腱板断裂術後早期の積極的後療法プログラムは安全に良好な臨床成績が期待できるか?

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It was sometimes difficult to perform early passive exercises after surgery for rotator cuff tear due to pain and increased muscle tonus during passive shoulder exercise. We developed a new rehabilitation protocol with using an original shoulder mobilizer which can apply traction and rotational motion and active exercises in supine flexed position, and reported favorable early passive ROM. The objectives of this study were to compare ROM after the start of anti-gravity active exercises and to evaluate the postoperative cuff integrity using MRIs. Sixty-three shoulders were classified as group I (GI); no tendon-to-bone repair, or group II (GII); with tendon-to-bone repair. In the former protocol, passive exercises started the next day of the surgery (GI) or in one week (GII). In the new protocol, the active exercises and the mobilizer started the next day; no passive exercises were applied. There were 10 former-GI, 9 new-GI, 22 former-GII, and 22 new-GII. Postoperative flexion, external-rotation, and internal-rotation at 1, 2, 4, 8 weeks were evaluated. In shoulders that carried out the new rehabilitation program and were followed-up for more than 1 year, JOA score was evaluated and postoperative cuff integrity was classified according to Sugayas classification of MRIs at 1 year. The ROM of the new-GI and new-GII was comparable or better than that of the former-GI and former-GII. Especially, the lag between active and passive flexion at the start of anti-gravity active exercises was smaller in the new program groups. The JOA score at 1 year was 96.0 points in the new-GI and 94.5 points in the new-GII. The cuff integrity in MRIs was classified as type 1 in all shoulders. The new postoperative rehabilitation program was proved to be safe and useful in this study.
日本肩関節学会の論文
2008-06-30

腱板断裂術後早期の積極的後療法プログラムは安全に良好な臨床成績が期待できるか?

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