Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Shoulder Elbow Surg. 2021 Nov;30(11):2577-2586. doi: 10.1016/j.jse.2021.04.013. Epub 2021 Apr 22.
Although rotator cuff repair is performed to restore the function of the rotator cuff muscles and glenohumeral (GH) joint motion, little has been known regarding the recovery process. The purpose of this study was (1) to investigate changes over time in activities of the supraspinatus and deltoid muscles assessed by ultrasound real-time tissue elastography (RTE) after rotator cuff repair and (2) to determine contributions of the activities of these muscles to the GH joint motion.
Twenty patients after rotator cuff repair and 13 control participants were enrolled in this study. Elasticity of the supraspinatus and middle deltoid muscles were measured at rest and 30° of humerothoracic elevation in the scapular plane (scaption) by using RTE. The elasticity at 30° of scaption was normalized to that at rest in each muscle to quantify their muscle activities. In addition, the supraspinatus-to-middle deltoid (SSP/MD) ratio for the normalized elasticity was calculated. The GH elevation angle was measured with a digital inclinometer, which was calculated by subtracting the scapular upward rotation angle from 30° of scaption. For patients after rotator cuff repair, all measurements were performed at 6 weeks, 8 weeks, 3 months, and 6 months after surgery. Rotator cuff integrity was examined with magnetic resonance imaging at 6 months after surgery.
Fifteen of 20 patients who remained intact at 6 months after surgery completed this study. The supraspinatus activity at 6 weeks was significantly smaller than that at 3 months (P = .006) and 6 months (P = .010). There was no significant difference in the supraspinatus activity between the patients at 3 months and the control participants (P = .586). The middle deltoid activity at 6 weeks was significantly greater than that at 6 months (P = .003). There was positive correlation between GH elevation angle and the activity of the supraspinatus relative to the deltoid at 6 weeks (r = 0.75, P = .001) and 8 weeks (r = 0.53, P = .041).
The supraspinatus activity increased from 6 weeks to 3 months after surgery. The supraspinatus activity at 3 months after surgery was the same level as that in healthy individuals. On the other hand, the deltoid activity decreased from 6 weeks to 6 months after surgery. The increase in activity of the supraspinatus relative to the deltoid was likely to be related to the increase in GH elevation during postoperative at 8 weeks.
尽管肩袖修复是为了恢复肩袖肌肉和盂肱（GH）关节运动的功能，但对于修复后的恢复过程知之甚少。本研究的目的是：（1）通过超声实时组织弹性成像（RTE）评估肩袖修复后冈上肌和三角肌的活动随时间的变化；（2）确定这些肌肉的活动对 GH 关节运动的贡献。
本研究纳入了 20 例肩袖修复患者和 13 例对照组参与者。在肩胛平面（外展）下，使用 RTE 在休息和肱骨胸提升 30°时测量冈上肌和中三角肌的弹性。用每个肌肉的休息时的弹性对 30°外展时的弹性进行归一化，以量化其肌肉活动。此外，还计算了归一化弹性的冈上肌与中三角肌（SSP/MD）比值。用数字测斜仪测量 GH 抬高角度，通过从 30°外展中减去肩胛骨上旋角度来计算。对于肩袖修复后的患者，所有测量均在术后 6 周、8 周、3 个月和 6 个月进行。术后 6 个月时通过磁共振成像检查肩袖完整性。
术后 6 个月时，15 例患者肩袖完整，完成了本研究。与 3 个月（P=.010）和 6 个月（P=.006）相比，6 周时冈上肌的活动明显较小。3 个月时患者的冈上肌活动与对照组参与者之间无显著差异（P=.586）。与 6 个月相比，6 周时三角肌的活动明显更大（P=.003）。术后 6 周（r=0.75，P=.001）和 8 周（r=0.53，P=.041）时，GH 抬高角度与冈上肌相对于三角肌的活动之间呈正相关。
术后 6 周至 3 个月，冈上肌活动增加。术后 3 个月时，冈上肌的活动与健康个体相同。另一方面，三角肌的活动从术后 6 周至 6 个月下降。冈上肌相对于三角肌的活动增加可能与术后 8 周时 GH 抬高的增加有关。
