength and stiffness when compared with the other techniques. In addition, objective measures of shoulder biomechanics were predictive of patient-reported physical and psychosocial well-being. The results emphasize the need for improved perioperative screening for shoulder functional deficits in patients undergoing breast reconstruction.
CLINICAL QUESITON/LEVEL OF EVIDENCE: Therapeutic, II.
乳房再造术后的重建技术会对患者报告的身体和心理社会健康产生不同的影响。肩部生物力学的客观测量指标受重建技术的影响，可能有助于了解重建技术对患者报告结果的影响。
从接受过乳房切除术和联合背阔肌皮瓣加胸肌下植入物、胸肌下植入物或 DIEP 皮瓣乳房重建的 46 名女性中获得了机器人辅助的肩部力量和刚度测量值以及五项经过验证的患者报告的结果调查。中介分析检查了功能性肩部生物力学作为重建技术和患者报告结果之间的中介变量的作用。
重建技术影响肩部生物力学，与胸肌下植入物和 DIEP 皮瓣患者相比，背阔肌皮瓣加胸肌下植入物患者的肩部力量和刚度降低。外旋力量增加可预测上肢功能改善（p=0.04）。肩部静止时的刚度增加可预测上肢功能恶化（p=0.03）。肩部静止和收缩时的刚度增加表明心理社会健康恶化（均 p≤0.02）。重建技术不能直接预测调查评分的功能，也不能通过功能性肩部生物力学来预测。
在当前队列中，与其他技术相比，背阔肌加胸肌下植入物乳房重建术明显降低了肩部力量和刚度。此外，肩部生物力学的客观测量指标与患者报告的身体和心理社会健康状况相关。这些结果强调了在接受乳房重建术的患者中需要改进围手术期肩部功能缺陷的筛查。
临床问题/证据水平：治疗，II 级。
