居家运动对肩袖损伤术后疼痛、功能和生活质量的效果

doi:10.3969/j.issn.1006-9771.2024.12.012

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (12): 1461-1472.doi: 10.3969/j.issn.1006-9771.2024.12.012

居家运动对肩袖损伤术后疼痛、功能和生活质量的效果

杨婷¹^,², 周敬杰¹^,²^,³, 王涛¹^,³, 朱伟伟¹^,²^,³, 褚凤明¹^,², 陈伟¹^,²^,³()

1.徐州医科大学徐州临床学院，江苏徐州市 221009
2.徐州医科大学附属徐州康复医院，江苏徐州市 221003
3.徐州市中心医院，江苏徐州市 221009

收稿日期:2024-08-08 修回日期:2024-11-01 出版日期:2024-12-25 发布日期:2024-12-30
通讯作者: 陈伟(1962-)，女，汉族，江苏徐州市人，硕士，主任医师，硕士研究生导师。E-mail： chenwei2339@163.com E-mail:chenwei2339@163.com
作者简介:杨婷(2000-)，女，汉族，江苏宿迁市人，硕士研究生，主要研究方向：骨关节康复。
基金资助:
1.徐州市科技计划医药卫生面上项目(KC23191);2.彭城英才-医学青年后备人才项目(XWRCHT20220007)

Effect of home exercise on pain, function and quality of life after operation for rotator cuff injury

YANG Ting¹^,², ZHOU Jingjie¹^,²^,³, WANG Tao¹^,³, ZHU Weiwei¹^,²^,³, CHU Fengming¹^,², CHEN Wei¹^,²^,³()

1. Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu 221009, China
2. Xuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu 221003, China
3. Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, China

Received:2024-08-08 Revised:2024-11-01 Published:2024-12-25 Online:2024-12-30
Contact: CHEN Wei E-mail:chenwei2339@163.com
Supported by:
Xuzhou Municipal Science and Technology Plan for Medical and Health (General)(KC23191);Pengcheng Talent: Young Medical Talent Program(XWRCHT20220007)

摘要/Abstract

摘要：

目的探讨居家运动对肩袖损伤术后患者疼痛、功能和生活质量的治疗效果。

方法 2023年6月至2024年6月，徐州医科大学附属徐州康复医院和徐州市中心医院康肩袖损伤术后患者45例，随机分为常规组、居家组和联合组，每组15例。常规组在医院接受常规康复训练8周，居家组接受居家运动处方训练8周，联合组先在院接受常规康复4周，后完成居家运动处方训练4周。治疗前、治疗4周、治疗8周，采用疼痛视觉模拟量表(VAS)、加州大学肩关节评分(UCLA)、Constant-Murley肩关节评分量表(CMS)、肩关节活动范围(ROM)和健康调查简表(SF-36)进行评定。

结果治疗4周和8周后，各组VAS评分较治疗前显著降低(Z > 2.964, P < 0.001)；治疗4周后，居家组VAS评分高于另外两组(|Z| > 2.531, P < 0.05)。UCLA、CMS、SF-36生理健康和心理健康评分时间效应均非常显著(F > 498.102, P < 0.001)，各组评分均较前一时期显著改善(P < 0.001)；SF-36心理健康评分组别效应显著(F = 7.408, P = 0.002)，治疗4周和8周后，居家组最高(P < 0.01)；SF-36生理健康评分交互效应显著(F = 10.138, P < 0.001)，治疗4周后，居家组最低(P < 0.05)。肩关节各方向ROM时间效应均非常显著(F > 672.601, P < 0.001)，各组均较前一时期显著改善(P < 0.001)；外展和外旋交互效应显著(F > 4.059, P < 0.01)，前屈交互效应接近显著(F = 2.412, P = 0.055)；前屈ROM，治疗4周后，居家组低于联合组(P = 0.047)，治疗8周后，居家组低于常规组(P = 0.042)；外展ROM，治疗4周后，居家组最低(P < 0.01)，治疗8周后，居家组低于联合组(P = 0.046)；外旋ROM，治疗4周后，居家组低于常规组(P = 0.022)。

结论居家康复可以改善肩袖损伤术后患者的疼痛、肩关节功能和生活质量，效果与机构康复各有所长，康复8周后总体差别不大。

关键词: 肩袖损伤, 居家康复, 疼痛, 生活质量

Abstract:

Objective To explore the effect of home exercise on pain, function and quality of life after operation for rotator cuff injury.

Methods From June, 2023 to June, 2024, 45 patients after operation for rotator cuff injury were selected from Xuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical University and Xuzhou Central Hospital, and randomly divided into conventional group (n = 15), home-based group (n = 15) and combined group (n = 15). The conventional group received an eight-week routine rehabilitation program in hospital, the home-based group received an eight-week home exercise prescription training, and the combined group first received four weeks of routine rehabilitation in hospital, and followed by four weeks of home exercise prescription training. They were assessed with Visual Analogue Scale for pain (VAS), University of California at Los Angeles shoulder rating scale (UCLA), Constant-Murley Score (CMS), range of motion (ROM) of shoulder, and the Short-form of Health Survey-36 (SF-36) before treatment, and four and eight weeks after treatment.

Results VAS scores decreased in all the three groups four and eight weeks after treatment (Z > 2.964, P< 0.001), which was the most in the home-based group four weeks after treatment (|Z| > 2.531, P< 0.05). The main effect of time was significant in scores of UCLA, CMS, and physical health and mental health of SF-36 (F > 498.102, P< 0.001), which improved after treatment (P< 0.001). The main effect of group was significant in score of mental health of SF-36 (F = 7.408, P= 0.002), which was the most in the home-based group four and eight weeks after treatment (P< 0.01). The interaction was significant in score of physical health of SF-36 (F = 10.138, P< 0.001), which was the least in the home-based group four weeks after treatment (P< 0.05). The main effect of time was significant in every direction of ROM, which improved after treatment (P< 0.001). The interaction was significant in ROM of abduction and external rotation (F > 4.059, P< 0.01), and almost significant in ROM of flexion (F = 2.412, P= 0.055). However, ROM of flexion was less in the home-based group than in the combined group four weeks after treatment (P= 0.047), which was less in the home-based group than in the conventional group eight weeks after treatment (P= 0.042); ROM of abduction was the least in the home-based group four weeks after treatment (P< 0.01), which was less in the home-based group than in the combined group eight weeks after treatment (P= 0.046); ROM of external rotation was less in the home-based group than in the combined group four weeks after treatment (P= 0.022).

Conclusion Home exercise is effective on pain, function and quality of life in patients after operation for rotator cuff injury. There are benefits with both home exercise and institution-based rehabilitation, and almost the same in a whole eight weeks after treatment.

Key words: rotator cuff injury, home rehabilitation, pain, quality of life

中图分类号:

R686

杨婷, 周敬杰, 王涛, 朱伟伟, 褚凤明, 陈伟. 居家运动对肩袖损伤术后疼痛、功能和生活质量的效果[J]. 《中国康复理论与实践》, 2024, 30(12): 1461-1472.

YANG Ting, ZHOU Jingjie, WANG Tao, ZHU Weiwei, CHU Fengming, CHEN Wei. Effect of home exercise on pain, function and quality of life after operation for rotator cuff injury[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(12): 1461-1472.

图/表 12

表1

表2

表3

表4

表5

表6

表7

表8

表9

肩关节ROM时间和组别效应事后LSD检验结果"

变量	组别/时间	组别/时间	组别/时间	平均值差	P值	95%CI
变量	组别/时间	组别/时间	组别/时间	平均值差	P值	下限	上限
前屈ROM	常规组	治疗前	治疗4周后	-29.600	< 0.001	-34.213	-24.987
		治疗前	治疗8周后	-57.667	< 0.001	-63.247	-52.087
		治疗4周后	治疗8周后	-28.067	< 0.001	-32.808	-23.325
	联合组	治疗前	治疗4周后	-29.533	< 0.001	-34.147	-24.920
		治疗前	治疗8周后	-50.400	< 0.001	-55.980	-44.820
		治疗4周后	治疗8周后	-20.867	< 0.001	-25.608	-16.125
	居家组	治疗前	治疗4周后	-24.067	< 0.001	-28.680	-19.453
		治疗前	治疗8周后	-49.133	< 0.001	-54.713	-43.553
		治疗4周后	治疗8周后	-25.067	< 0.001	-29.808	-20.325
	治疗前	常规组	联合组	-3.000	0.683	-17.727	11.727
		常规组	居家组	4.333	0.556	-10.393	19.060
		联合组	居家组	7.333	0.321	-7.393	22.060
	治疗4周后	常规组	联合组	-2.933	0.642	-15.575	9.709
		常规组	居家组	9.867	0.123	-2.775	22.509
		联合组	居家组	12.800	0.047	0.158	25.442
	治疗8周后	常规组	联合组	4.267	0.491	-8.139	16.672
		常规组	居家组	12.867	0.042	0.461	25.272
		联合组	居家组	8.600	0.169	-3.805	21.005
外展ROM	常规组	治疗前	治疗4周后	-30.467	< 0.001	-34.176	-26.757
		治疗前	治疗8周后	-55.267	< 0.001	-60.846	-49.687
		治疗4周后	治疗8周后	-24.800	< 0.001	-29.072	-20.528
	联合组	治疗前	治疗4周后	-26.867	< 0.001	-30.576	-23.157
		治疗前	治疗8周后	-51.533	< 0.001	-57.113	-45.954
		治疗4周后	治疗8周后	-24.667	< 0.001	-28.939	-20.394
	居家组	治疗前	治疗4周后	-18.067	< 0.001	-21.776	-14.357
		治疗前	治疗8周后	-47.933	< 0.001	-53.513	-42.354
		治疗4周后	治疗8周后	-29.867	< 0.001	-34.139	-25.594
	治疗前	常规组	联合组	-4.133	0.409	-14.132	5.865
		常规组	居家组	2.000	0.689	-7.999	11.999
		联合组	居家组	6.133	0.223	-3.865	16.132
	治疗4周后	常规组	联合组	-0.533	0.906	-9.624	8.557
		常规组	居家组	14.400	0.003	5.310	23.490
		联合组	居家组	14.933	0.002	5.843	24.024
	治疗8周后	常规组	联合组	-0.400	0.933	-9.931	9.131
		常规组	居家组	9.333	0.055	-0.198	18.865
		联合组	居家组	9.733	0.046	0.202	19.265
外旋ROM	常规组	治疗前	治疗4周后	-13.933	< 0.001	-16.673	-11.194
		治疗前	治疗8周后	-32.733	< 0.001	-35.825	-29.641
		治疗4周后	治疗8周后	-18.800	< 0.001	-21.087	-16.513
	联合组	治疗前	治疗4周后	-7.467	< 0.001	-10.206	-4.727
		治疗前	治疗8周后	-25.933	< 0.001	-29.025	-22.841
		治疗4周后	治疗8周后	-18.467	< 0.001	-20.754	-16.180
	居家组	治疗前	治疗4周后	-6.800	< 0.001	-9.540	-4.060
		治疗前	治疗8周后	-26.733	< 0.001	-29.825	-23.641
		治疗4周后	治疗8周后	-19.933	< 0.001	-22.220	-17.646
	治疗前	常规组	联合组	-4.000	0.124	-9.136	1.136
		常规组	居家组	-1.867	0.467	-7.003	3.269
		联合组	居家组	2.133	0.407	-3.003	7.269
	治疗4周后	常规组	联合组	2.467	0.271	-2.001	6.934
		常规组	居家组	5.267	0.022	0.799	9.734
		联合组	居家组	2.800	0.213	-1.667	7.267
	治疗8周后	常规组	联合组	2.800	0.181	-1.357	6.957
		常规组	居家组	4.133	0.051	-0.023	8.290
		联合组	居家组	1.333	0.521	-2.823	5.490

表9

表10

表11

表12

治疗前后SF-36评分组别效应事后LSD检验结果"

变量	组别/时间	组别/时间	组别/时间	平均值差	P值	95%CI
变量	组别/时间	组别/时间	组别/时间	平均值差	P值	下限	上限
生理健康	常规组	治疗前	治疗4周后	-18.083	< 0.001	-20.561	-15.606
		治疗前	治疗8周后	-23.833	< 0.001	-26.701	-20.966
		治疗4周后	治疗8周后	-5.750	< 0.001	-7.609	-3.891
	联合组	治疗前	治疗4周后	-18.667	< 0.001	-21.144	-16.189
		治疗前	治疗8周后	-25.500	< 0.001	-28.367	-22.633
		治疗4周后	治疗8周后	-6.833	< 0.001	-8.693	-4.974
	居家组	治疗前	治疗4周后	-9.083	< 0.001	-11.561	-6.606
		治疗前	治疗8周后	-20.417	< 0.001	-23.284	-17.549
		治疗4周后	治疗8周后	-11.333	< 0.001	-13.193	-9.474
	治疗前	常规组	联合组	0.833	0.769	-4.867	6.533
		常规组	居家组	-2.833	0.322	-8.533	2.867
		联合组	居家组	-3.667	0.201	-9.367	2.033
	治疗4周后	常规组	联合组	0.250	0.915	-4.471	4.971
		常规组	居家组	6.167	0.012	1.446	10.887
		联合组	居家组	5.917	0.015	1.196	10.637
	治疗8周后	常规组	联合组	-0.833	0.648	-4.493	2.827
		常规组	居家组	0.583	0.749	-3.077	4.243
		联合组	居家组	1.417	0.439	-2.243	5.077
心理健康	常规组	治疗前	治疗4周后	-11.404	< 0.001	-13.442	-9.365
		治疗前	治疗8周后	-20.811	< 0.001	-23.749	-17.873
		治疗4周后	治疗8周后	-9.407	< 0.001	-11.657	-7.158
	联合组	治疗前	治疗4周后	-10.611	< 0.001	-12.650	-8.573
		治疗前	治疗8周后	-20.581	< 0.001	-23.519	-17.644
		治疗4周后	治疗8周后	-9.970	< 0.001	-12.219	-7.721
	居家组	治疗前	治疗4周后	-14.381	< 0.001	-16.420	-12.343
		治疗前	治疗8周后	-24.556	< 0.001	-27.493	-21.618
		治疗4周后	治疗8周后	-10.174	< 0.001	-12.423	-7.925
	治疗前	常规组	联合组	2.500	0.333	-2.656	7.656
		常规组	居家组	-2.602	0.314	-7.758	2.555
		联合组	居家组	-5.102	0.052	-10.258	0.055
	治疗4周后	常规组	联合组	3.293	0.085	-0.470	7.055
		常规组	居家组	-5.580	0.005	-9.342	-1.817
		联合组	居家组	-8.872	< 0.001	-12.635	-5.110
	治疗8周后	常规组	联合组	2.730	0.235	-1.846	7.305
		常规组	居家组	-6.346	0.008	-10.922	-1.771
		联合组	居家组	-9.076	< 0.001	-13.652	-4.500

表12

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组别	n	性别(男/女)/n	年龄/岁	病程/d	优势侧损伤(是/否)/n
常规组	15	6/9	55.60±5.47	41.20±6.14	9/6
联合组	15	7/8	54.13±6.13	43.27±6.62	11/4
居家组	15	4/11	49.60±11.96	38.53±4.98	9/6
χ²/F值		1.324	2.092	2.382	0.776
P值		0.516	0.136	0.105	0.687

组别	n	时间	M(Q_L,Q_U)	Z值	P值
常规组	15	治疗前	5.00(3.00, 5.00)	3.305	< 0.001
		治疗4周后	3.00(2.00, 3.00)
		治疗8周后	2.00(1.00, 2.00)
联合组	15	治疗前	4.00(3.00, 4.00)	3.073	< 0.001
		治疗4周后	3.00(2.00, 3.00)
		治疗8周后	2.00(1.00, 2.00)
居家组	15	治疗前	4.00(4.00, 5.00)	2.964	< 0.001
		治疗4周后	4.00(3.00, 4.00)
		治疗8周后	2.00(2.00, 2.00)
治疗前常规组和联合组差值			0.00(-1.00, 2.00)	-1.494	0.135
治疗前常规组和居家组差值			0.00(-1.00, 1.00)	-0.155	0.877
治疗前联合组和居家组差值			-1.00(-1.00, 0.00)	-1.434	0.152
治疗4周后常规组和联合组差值			0.00(-1.00, 1.00)	-0.159	0.873
治疗4周后常规组和居家组差值			-1.00(-2.00, 0.00)	-2.883	0.004
治疗4周后联合组和居家组差值			-1.00(-2.00, -1.00)	-2.531	0.011
治疗8周后常规组和联合组差值			0.00(-2.00, 1.00)	-0.939	0.347
治疗8周后常规组和居家组差值			0.00(-1.00, 1.00)	-1.392	0.164
治疗8周后联合组和居家组差值			0.00(-1.00, 1.00)	-0.277	0.782

变量	效应	平方和	自由度	均方	F值	P值
UCLA	时间	4364.281	2	2182.141	830.831	< 0.001
	组别	36.104	2	18.052	1.056	0.357
	时间×组别	14.430	4	3.607	1.373	0.250
CMS	时间	18449.837	2	9224.919	856.593	< 0.001
	组别	110.237	2	55.119	0.593	0.557
	时间×组别	120.207	4	30.052	2.791	0.031

变量	组别	n	治疗前	治疗4周后	治疗8周后
前屈ROM	常规组	15	83.60±18.66	113.20±14.50	141.27±17.06
	联合组	15	86.60±15.72	116.13±13.12	137.00±13.55
	居家组	15	79.27±24.56	103.33±22.38	128.40±19.38
外展ROM	常规组	15	73.33±13.73	103.80±11.88	128.60±11.49
	联合组	15	77.47±14.40	104.33±12.51	129.00±12.83
	居家组	15	71.33±12.51	89.40±12.60	119.27±14.33
外旋ROM	常规组	15	21.80±6.11	35.73±5.42	54.53±6.27
	联合组	15	25.80±8.33	33.27±7.21	51.73±5.44
	居家组	15	23.67±6.24	30.47±5.38	50.40±5.15

变量	效应	平方和	自由度	均方	F值	P值
前屈ROM	时间	61850.133	2	30925.067	672.601	< 0.001
	组别	2601.644	2	1300.822	1.470	0.242
	时间×组别	443.689	4	110.922	2.412	0.055
外展ROM	时间	59868.904	2	29934.452	772.307	< 0.001
	组别	2727.526	2	1363.763	3.201	0.051
	时间×组别	629.274	4	157.319	4.059	0.005
外旋ROM	时间	18933.733	2	9466.867	691.707	< 0.001
	组别	162.711	2	81.356	0.906	0.412
	时间×组别	299.289	4	74.822	5.467	0.001

居家运动对肩袖损伤术后疼痛、功能和生活质量的效果

Effect of home exercise on pain, function and quality of life after operation for rotator cuff injury

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变量	组别	n	治疗前	治疗4周后	治疗8周后
UCLA	常规组	15	12.53±2.13	22.07±2.76	27.27±1.98
	联合组	15	13.80±2.83	22.80±3.30	27.20±2.88
	居家组	15	12.73±2.76	21.67±3.15	25.60±2.47
CMS	常规组	15	46.47±4.70	62.47±4.67	78.07±4.70
	联合组	15	48.93±6.98	61.00±8.54	75.40±6.95
	居家组	15	46.73±6.47	59.33±7.08	74.53±3.96

变量	组别	n	治疗前	治疗4周后	治疗8周后
生理健康	常规组	15	50.33±5.68	68.42±5.44	74.17±5.54
	联合组	15	49.50±9.35	68.17±7.54	75.00±5.47
	居家组	15	53.17±7.73	62.25±6.05	73.58±3.66
心理健康	常规组	15	49.76±6.82	61.16±5.83	70.57±5.60
	联合组	15	47.26±8.25	57.87±5.61	67.84±7.63
	居家组	15	52.36±5.68	66.74±3.58	76.91±5.11

变量	效应	平方和	自由度	均方	F值	P值
生理健康	时间	12562.940	2	6281.470	574.393	< 0.001
	组别	48.079	2	24.039	0.232	0.794
	时间×组别	443.449	4	110.862	10.138	< 0.001
心理健康	时间	10911.934	2	5455.967	498.102	< 0.001
	组别	1358.312	2	679.156	7.408	0.002
	时间×组别	90.874	4	22.718	2.074	0.091

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