分阶段康复训练联合发散式冲击波促进巨大肩袖撕裂术后康复的疗效研究

目的：观察分阶段康复训练联合发散式冲击波促进巨大肩袖撕裂术后康复的疗效。方法：38例肩关节镜下修复术的巨大肩袖损伤患者分为对照组18例和观察组20例。2组患者进行术后为期12周的康复治疗，对照组患者采用分阶段康复训练，观察组患者在此基础上增加体外发散式冲击波辅助治疗。并在治疗前、治疗4周、8周、12周及末次随访时应用视觉模拟评分（VAS）、加州大学肩关节评分系统(UCLASS)、Constant肩关节功能评分、关节外展活动度（ROM）对患者进行评定。结果：治疗后4周、8周、12周及末次随访时，2组VAS评分较治疗前均明显降低（均P<0.05），UCLASS及Constant评分较治疗前均明显提高（均P<0.05），且ROM较治疗前均明显增加（均P<0.05）；治疗后4周、8周，观察组VAS评分与对照组同时间点比较均明显降低（均P<0.05），UCLASS、Constant评分与对照组同时间点比较均明显提高（均P<0.05），且ROM较对照组均明显增加（均P<0.05）；治疗后12周，观察组VAS评分与对照组同时间点比较明显降低（P<0.05），其余指标2组间比较差异无统计学意义；末次随访时，2组间各指标比较差异均无统计学意义。结论：分阶段康复训练联合发散式冲击波可明显缓解巨大肩袖撕裂修复术后早期患者疼痛，促进患者早期活动度和功能的恢复，这对于患者早期康复和快速康复具有重要意义，值得临床推广。

Effect of staged rehabilitation training combined with divergent shock wave on the rehabilitation of patients after arthroscopic massive rotator cuff tear repair

Objective: To observe the effect of staged rehabilitation training combined with divergent shock wave on the rehabilitation of patients after massive rotator cuff tear repair. Methods: A total of 38 patients with massive rotator cuff injury who underwent arthroscopic repair were randomly divided into control group (n=18) and treatment group (n=20). All patients in two groups were given rehabilitation treatment for 12 weeks after operation. Patients in both groups received staged rehabilitation training, and patients in treatment group were additionally treated with extracorporeal divergent shock wave. The patients were evaluated by visual analogue scale (VAS), UCLASS, Constant shoulder joint function scale and joint abduction range of motion (ROM) before treatment, 4 weeks, 8 weeks, 12 weeks after treatment and at the last follow-up. Results: At the 4th, 8th, 12th week after treatment and at the last follow-up, VAS scores in both groups decreased significantly (all P<0.05), UCLASS and Constant scores increased significantly (all P<0.05), and ROM increased significantly (all P<0.05). At the 4th and 8th week after treatment, the VAS scores in the treatment group were significantly lower than those in the control group at the same time point (all P<0.05), while the UCLASS and Constant scores were significantly higher than those in the control group at the same time point (all P<0.05), and the ROM was significantly higher than that in the control group (all P<0.05). At 12th week after treatment, the VAS score in the treatment group was significantly lower than that in the control group at the same time point (P<0.05), and there was no significant difference in other indexes between the two groups. At the last follow-up, there was no significant difference between the two groups. Conclusion: Staged rehabilitation training combined with divergent shock wave can significantly relieve the pain of patients with massive rotator cuff tear repair, and promote the recovery of early activity and function of patients, which is of great significance for early rehabilitation of patients.