Lang Angelica E, Card Annika, Barden John, Kim Soo Y
From the School of Rehabilitation Science, College of Medicine, University of Saskatchewan; Division of Plastic Surgery, Department of Surgery, Saskatchewan Health Authority; and Faculty of Kinesiology and Health Studies, University of Regina.
Plast Reconstr Surg. 2022 Oct 1;150(4):747e-756e. doi: 10.1097/PRS.0000000000009522. Epub 2022 Jul 22.
Breast reconstruction after curative breast cancer surgery is becoming increasingly common. There is evidence to suggest that these surgeries have negative effects on shoulder function, but to date there have been no investigations of shoulder biomechanics during functional tasks in this group. The purpose of this study was to define and compare upper limb motion of patients with breast cancer who underwent mastectomy only or mastectomy with reconstruction with a control group without cancer during a range of work-related functional tasks.
Ninety-five women participated: 25 controls, 25 patients with breast cancer who received a mastectomy only, and 45 patients with breast cancer who received a mastectomy with reconstruction (implant, latissimus dorsi flap, or deep inferior epigastric artery perforator flap). Motion of the torso, humeri, and scapulae were tracked during arm-focused functional tasks, involving reaching, dexterity, and lifting overhead, and joint angles were calculated. Mean, maximum, and minimum angles were calculated and compared among groups using one-way analyses of variance ( p < 0.05).
The reconstruction group had significantly different kinematics than the other two groups. Throughout task performance, patients who had reconstruction had increased scapular posterior tilt and increased humeral external rotation. These findings are consistent with reconstruction surgical procedures and may highlight muscle pattern alterations that interfere with co-contraction, stability, and functional task performance.
The findings suggest that breast reconstruction surgery influences functional task performance. Scapular and humeral kinematics may indicate movement pattern differences that are important to address in rehabilitation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
根治性乳腺癌手术后的乳房重建越来越普遍。有证据表明这些手术会对肩部功能产生负面影响，但迄今为止，尚未对该组患者在功能任务期间的肩部生物力学进行研究。本研究的目的是定义和比较仅接受乳房切除术或乳房切除术后重建的乳腺癌患者与无癌症的对照组在一系列与工作相关的功能任务中的上肢运动。
95名女性参与研究：25名对照组、25名仅接受乳房切除术的乳腺癌患者以及45名接受乳房切除术后重建（植入物、背阔肌皮瓣或腹壁下动脉穿支皮瓣）的乳腺癌患者。在专注于手臂的功能任务（包括伸手、灵活性和举过头顶）期间，跟踪躯干、肱骨和肩胛骨的运动，并计算关节角度。使用单因素方差分析计算并比较各组的平均、最大和最小角度（p < 0.05）。
重建组的运动学与其他两组有显著差异。在整个任务执行过程中，接受重建的患者肩胛骨后倾增加，肱骨外旋增加。这些发现与重建手术程序一致，可能突出了干扰协同收缩、稳定性和功能任务表现的肌肉模式改变。
研究结果表明乳房重建手术会影响功能任务表现。肩胛骨和肱骨的运动学可能表明运动模式差异，这在康复中很重要。
临床问题/证据水平：风险，II级。
