三角肌肌张力与肩袖损伤患者手术预后的相关性研究  

Correlation between deltoid muscle tone and postoperative prognosis of patients with rotator cuff tear

作　　者：鲍童 王锦溢 陈阳 许峰 李非 Bao Tong;Wang Jinyi;Chen Yang;Xu Feng;Li Fei(Department of Orthopaedics,the First Hospital of Tsinghua University,Beijing 100020,China;School of Medicine,Tsinghua University,Beijing 100089,China)

机构地区：[1]清华大学第一附属医院骨科,北京100020 [2]清华大学医学院,北京100089

出　　处：《中华骨科杂志》2025年第6期361-367,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨肩关节镜下肩袖修补术(arthroscopic rotator cuff repair,ARCR)前后三角肌肌张力的变化与肩关节疼痛及肩关节功能的相关性。方法回顾性分析2019年12月至2023年6月于清华大学第一附属医院接受ARCR手术治疗的55例肩袖损伤患者资料,男22例、女33例,年龄(60.44±9.54)岁(范围41~78岁),BMI(25.86±4.25)kg/m 2(范围18.82~42.32 kg/m 2),病程(5.94±7.27)个月(范围0.3~36.0个月)。均为单侧,左侧23例、右侧32例;肩袖撕裂大小(16.47±5.98)mm(范围6.92~36.38 mm)。术后均按计划进行康复锻炼,随访时间至少6个月。使用肌张力测试仪在术前和术后1、3、6个月对患者健侧、患侧三角肌肌张力进行测量,通过压力-位移曲线下面积(area under curve,AUC)反映肌张力大小,AUC值越大肌张力越小;同时评估记录患者的疼痛视觉模拟评分(visual analogue scale,VAS)与Constant-Murley肩关节功能评分。结果患者术后1、3、6个月VAS与术前相比均降低;Constant-Murley肩关节功能评分、患侧三角肌压力-位移AUC值与术前相比均升高(P<0.05)。手术前后健侧三角肌压力-位移AUC值均高于患侧(P<0.05)。年龄、性别、病程、BMI值与三角肌压力-位移AUC变化值均无相关性(P>0.05),肩袖撕裂大小与三角肌压力-位移AUC变化值呈正相关(r=0.369,P=0.006)。VAS变化值与三角肌压力-位移AUC变化值呈正相关(t=0.424,P<0.001),线性回归方程:VAS变化值=4.314+0.837×三角肌压力-位移AUC变化值;Constant-Murley评分变化值与三角肌压力-位移AUC变化值呈正相关(t=5.336,P<0.001),线性回归方程:Constant-Murley评分变化值=24.838+6.097×三角肌压力-位移AUC变化值。结论ARCR可降低患侧三角肌肌张力,减轻肩关节疼痛,改善肩关节功能,且三角肌肌张力变化与肩关节疼痛及功能变化呈正相关。ObjectiveTo explore whether changes in the deltoid muscle tone of the affected side before and after arthroscopic rotator cuff repair(ARCR)are correlated with shoulder joint pain and shoulder joint function.MethodsA total of 55 patients(22 males and 33 females,aged 60.44±9.54 years with a range of 41 to 78 years,BMI 25.86±4.25 kg/m 2 with a range of 18.82 to 42.32 kg/m 2,symptom duration 5.94±7.27 months with a range of 0.3 to 36.0 months)diagnosed with rotator cuff tear and underwent ARCR at the First Affiliated Hospital of Tsinghua University between December 2019 and June 2023 were included.All the patients suffered from unilateral symptom(23 left side and 32 right side),the size of rotator cuff tear was 16.47±5.98 mm(range,6.92-36.38 mm).Following the operation,postoperative rehabilitation exercises were arranged with a minimum follow-up duration of six months.The muscle tone of the deltoid was measured bilaterally using a muscle tone tester before the operation and at 1,3,6 months after operation.The area under curve(AUC)of the pressure-displacement curve was used to reflect the muscle tone,with larger AUC values represent less muscle tone.Visual analogue scale(VAS)and Constant-Murley score were evaluated and recorded at the same time points.ResultsAt 1,3,and 6 months postoperatively,the VAS scores were all significantly reduced compared to preoperative values,with the Constant-Murley scores and the AUC values of the pressure-displacement of the affected-side deltoid significantly increased(P<0.05).The postoperative AUC values of the pressure-displacement of the affected side deltoid muscle were significantly lower than those of the contralateral side(P<0.05).There was no significant correlation between the changes in deltoid muscle pressure-displacement AUC and age,gender,disease duration,or BMI(P>0.05),while a significant positive correlation was observed between the AUC and the size of the rotator cuff tear(r=0.369,P=0.006).There was a positive correlation between the change in VAS and the change in d

关 键 词：肩袖损伤 三角肌 肌张力 肩关节镜下肩袖修补术 预后因素 

分 类 号：R687.4[医药卫生—骨科学]