Damron T A, Rock M G, O'Connor M I, Johnson M E, An K N, Pritchard D J, Sim F H, Shives T C
Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
Ann Surg Oncol. 1997 Apr-May;4(3):237-46. doi: 10.1007/BF02306616.
Most functional analyses after limb salvage operations about the shoulder have focused on proximal function with the assumption that distal function is largely unaffected. This analysis examines distal function objectively.
Objective laboratory data regarding distal upper extremity strength after reconstructive procedures for tumors near the shoulder joint was collected over a 16-year period. Thirty-two patients were able to participate fully in the data collection at an average most recent follow-up duration of > 3.5 years.
Statistically significant reductions on the involved side compared with the uninvolved side in grip, forearm pronation, forearm supination, elbow flexion, and elbow extension strength were documented (p < 0.05). The magnitude of reduction in strength diminishes distally, with the greatest effect in this group of patients being observed in elbow extension, followed by elbow flexion, forearm supination, and forearm pronation. Grip strength consistently showed the least amount of strength reduction compared with the uninvolved side, even within resection and reconstruction groups. Subjective patient rating of dexterity was no less than 3 of 5. Ninety percent of patients rated their dexterity 4 of 5 (52%) or 5 of 5 (38%).
Despite the insistence of "normal" function in the distal upper extremity after limb salvage procedures, complete normality is not maintained. However, the degree of maintenance of distal function appears to be high, especially for grip strength and forearm pronation strength, and patient satisfaction is acceptable.
大多数肩部保肢手术后的功能分析都集中在近端功能上，假设远端功能基本不受影响。本分析客观地研究了远端功能。
在16年的时间里收集了关于肩关节附近肿瘤重建手术后上肢远端力量的客观实验室数据。32例患者能够在平均最近随访时间超过3.5年时充分参与数据收集。
记录到患侧与健侧相比，握力、前臂旋前、前臂旋后、肘屈曲和肘伸展力量有统计学意义的降低（p < 0.05）。力量降低的幅度向远端逐渐减小，在这组患者中，肘伸展力量降低的影响最大，其次是肘屈曲、前臂旋后和前臂旋前。与健侧相比，即使在切除和重建组中，握力始终显示出最小程度的力量降低。患者对灵活性的主观评分不低于5分中的3分。90%的患者将他们的灵活性评为5分中的4分（52%）或5分中的5分（38%）。
尽管保肢手术后上肢远端功能坚持“正常”，但并未保持完全正常。然而，远端功能的维持程度似乎较高，尤其是握力和前臂旋前力量，并且患者满意度可以接受。
