改良版康复程序在镜下Latarjet手术后的应用效果

doi:10.3969/j.issn.1006-9771.2021.02.012

摘要/Abstract

摘要： 目的

探讨全关节镜下Latarjet手术后应用改良版康复程序治疗的临床效果。

方法

2017年7月至2019年3月，本中心共收治32例全关节镜下Latarjet手术治疗肩关节习惯性脱位的患者，随机分为对照组(n = 15)和实验组(n = 17)。对照组采用常规肩关节镜Bankart修复术后康复程序，实验组采用改良版关节镜下Latarjet术后康复程序。术后严格按照本科室制定的制动及康复方案进行治疗，分别于术前、术后3个月、术后6个月行疼痛视觉模拟评分(VAS)、患侧肩关节主动活动度(AROM)和肩关节功能评价。术后12个月评价患者满意度。

结果

32例患者均得到有效随访，所有患者均未出现再脱位。术后3个月时，实验组VAS、肩关节AROM和肩关节功能评分均优于对照组(|t| > 2.149, P < 0.05)；术后6个月，两组VAS和肩关节AROM无显著性差异(|t| < 1.481, P > 0.05)，实验组肩关节功能评分优于对照组(|t| > 2.300, P < 0.05)；术后12个月终末随访时，实验组恢复投掷运动的比例和患者满意度(t = -4.564, P < 0.001)高于对照组。

结论

与常规肩关节镜Bankart修复术后康复程序相比，全关节镜下Latarjet手术后应用本科室改良版术后康复程序安全有效，患者功能恢复更快，满意度高，早期临床效果好。

关键词: 肩关节习惯性脱位, 关节镜, Latarjet手术, 康复

Abstract: Objective

To assess the clinical outcomes of our modified postoperative rehabilitation program after total arthroscopic Latarjet procedure.

Methods

From July, 2017 to March, 2019, 32 patients suffered from habitual anterior shoulder dislocation were treated with arthroscopic Latarjet procedure in our medical center. They were randomly assigned to control group (n = 15) and experimental group (n = 17). The control group received conventional rehabilitation program after shoulder arthroscopic Bankart repair, while the experimental group received modified rehabilitation program after arthroscopic Latarjet procedure. After surgery, they followed our postoperative management and rehabilitation program, and finished every phase of follow-up. Before and three weeks and six weeks after surgery, they were accessed with Visual Analogue Score (VAS) for pain, active range of motion (AROM) and functional assessment. Twelve months after surgery, their satisfaction were compared.

Results

None of them was lost at one-year follow-up postoperatively. No recurrent dislocation occurred. Three months after surgery, the VAS, AROM and the scores of shoulder functional assessments were better in the experimental group than in the control group (|t| > 2.149, P < 0.05). Six months after surgery, no significant difference was found in VAS and AROM between two groups (|t| < 1.481, P > 0.05), and the scores of shoulder functional assessments were better in the experimental group than in the control group (|t| > 2.300, P < 0.05). Twelve months after surgery, the percentage of restored throwing ability and patients' satisfaction (t = -4.564, P < 0.001) were higher in the experimental group than in the control group.

Conclusion

Compared with the conventional rehabilitation program after shoulder arthroscopic Bankart repair, modified postoperative rehabilitation program for arthroscopic Latarjet procedure is safer and more effective, which could bring better functional outcomes and higher patients' satisfaction.

Key words: habitual anterior shoulder dislocation, arthroscopy, Latarjet procedure, rehabilitation

中图分类号:

R684

孙维,雷红,景玮祎,张振东,黄炎. 改良版康复程序在镜下Latarjet手术后的应用效果[J]. 《中国康复理论与实践》, 2021, 27(2): 191-196.

Wei SUN,Hong LEI,Wei-yi JING,Zhen-dong ZHANG,Yan HUANG. Effect of Modified Rehabilitation Program for Postoperative Management after Arthroscopic Latarjet Procedure[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 191-196.

图/表 2

表1

表2

参考文献 20

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组别	n	年龄(岁)	侧别(左/右，n)	脱位次数	初次脱位至手术时间(年)	初次/翻修(n)	手术用时(min)
对照组	15	26.7±5.6	6/9	32.4±51.2	3.7±3.2	12/3	107.4±47.3
实验组	17	24.8±4.7	8/9	27.8±33.9	3.3±2.8	13/4	118.8±47.0
χ²/F值		3.454	0.503	1.829	0.347	0.221	0.019
P值		0.300	0.699	0.850	0.695	0.817	0.502

项目	对照组(n = 15)	实验组(n = 17)	t值	P值
术前
AROM
前屈上举(o)	166.0±6.0	166.8±7.9	-0.305	0.763
外旋(o)	53.3±5.9	55.3±5.7	-0.955	0.347
内旋(节段)	9.7±1.0	9.6±1.2	0.359	0.722
外展90°外旋(o)	71.3±7.9	71.2±4.9	0.069	0.946
肩关节功能
Rowe	41.3±5.2	40.3±5.7	0.537	0.596
Walch-Duplay	30.3±4.4	30.6±3.9	-0.173	0.864
SSV(%)	64.0±5.1	63.5±6.8	0.220	0.828
术后3个月
VAS	2.9±1.0	2.1±0.9	2.658	0.012
AROM
前屈上举(o)	135.0±6.8	143.2±7.9	-3.137	0.004
外旋(o)	31.0±5.1	35.9±4.0	-3.027	0.005
内旋(节段)	4.3±0.8	5.4±0.9	-3.272	0.003
外展90°外旋(o)	39.3±8.2	47.6±7.5	-2.989	0.006
肩关节功能
Rowe评分	52.0±7.0	59.1±8.9	-2.491	0.018
Walch-Duplay评分	38.0±7.7	45.9±7.1	-2.999	0.005
SSV(%)	46.0±7.6	51.2±6.0	-2.149	0.040
术后6个月
VAS	1.3±0.8	0.9±0.7	1.418	0.166
AROM
前屈上举(o)	164.3±5.3^a	165.9±4.4^h	-0.902	0.374
外旋(o)	51.0±5.1^b	53.8±4.9ⁱ	-1.609	0.118
内旋(节段)	9.4±1.2^c	9.8±1.3^j	-0.826	0.416
外展90°外旋(o)	68.7±5.8^d	72.4±5.6^k	-1.821	0.079
肩关节功能
Rowe评分	73.3±11.6^e	83.2±12.6^l	-2.300	0.029
Walch-Duplay评分	72.0±10.0^f	82.4±7.5^m	-3.341	0.002
SSV(%)	71.3±7.7^g	80.0±4.7ⁿ	-3.912	< 0.001
术后12个月患者满意度	3.3±0.7	4.4±0.7	-4.564	< 0.001

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