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中华肩肘外科电子杂志 ›› 2021, Vol. 09 ›› Issue (04) : 360 -364. doi: 10.3877/cma.j.issn.2095-5790.2021.04.013

论著

ERAS理念早期康复的医护患新模式在肩袖损伤关节镜术后的临床效果研究
王洋1, 刘俐惠2,(), 刘伟1, 田红梅2, 毛永鹏1, 李旭阳1, 曹冉1, 王振威1, 艾笛1, 张腾1, 毛子木1, 姜双鹏1   
  1. 1. 100038 首都医科大学附属北京世纪坛医院关节外科
    2. 100038 首都医科大学附属北京世纪坛医院护理部
  • 收稿日期:2021-08-21 出版日期:2021-11-05
  • 通信作者: 刘俐惠
  • 基金资助:
    北京市自然科学基金—海淀原始创新联合基金(L202052)

Clinical effect of a new mode of early rehabilitation with ERAS concept on rotator cuff injury after arthroscopy

Yang Wang1, Lihui Liu2,(), Wei Liu1, Hongmei Tian2, Yongpeng Mao1, Xuyang Li1, Ran Cao1, Zhenwei Wang1, Di Ai1, Teng Zhang1, Zimu Mao1, Shuangpeng Jiang1   

  1. 1. Department of Joint Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
    2. Department of Nursing, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2021-08-21 Published:2021-11-05
  • Corresponding author: Lihui Liu
引用本文:

王洋, 刘俐惠, 刘伟, 田红梅, 毛永鹏, 李旭阳, 曹冉, 王振威, 艾笛, 张腾, 毛子木, 姜双鹏. ERAS理念早期康复的医护患新模式在肩袖损伤关节镜术后的临床效果研究[J/OL]. 中华肩肘外科电子杂志, 2021, 09(04): 360-364.

Yang Wang, Lihui Liu, Wei Liu, Hongmei Tian, Yongpeng Mao, Xuyang Li, Ran Cao, Zhenwei Wang, Di Ai, Teng Zhang, Zimu Mao, Shuangpeng Jiang. Clinical effect of a new mode of early rehabilitation with ERAS concept on rotator cuff injury after arthroscopy[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(04): 360-364.

目的

探讨医护患一体化术后加速康复(enhanced recovery after surgery,ERAS)模式对肩关节镜治疗肩袖损伤患者术后患肢功能康复训练中的自我效能及康复效果的影响。

方法

2020年4月至2021年4月首都医科大学附属北京世纪坛医院对实施肩关节镜手术治疗的肩袖损伤60例患者完成了随机对照研究,按照随机数字表,分为日常护理组(DN组,n=29)和快速康复组(ER组,n=31)。随访周期3个月,两组患者分别采用日常护理方案和医护患一体化ERAS方案进行术后康复,采用体格检查、康复自我效能量表、Constant-Murley量表评估两组患者临床效果差异。

结果

术后3个月,两组患者锻炼自我效能、应对自我效能、康复自我效能量表总分高于干预前,且ER组显著高于DN组,差异有统计学意义(P<0.05);在术后1周和术后3个月Constant-Murley量表评分上,与DN组相比,ER组显著偏高,差异有统计学意义(P<0.05);在术后3个月功能锻炼依从性上,ER组较DN组显著偏高,差异有统计学意义(P<0.05)。

结论

医护患一体化ERAS模式有助于提高关节镜下治疗肩袖损伤术后上肢康复训练自我效能水平,提升康复锻炼依从性,可较快恢复患肢机能。

Background

Rotator cuff injury, also known as rotator cuff tear (RCT) , is a common shoulder joint injury. Currently there is no unified standard for arthroscopic rehabilitation for RCT injury in terms of improving shoulder function, relieving pain and improving quality of life.

Objective

To explore the effect of medical care patient integration with enhanced recovery after surgery (ERAS) rehabilitation model on self-efficacy and rehabilitation effect of functional rehabilitation training of affected limbs after shoulder arthroscopy in patients with RCT.

Methods

From April 2020 to April 2021, a randomized controlled study with 60 patients was completed, and the follow-up period was 3 months (daily-nursing group: n=29; ERAS rehabilitation group: n=31) . Postoperative rehabilitation of patients in the two groups was carried out by daily nursing regimen and medical-patient integration ERAS protocol, respectively. The clinical effects of the two groups were evaluated by physical examination, self-efficacy for rehabilitation outcome scale (SER) , Constant-Murley scale.

Results

Three months after operation, the total scores of exercise self-efficacy, coping self-efficacy and rehabilitation self-efficacy in the two groups at last follow-up were higher than preoperatively, the experimental group was significantly higher than that in the control group (P < 0.05) ; in the score of Constant-Murley scale 1-week and 3-months after surgery, the ERAS rehabilitation group was significantly higher than that in the Daily-nursing group, and the difference was statistically significant (P < 0.05) ; the compliance of functional exercise in the experimental group was significantly higher than that in the control group 3 months after operation (P < 0.05) .

Conclusion

The integrated ERAS rehabilitation model of medical care and patients is helpful to improve the self-efficacy level of upper limb rehabilitation training after arthroscopic treatment of rotator cuff injury, enhance the compliance of rehabilitation exercise, and quickly restore the function of affected limbs.

表1 两组患者康复自我效能评分比较(分,±s
表2 两组患者肩关节功能Constant-Murley评分比较(分,±s
表3 两组患者功能锻炼的依从性的比较(分,±s
[1]
Hopewell S, Keene DJ, Marian IR, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial [J]. Lancet, 2021, 398(10298): 416-428.
[2]
Mitchell C, Adebajo A, Hay E, et al. Shoulder pain: diagnosis and management in primary care [J]. BMJ, 2005, 331(7525): 1124-1128.
[3]
Linsell L, Dawson J, Zondervan K, et al. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral [J]. Rheumatology (Oxford), 2006, 45(2): 215-221.
[4]
Yamamoto A, Takag K, Osawa T, 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.
[5]
Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village [J]. J Orthop, 2013, 10(1): 8-12.
[6]
Page MJ, Green S, Mcbain B, et al. Manual therapy and exercise for rotator cuff disease [J]. Cochrane Database Syst Rev, 2016, 6: CD012224.
[7]
Kjær BH, Magnusson SP, Henriksen M, et al. Effects of 12 Weeks of Progressive Early Active Exercise Therapy After Surgical Rotator Cuff Repair: 12 Weeks and 1-Year Results From the CUT-N-MOVE Randomized Controlled Trial [J]. Am J Sports Med, 2021, 49(2): 321-331.
[8]
Peng L, Yue J, Ouyang K, et al. Arthroscopic repair of the medium-size rotator cuff tear with the novel technique of the point union bridge: a minimum 2-year follow-up cohort study [J]. J Shoulder Elbow Surg, 2021, 30(9): 2056-2064.
[9]
Ribinik P, Calmels P, Barrols B, et al. Physical and rehabilitation medicine (PRM) care pathways: "Patients after rotator cuff tear surgery" [J]. Ann Phys Rehabiln Med, 2011, 54(8): 496-500.
[10]
Song W, Wang X, Zhou J, et al. Rehabilitation of An Analgesic Bracelet Based on Wrist-Ankle Acupuncture in Patients with Rotator Cuff Injury: A Randomized Trial [J]. Pain Res Manag, 2021, 2021:9946548.
[11]
Weekes DG, Campbell RE, Wicks ED, et al. Do Relaxation Exercises Decrease Pain After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial [J]. Clin Orthop Relat Res, 2021, 479(5): 870-884.
[12]
Grosh T, Elkassabany NM. Enhanced Recovery After Shoulder Arthroplasty [J]. Anesthesiol Clin, 2018, 36(3): 417-430.
[13]
Liungqvis O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review [J]. JAMA Surg, 2017, 152(3): 292-298.
[14]
Waldrop D, Lightsey OR Jr, Ethington CA, et al. Self-efficacy, optimism, health competence, and recovery from orthopedic surgery [J]. J Counseling Psychol, 2001, 48(2): 233-238.
[15]
Xia A, Zhang X, Liu Y, et al. Validation of the Chinese Version of the Modified Gait Efficacy Scale for Patients Removing Ilizarov External Fixation Device for Over One Year [J]. Patient Prefer Adherence, 2020, 14:1307-1315.
[16]
Stevens M, Van Den Akker-Scheek I, Van Horn JR. A Dutch translation of the Self-Efficacy for Rehabilitation Outcome Scale (SER): a first impression on reliability and validity [J]. Patient Educ Couns, 2005, 58(2): 121-126.
[17]
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation [J]. Br J Anaesth, 1997, 78(5): 606-617.
[18]
Brodner G, Pogatzki E, Van Aken H, et al. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy [J]. Anesth Analg, 1998, 86(2): 228-234.
[19]
Barber EL, Van Le L. Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology [J]. Obstet Gynecol Surv, 2015, 70(12): 780-792.
[20]
Scheib SA, Thomassee M, Kenner JL. Enhanced Recovery after Surgery in Gynecology: A Review of the Literature [J]. J Minim Invasive Gynecol, 2019, 26(2): 327-343.
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