关节镜下肩袖修复术后康复治疗的研究进展
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摘要
肩袖损伤是导致肩部疼痛和活动障碍的常见原因。关节镜下肩袖修复术可有效减轻疼痛,改善患肢活动及功能,然而肩袖修复术的手术效果与术后康复治疗密切相关。科学有效康复治疗的缺失往往会显著降低手术疗效,越来越多的学者认为应将康复环节介入到临床治疗体系之中,做到康复锻炼与临床治疗同步,并贯穿于医疗的全过程。因此,术后采取康复治疗加速肩袖修复重建对提高手术效果至关重要。但目前术后的康复方案尚未达成共识,本文通过回顾文献,以肩袖的解剖及生物力学为基础,在术后制动、被动运动、主动运动及其他康复治疗等方面对关节镜下肩袖修复术后的康复治疗进行综述,从而为肩袖修复术后制定科学、有效的康复锻炼方案提供依据。
Rotator cuff injury cause shoulder pain and movement disorders. It is a frequent occurrence of shoulder joints. Arthroscopic rotator cuff repair can effectively alleviate pain, improve limb movement and function. However, the surgical effect of rotator cuff repair is closely related to early postoperative rehabilitation, the lack of scientific and effective rehabilitation treatment often leads to a significant reduction in the surgical effect. More and more scholars believe that rehabilitation should be intervened in clinical treatment. So it is very important to accelerate the rotator cuff repair and reconstruction by rehabilitation therapy after surgery to improve the surgical effect. At present, there is no consensus on the rehabilitation program after surgery. This article reviews the literature on the rehabilitation after arthroscopic rotator cuff repair, mainly in the aspects of anatomy and biomechanics, postoperative braking, passive movement, active movement and other rehabilitation treatment, so as to provide a basis for formulating a scientific and effective rehabilitation program after rotator cuff repair.
Rotator cuff injury cause shoulder pain and movement disorders. It is a frequent occurrence of shoulder joints. Arthroscopic rotator cuff repair can effectively alleviate pain, improve limb movement and function. However, the surgical effect of rotator cuff repair is closely related to early postoperative rehabilitation, the lack of scientific and effective rehabilitation treatment often leads to a significant reduction in the surgical effect. More and more scholars believe that rehabilitation should be intervened in clinical treatment. So it is very important to accelerate the rotator cuff repair and reconstruction by rehabilitation therapy after surgery to improve the surgical effect. At present, there is no consensus on the rehabilitation program after surgery. This article reviews the literature on the rehabilitation after arthroscopic rotator cuff repair, mainly in the aspects of anatomy and biomechanics, postoperative braking, passive movement, active movement and other rehabilitation treatment, so as to provide a basis for formulating a scientific and effective rehabilitation program after rotator cuff repair.
引文
1 Barnes LA,Kim HM,Caldwell JM,et al.Satisfaction,function and repair integrity after arthroscopic versus mini-open rotator cuff repair[J].Bone Joint,2017,99B(2):245-249.
2 Yoshida M,Collin P,Josseaume T,et al.Post-operative rotator cuff integrity,based on Sugaya's classification,can reflect abduction muscle strength of the shoulder[J].Knee Surg Sports Traumatol Arthrosc,2018,26(1):161-168.
3 Yamamoto A,Takagishi K,Osawa TA,et al.Prevalence and risk factors of a rotator cuff tear in the general population[J].J Shoulder Elbow Surg,2010,19(1):116-120.
4 Briggs L,Murrell GA.Diagnostic ultrasound:examination of the shoulder[J].Tech Shoulder Elb Surg,2011,12(4):101-107.
5 Yoon JP,Jung JW,Lee CH,et al.Fatty degeneration of the rotator cuff reflects shoulder strength deficits in patients with rotator cuff tears[J].Orthopedics,2018,41(1):E15-E21.
6 Huberty DP,Schoolfield JD,Brady PC,et al.Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair[J].Arthroscopy,2009,25(8):880-890.
7 Brislin KJ,Field LD,Savoie FH 3rd.Complications after arthroscopic rotator cuff repair[J].Arthroscopy,2007,23(2):124-128.
8 Kurz AZ,Kelly MJ,Hackett L,et al.Effect of surgeon monographer interaction on ultrasound diagnosis of rotator cuff tears:a five-year cohort study in 775 shoulders[J].J Shoulder Elbow Surg,2016,25(9):1385-1394.
9 Stackhouse SK,Eisennagel A,Eisennagel JA,et al.Experimental pain inhibits infraspinatus activation during isometric external rotation[J].J Shoulder Elbow Surg,2013,22(4):478-484.
10 Codman LV,Rodeo SA.Growth factors for rotator cuff repair[J].Clin Sports Med,2009,28(1):13-23.
11 Sonnabend DH,Howlett CR,Young AA.Histological evaluation of repair of the rotator cuff in a Primate model[J].J Bone Joint Surg Br,2010,92(4):586-594.
12 Golding W,Mcmullen J.Scapular dyskinesis and its relation to shoulder pain[J].Am Acad Orthop Surg,2018,11(2):142-151.
13 Machida PW,Michener L,Sennett B,et al.Direct 3-Dimential measurement of scapular kinematics during dynamic movements in vivo[J].Shoulder Elb Surg,2001,3(3):269-277.
14 Le BT,Wu XL,Lam PH,et al.Factors predicting rotator cuff retears an analysis of 1000 consecutive rotator cuff repairs[J].Am J Sports Med,2014,42(5):1134-1142.
15 Zhang SR,Li H,Tao HY,et al.Delayed early passive motion is harmless to shoulder rotator cuff healing in a rabbit model[J].Am JSports Med,2013,41(8):1885-1892.
16 Uezono K,Ide J,Tokunaga T,et al.Effect of postoperative passive motion on rotator cuff Reconstruction with acellular dermal matrix grafts in a rat model[J].Am J Sports Med,2014,42(8):1930-1938.
17 Cuff DJ,Pupello DR.Prospective and randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol[J].J Shoulder Elbow Surg,2011,21(4):1450-1455.
18 Lee BG,Cho NS,Rhee YG.Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repairs:Aggressive versus limited early passive exercises[J].Arthroscopy,2012,28(1):39-42.
19 Arndt J,Clavert P,Mielcarek P,et al.Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair:a prospective randomized study[J].Orthop Traumatol Surg Res,2012,98(6 Suppl):S131-S138.
20 Düzgün I,Baltac?G,Atay OA.Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair:pain and functional activity[J].Acta Orthop Traumatol Turc,2011,45(1):23-33.
21 Chen Y,Itoi E,Pradhan RL,et al.Effect of arm elevation and rotation on the strain in the repaired rotator cuff tendon.A academic study[J].Sports Med,2011,29(1):780-794.
22 Littlewood JC,Szomor Z,Murrell GA.Examination of the shoulder[J].Tech Shoulder Elb Surg,2011,12(4):116-125.
23 Li S,Min SX,Zhang H,et al.Effect of continuous passive motion on basic fibroblast growth factor expression during tendon-bone repair after surgical repair of acute rupture of the supraspinatus tendon in rabbits[J].South Med Univ,2010,30(7):1020-1023.
24 Peltz CD,Dourte LM,Kuntz AF,et al.The effect of postoperative passive motion on rotator cuff healing in a rat model[J].J Bone Joint Surg Am,2009,91A(10):2421-2429.
25 Gimbel JA,Kleunen JP,Williams GR,et al.Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site[J].Biomech Eng1,2007,29(4):400-404.
26 Xu YH,Bonar F,Murrell GA.Neoinnervation in rotator cuff tendinopathy[J].Sports Med Arthrosc,2011,19(4):354-359.
27 Kluczynski DY,Walton JR,Lam P,et al.The relationship between intraoperative tear dimensions and postoperative pain in 1624 consecutive arthroscopic rotator cuff repairs[J].Sports Med,2017,45(4):788-793.
28 Saul KR,Hayon S,Smith TL,et al.Postural dependence of passive tension in the supraspinatus following rotator cuff repair:A simulation analysis[J].Clin Biomech,2011,26(8):804-810.
29 Jackson M,Sylvestre E,Bleau J,et al.Estimating optimal shoulder immobilization postures following surgical repair of massive rotator cuff tears[J].J Biomech,2013,46(1):179-182.
30 Hatakeyama Y,Itoi E,Pradhan RL,et al.Effect of arm elevation and rotation on the strain in the repaired rotator cuff tendon[J].Am JSports Med,2001,29(6):788-794.
31 Du Plessis M,Eksteen E,Jenneker A,et al.The effectiveness of continuous passive motion on range of motion,pain and muscle strength following rotator cuff repair:a systematic review[J].Clin Rehabil,2011,25(6):291-302.
32 Gallagher BP,Bishop ME,Tjoumakaris FP.Early versus delayed rehabilitation following arthroscopic rotator cuff repair:A systematic review[J].Phys Sportsmed,2015,43(2):178-187.
33 Kim YS,Chung SW,Kim JY,et al.Is early passive motion exercise necessary after arthroscopic rotator cuff repair?[J].Am J Sports Med,2012,40(4):815-821.
34 Raab MG,Rzeszutko D,Connor W,et al.Early results of continuous passive motion after rotator cuff repair:a prospective,randomized,blinded,controlled study[J].Am J Orthop(Belle Mead NJ),1999,25(4):214-220.
35 Garofalo R,Conti M,Notarnicola A,et al.Effects of one-month continuous passive motion after arthroscopic rotator cuff repair:results at 1-year follow-up of a prospective randomized study[J].Musculoskelet Surg,2010,94(4):79-83.
36 Hayes YS,Chung SW,Jy K,et al.Is early passive motion exercise necessary after arthroscopic rotator cuff repair[J].Sport Med,2012,40(4):815-821.
37 Marc BG,Cho NS,Rhee YG.Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair:aggressive versus limited early passive exercises[J].Arthroscopy,2012,28(9):34-42.
38 Lombardi I,Baltaci G,Atay O.Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair:pain and functional activity[J].Acta Orthop Traumatol Turc,2011,45(5):23-33.
39 Thomopoulos M,Patrick L,George AC,et al.Repair integrity in patients returning for an unscheduled visit after arthroscopic rotator cuff repair[J].Sports Med,2018,7(5):4-6.
40 Speer D,Briss PA,Eccles M,et al.Grading quality of evidence and strength of recommendation[J].Arthroscopy,2004,328(3):1490-1491.
41 Mazuquin BF,Wright AC,Russell SA,et al.Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery:an overview of systematic reviews[J].Br JSports Med,2018,52(2):111-121.
42 Van OA,Westgard P,Chandler Z,et al.Rehabilitation after arthroscopic rotator cuff repair:current concepts review and evidence based guidelines[J].Sports Phys,2012,7(6):197-208.
43 Mazzocca AD,Mccarthy MB,Chowaniec D,et al.Bone Marrow-Derived mesenchymal stem cells obtained during arthroscopic rotator cuff repair surgery show potential for tendon cell differentiation after treatment with insulin[J].Arthroscopy-the Journal of Arthroscopic and Related Surgery,2011,27(11):1459-1471.
44蔡凯.温针灸肩三针治疗肩袖修补术患者的临床观察[J].光明中医,2017(23):3443-3444.
2 Yoshida M,Collin P,Josseaume T,et al.Post-operative rotator cuff integrity,based on Sugaya's classification,can reflect abduction muscle strength of the shoulder[J].Knee Surg Sports Traumatol Arthrosc,2018,26(1):161-168.
3 Yamamoto A,Takagishi K,Osawa TA,et al.Prevalence and risk factors of a rotator cuff tear in the general population[J].J Shoulder Elbow Surg,2010,19(1):116-120.
4 Briggs L,Murrell GA.Diagnostic ultrasound:examination of the shoulder[J].Tech Shoulder Elb Surg,2011,12(4):101-107.
5 Yoon JP,Jung JW,Lee CH,et al.Fatty degeneration of the rotator cuff reflects shoulder strength deficits in patients with rotator cuff tears[J].Orthopedics,2018,41(1):E15-E21.
6 Huberty DP,Schoolfield JD,Brady PC,et al.Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair[J].Arthroscopy,2009,25(8):880-890.
7 Brislin KJ,Field LD,Savoie FH 3rd.Complications after arthroscopic rotator cuff repair[J].Arthroscopy,2007,23(2):124-128.
8 Kurz AZ,Kelly MJ,Hackett L,et al.Effect of surgeon monographer interaction on ultrasound diagnosis of rotator cuff tears:a five-year cohort study in 775 shoulders[J].J Shoulder Elbow Surg,2016,25(9):1385-1394.
9 Stackhouse SK,Eisennagel A,Eisennagel JA,et al.Experimental pain inhibits infraspinatus activation during isometric external rotation[J].J Shoulder Elbow Surg,2013,22(4):478-484.
10 Codman LV,Rodeo SA.Growth factors for rotator cuff repair[J].Clin Sports Med,2009,28(1):13-23.
11 Sonnabend DH,Howlett CR,Young AA.Histological evaluation of repair of the rotator cuff in a Primate model[J].J Bone Joint Surg Br,2010,92(4):586-594.
12 Golding W,Mcmullen J.Scapular dyskinesis and its relation to shoulder pain[J].Am Acad Orthop Surg,2018,11(2):142-151.
13 Machida PW,Michener L,Sennett B,et al.Direct 3-Dimential measurement of scapular kinematics during dynamic movements in vivo[J].Shoulder Elb Surg,2001,3(3):269-277.
14 Le BT,Wu XL,Lam PH,et al.Factors predicting rotator cuff retears an analysis of 1000 consecutive rotator cuff repairs[J].Am J Sports Med,2014,42(5):1134-1142.
15 Zhang SR,Li H,Tao HY,et al.Delayed early passive motion is harmless to shoulder rotator cuff healing in a rabbit model[J].Am JSports Med,2013,41(8):1885-1892.
16 Uezono K,Ide J,Tokunaga T,et al.Effect of postoperative passive motion on rotator cuff Reconstruction with acellular dermal matrix grafts in a rat model[J].Am J Sports Med,2014,42(8):1930-1938.
17 Cuff DJ,Pupello DR.Prospective and randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol[J].J Shoulder Elbow Surg,2011,21(4):1450-1455.
18 Lee BG,Cho NS,Rhee YG.Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repairs:Aggressive versus limited early passive exercises[J].Arthroscopy,2012,28(1):39-42.
19 Arndt J,Clavert P,Mielcarek P,et al.Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair:a prospective randomized study[J].Orthop Traumatol Surg Res,2012,98(6 Suppl):S131-S138.
20 Düzgün I,Baltac?G,Atay OA.Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair:pain and functional activity[J].Acta Orthop Traumatol Turc,2011,45(1):23-33.
21 Chen Y,Itoi E,Pradhan RL,et al.Effect of arm elevation and rotation on the strain in the repaired rotator cuff tendon.A academic study[J].Sports Med,2011,29(1):780-794.
22 Littlewood JC,Szomor Z,Murrell GA.Examination of the shoulder[J].Tech Shoulder Elb Surg,2011,12(4):116-125.
23 Li S,Min SX,Zhang H,et al.Effect of continuous passive motion on basic fibroblast growth factor expression during tendon-bone repair after surgical repair of acute rupture of the supraspinatus tendon in rabbits[J].South Med Univ,2010,30(7):1020-1023.
24 Peltz CD,Dourte LM,Kuntz AF,et al.The effect of postoperative passive motion on rotator cuff healing in a rat model[J].J Bone Joint Surg Am,2009,91A(10):2421-2429.
25 Gimbel JA,Kleunen JP,Williams GR,et al.Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site[J].Biomech Eng1,2007,29(4):400-404.
26 Xu YH,Bonar F,Murrell GA.Neoinnervation in rotator cuff tendinopathy[J].Sports Med Arthrosc,2011,19(4):354-359.
27 Kluczynski DY,Walton JR,Lam P,et al.The relationship between intraoperative tear dimensions and postoperative pain in 1624 consecutive arthroscopic rotator cuff repairs[J].Sports Med,2017,45(4):788-793.
28 Saul KR,Hayon S,Smith TL,et al.Postural dependence of passive tension in the supraspinatus following rotator cuff repair:A simulation analysis[J].Clin Biomech,2011,26(8):804-810.
29 Jackson M,Sylvestre E,Bleau J,et al.Estimating optimal shoulder immobilization postures following surgical repair of massive rotator cuff tears[J].J Biomech,2013,46(1):179-182.
30 Hatakeyama Y,Itoi E,Pradhan RL,et al.Effect of arm elevation and rotation on the strain in the repaired rotator cuff tendon[J].Am JSports Med,2001,29(6):788-794.
31 Du Plessis M,Eksteen E,Jenneker A,et al.The effectiveness of continuous passive motion on range of motion,pain and muscle strength following rotator cuff repair:a systematic review[J].Clin Rehabil,2011,25(6):291-302.
32 Gallagher BP,Bishop ME,Tjoumakaris FP.Early versus delayed rehabilitation following arthroscopic rotator cuff repair:A systematic review[J].Phys Sportsmed,2015,43(2):178-187.
33 Kim YS,Chung SW,Kim JY,et al.Is early passive motion exercise necessary after arthroscopic rotator cuff repair?[J].Am J Sports Med,2012,40(4):815-821.
34 Raab MG,Rzeszutko D,Connor W,et al.Early results of continuous passive motion after rotator cuff repair:a prospective,randomized,blinded,controlled study[J].Am J Orthop(Belle Mead NJ),1999,25(4):214-220.
35 Garofalo R,Conti M,Notarnicola A,et al.Effects of one-month continuous passive motion after arthroscopic rotator cuff repair:results at 1-year follow-up of a prospective randomized study[J].Musculoskelet Surg,2010,94(4):79-83.
36 Hayes YS,Chung SW,Jy K,et al.Is early passive motion exercise necessary after arthroscopic rotator cuff repair[J].Sport Med,2012,40(4):815-821.
37 Marc BG,Cho NS,Rhee YG.Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair:aggressive versus limited early passive exercises[J].Arthroscopy,2012,28(9):34-42.
38 Lombardi I,Baltaci G,Atay O.Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair:pain and functional activity[J].Acta Orthop Traumatol Turc,2011,45(5):23-33.
39 Thomopoulos M,Patrick L,George AC,et al.Repair integrity in patients returning for an unscheduled visit after arthroscopic rotator cuff repair[J].Sports Med,2018,7(5):4-6.
40 Speer D,Briss PA,Eccles M,et al.Grading quality of evidence and strength of recommendation[J].Arthroscopy,2004,328(3):1490-1491.
41 Mazuquin BF,Wright AC,Russell SA,et al.Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery:an overview of systematic reviews[J].Br JSports Med,2018,52(2):111-121.
42 Van OA,Westgard P,Chandler Z,et al.Rehabilitation after arthroscopic rotator cuff repair:current concepts review and evidence based guidelines[J].Sports Phys,2012,7(6):197-208.
43 Mazzocca AD,Mccarthy MB,Chowaniec D,et al.Bone Marrow-Derived mesenchymal stem cells obtained during arthroscopic rotator cuff repair surgery show potential for tendon cell differentiation after treatment with insulin[J].Arthroscopy-the Journal of Arthroscopic and Related Surgery,2011,27(11):1459-1471.
44蔡凯.温针灸肩三针治疗肩袖修补术患者的临床观察[J].光明中医,2017(23):3443-3444.