肩周肌群的抗阻力量训练对肩袖损伤患者术后功能恢复及预后质量的影响

doi:10.3877/cma.j.issn.2095-5790.2024.02.004

目的

分析肩周肌群的抗阻力量训练对肩袖损伤患者术后功能恢复及预后质量的影响。

方法

选择在本院行手术治疗的肩袖损伤患者90例，纳入时间为2020年1月至2023年6月，随机数字表法分为对照组（n=45）、观察组（n=45），对照组给予常规围术期护理，观察组在对照组基础上给予肩周肌群的抗阻力量训练，比较两组患者肩关节功能优良率，比较两组患者治疗前、治疗后1个月、治疗后3个月肩关节功能恢复情况[肩关节功能评分（constant-murley score,CMS）]，比较两组患者治疗前、治疗后3个月肩关节活动度和生活质量评分。

结果

对照组、观察组患者肩关节功能优良率分别为77.78%、93.33%，观察组肩关节功能优良率明显高于对照组（P<0.05）。治疗后1个月、3个月时间点中，观察组患者CMS评分明显高于对照组（P<0.05）。治疗后3个月，观察组患者前屈、外展、外旋、内旋活动度明显高于对照组（P<0.05）。治疗后3个月，观察组患者生理、心理、社会关系、环境各维度评分明显高于对照组（P<0.05）。

结论

肩周肌群的抗阻力量训练可有效提高肩袖损伤患者术后肩关节功能恢复效果，改善肩关节活动能力，增强患者生活质量，可推广应用。

关键词: 肩周肌群, 抗阻力量训练, 肩袖损伤, 术后, 功能恢复, 预后

Background

Rotator cuff injury, one of the common shoulder joint diseases in the clinic, refers to the injury of tendons, muscles, ligaments, and other tissue structures around the shoulder joint. There are various treatment methods for rotator cuff injury, among which surgical treatment is the most common and effective. However, postoperative functional recovery has become the focus of patients and doctors, and how to improve patients' postoperative quality of life and promote functional recovery has become an essential topic of current research. Arthroscopic rotator cuff repair (ARCR) is a commonly used surgical method for treating and repairing rotator cuff injuries. However, patients' postoperative shoulder mobility and function are still limited to a certain extent, so postoperative rehabilitation exercises are of great significance for improving shoulder function. The importance of rehabilitation after rotator cuff injury is self-evident. Conversely, postoperative rehabilitation can help joint fluid circulation, reduce swelling, and prevent joint adhesion. On the other hand, rehabilitation training can stimulate muscle growth, increase muscle strength, and improve joint stability, thereby improving patients' quality of life. However, in the process of postoperative rehabilitation, patients often face many problems, such as pain, limited joint activity, and decreased muscle strength, which seriously affect the rehabilitation process of patients. Therefore, exploring an effective method to improve patients functional recovery and quality of life after surgery is of great significance. Resistance strength training is a kind of resistance training and activity mode of muscle tissue, which can effectively improve the resistance ability of the trainer's muscles and is also a standard mode of sports training and rehabilitation. It has been applied significantly after hip surgery, but there are few studies on the influence of resistance training of the perishoulder muscle group on the postoperative function of patients with postoperative rotator cuff injury.

Objective

To analyze the effect of resistance strength training of shoulder muscles on functional recovery and prognostic quality of patients with rotator cuff injury after surgery.

Methods

A total of 90 patients with rotator cuff injury who underwent surgical treatment in our hospital were selected from January 2020 to June 2023 and were divided into conventional group (n=45) and resistance group (n=45) by random number table method. The conventional group was given routine perioperative nursing, and the resistance group was given resistance strength training for the shoulder muscle group based on the conventional group. The excellent and good rates of shoulder joint function between the two groups were compared, and the recovery of shoulder joint function between the two groups before treatment, one month after treatment, and three months after treatment [shoulder joint function score (CMS) ] was compared, and the scores of shoulder joint motion and quality of life between the two groups were compared before treatment and three months after treatment.

Results

The excellent and good rates of shoulder joint function in the conventional and anti-resistance groups were 77.78% and 93.33%, respectively. The excellent and good rates of shoulder joint function in the anti-resistance group were significantly higher than those in the conventional group (P<0.05). At the time points of 1 month and three months after treatment, the CMS score of the anti-resistance group was significantly higher than that of the conventional group (P<0.05). Three months after treatment, the activity of flexion, abduction, external rotation, and internal rotation in the resistance group was significantly higher than in the conventional group (P<0.05). After three months of treatment, WHOQOL-BREF scores of patients in the anti-resistance group were significantly higher than those in the conventional group regarding physiological, psychological, social, and environmental dimensions (P<0.05) .

Conclusion

The resistance strength training of the perishoulder muscle group can effectively improve the functional recovery effect of the shoulder joint in patients with rotator cuff injury after surgery, improve the mobility of the shoulder joint, and enhance the quality of life of patients, and can be widely applied.

Key words: Perishoulder muscles, Resistance strength training, Rotator cuff injury, Postoperation, Functional recovery, Prognosis

表1 两组患者肩关节功能优良率[例（%）]

组别	例数	优	良	可	差	优良率
对照组	45	15（33.33）	20（44.44）	6（13.33）	4（8.89）	35（77.78）
观察组	45	18（40.00）	24（53.33）	3（6.67）	0（0.00）	42（93.33）
x²值						4.406
P值						0.036

表1 两组患者肩关节功能优良率[例（%）]

组别	例数	优	良	可	差	优良率
对照组	45	15（33.33）	20（44.44）	6（13.33）	4（8.89）	35（77.78）
观察组	45	18（40.00）	24（53.33）	3（6.67）	0（0.00）	42（93.33）
x²值						4.406
P值						0.036

表2 两组患者肩关节功能恢复情况（分，

±s）

组别	例数	CMS评分
组别	例数	治疗前	治疗后1个月	治疗后3个月
对照组	45	58.96±5.12	74.18±6.19^a	80.11±8.46^ab
观察组	45	59.33±6.18	86.12±7.41^a	90.38±9.15^ab
t值		0.309	8.296	5.528
P值		0.758	<0.001	<0.001

表2 两组患者肩关节功能恢复情况（分，

±s）

组别	例数	CMS评分
组别	例数	治疗前	治疗后1个月	治疗后3个月
对照组	45	58.96±5.12	74.18±6.19^a	80.11±8.46^ab
观察组	45	59.33±6.18	86.12±7.41^a	90.38±9.15^ab
t值		0.309	8.296	5.528
P值		0.758	<0.001	<0.001

表3 两组患者肩关节活动度比较（°，

±s）

组别	例数	前屈		外展		外旋		内旋
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
对照组	45	78.52±6.33	124.85±15.42^a	89.74±10.44	140.41±15.28^a	26.49±5.12	38.52±6.27^a	60.03±10.41	72.10±11.09^a
观察组	45	78.60±7.15	145.28±20.16^a	90.45±11.27	159.72±20.05^a	25.87±4.66	44.51±6.29^a	59.76±10.24	86.57±15.49^a
t值		0.049	5.400	0.310	5.139	0.601	4.524	0.124	5.095
P值		0.961	<0.001	0.757	<0.001	0.55	<0.001	0.902	<0.001

表3 两组患者肩关节活动度比较（°，

±s）

组别	例数	前屈		外展		外旋		内旋
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
对照组	45	78.52±6.33	124.85±15.42^a	89.74±10.44	140.41±15.28^a	26.49±5.12	38.52±6.27^a	60.03±10.41	72.10±11.09^a
观察组	45	78.60±7.15	145.28±20.16^a	90.45±11.27	159.72±20.05^a	25.87±4.66	44.51±6.29^a	59.76±10.24	86.57±15.49^a
t值		0.049	5.400	0.310	5.139	0.601	4.524	0.124	5.095
P值		0.961	<0.001	0.757	<0.001	0.55	<0.001	0.902	<0.001

表4 两组患者生活质量比较（分，

±s）

组别	例数	生理		心理		社会关系		环境
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
对照组	45	10.45±2.33	18.52±4.19^a	11.51±2.35	18.72±3.06^a	15.28±4.19	24.18±6.02^a	12.03±3.01	18.26±4.15^a
观察组	45	10.37±3.01	23.51±6.18^a	11.60±2.83	23.15±3.07^a	15.39±4.27	31.28±6.09^a	12.27±3.19	25.11±5.07^a
t值		0.141	4.483	0.164	6.856	0.123	5.562	0.531	7.013
P值		0.888	<0.001	0.87	<0.001	0.902	<0.001	0.676	<0.001

表4 两组患者生活质量比较（分，

±s）

组别	例数	生理		心理		社会关系		环境
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
对照组	45	10.45±2.33	18.52±4.19^a	11.51±2.35	18.72±3.06^a	15.28±4.19	24.18±6.02^a	12.03±3.01	18.26±4.15^a
观察组	45	10.37±3.01	23.51±6.18^a	11.60±2.83	23.15±3.07^a	15.39±4.27	31.28±6.09^a	12.27±3.19	25.11±5.07^a
t值		0.141	4.483	0.164	6.856	0.123	5.562	0.531	7.013
P值		0.888	<0.001	0.87	<0.001	0.902	<0.001	0.676	<0.001

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Effect of resistance strength training of perishoulder muscles on functional recovery and prognostic quality of patients with rotator cuff injury after surgery

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Effect of resistance strength training of perishoulder muscles on functional recovery and prognostic quality of patients with rotator cuff injury after surgery