肩袖撕裂患者肩部力量和肩部功能的相关性研究

目的探讨肩袖撕裂患者手术前肩部力量和肩部功能状况及两者之间的关系。 方法选择2016年3月至2019年7月在本院进行手术治疗的全层肩袖撕裂患者243例。在患者手术前应用等速肌力测试检测患者肩部力量，应用临床评分系统测量患者肩部功能。根据患者撕裂程度大小将患者分为4组：小型撕裂组、中型撕裂组、大型撕裂组、巨大型撕裂组。分析每组患者肩部力量和肩部功能的相关性。 结果在肩袖小型撕裂患者中，外展力量和视觉模拟评分（visual analogue scale，VAS）存在负相关（r=-0.307，P=0.018）；在肩袖中型撕裂患者中，外展力量和美国加州大学肩关节评分系统（ University of California at Los Angeles ,UCLA）（r=0.262，P=0.015）、SF-36躯体健康总评（physical component summary,PCS）（r=0.226，P=0.038）存在正相关；外旋力量和UCLA评分存在正相关（r=0.289，P=0.007）；在肩袖大型撕裂患者中，外展力量和Constant评分（r=0.282，P=0.043）、加州大学肩关节评分系统（American shoulder and elbow surgeon' form , ASES）（r=0.309，P=0.026）、SF-36PCS评分（r=0.317，P=0.022）存在正相关；外旋力量和UCLA评分（r=0.288，P=0.038）、Constant评分（r=0.293，P=0.035）、ASES评分（r=0.329，P=0.017）存在正相关；内旋力量和UCLA评分（r =0.383，P=0.005）、Constant评分（r=0.401，P=0.003）、ASES评分（r=0.314，P=0.023）、SF-36PCS评分（r=0.285，P=0.041）、SF-36精神健康总评（mental component summary , MCS）（r=0.304，P=0.028）存在正相关；在肩袖巨大型撕裂患者中，外展力量和VAS评分（r=-0.308，P=0.035）存在负相关，和UCLA评分（r=0.413，P=0.004）、Constant评分（r=0.489，P=0.000）、ASES评分（r=0.473，P=0.001）、SF-36PCS评分（r=0.772，P=0.000）、SF-36 MCS评分（r=0.293，P=0.046）存在正相关；外旋力量和VAS评分（r=-0.292，P=0.046）存在负相关，和UCLA评分（r=0.629，P=0.000）、Constant评分（r=0.413，P=0.004）、ASES评分（r=0.695，P=0.000）、SF-36 PCS评分（r=0.583，P=0.000）存在正相关；内旋力量和VAS评分（r=-0.309，P=0.035）存在负相关，和UCLA评分（r=0.512，P=0.000）、Constant评分（r=0.709，P=0.000）、ASES评分（r=0.802，P=0.000）、SF-36PCS评分（r=0.501，P=0.000）存在正相关。 结论撕裂程度可能是决定患者肩部力量和肩部功能相关程度的关键因素，部分修复不可修复的巨大撕裂非常重要。

Correlation study of shoulder strength and shoulder function in patients with rotator cuff tears

BackgroundRotator cuff tear is one of the main causes of shoulder function reduction in middle-aged and elderly people. Shoulder muscle strength is one of the essential factors to ensure shoulder stability. It is important to determine the degree of influence of insufficient shoulder strength on patients' symptoms to guide clinical treatment. Currently, the extent to which inadequate shoulder strength affects shoulder joint function in rotator cuff tears has not been determined. ObjectiveTo investigate the relationship between shoulder strength and shoulder function before rotator cuff tear surgery. MethodsWe selected 243 patients with full-thickness rotator cuff tear who underwent surgical treatment in our hospital from March 2016 to July 2019. Isokinetic muscle strength test is used to measure the patient's shoulder strength before surgery, and the clinical scoring system is used to measure the patient’s shoulder function. According to the degree of tear, the patients were divided into 4 groups: small tear group, medium tear group, large tear group, and massive tear group. The correlation between shoulder strength and shoulder function of each group of patients was analyzed. ResultsThere was a negative correlation between abduction function and VAS score in patients of small tear group (r=-0.307, P=0.018) . In patients of medium tear group, the abduction function and UCLA score (r=0.262, P=0.015) , SF-36 PCS score (r=0.226, P=0.038) were positively correlated, and the external rotation function and UCLA score are positively correlated (r= 0.289, P=0.007) . In patients of large tear group, the abduction function and Constant score (r=0.282, P=0.043) , ASES score (r=0.309, P=0.026) , SF-36PCS score (r=0.317, P=0.022) were positively correlated. The external rotation function and UCLA score (r=0.288, P=0.038) , Constant score (r=0.293, P=0.035) , ASES score (r=0.329, P=0.017) were positively correlated. The internal rotation strength and UCLA score (r=0.383, P=0.005) , Constant score (r=0.401, P=0.003) , ASES score (r=0.314, P=0.023) , SF-36PCS score (r=0.285, P=0.041) , SF-36 MCS score (r=0.304 , P=0.028) were positively correlated. In patients of massive tear group, the abduction function and VAS score (r=-0.308, P=0.035) were negatively correlated. It was positively correlated with UCLA score (r=0.413, P=0.004) , Constant score (r=0.489, P=0.000) , ASES score (r=0.473, P=0.001) , SF-36PCS score (r=0.772, P=0.000) , and SF-36 MCS score (r = 0.293, P=0.046) . The external rotation function and VAS score (r = -0.292, P =0.046) were negatively correlated. It was positively correlated with UCLA score (r=0.629, P=0.000) , Constant score (r= 0.413, P=0.004) , ASES score (r=0.695, P=0.000) , and SF-36 PCS score (r=0.583, P=0.000) . There was a negative correlation between the internal rotation function and VAS score (r=-0.309, P=0.035) . It was positively correlated with UCLA score (r=0.512, P=0.000) , Constant score (r=0.709, P=0.000) , ASES score (r=0.802, P=0.000) , and SF-36PCS score (r=0.501, P=0.000) . ConclusionThe tear degree may be a key factor in determining the degree of correlation between shoulder strength and shoulder function. The partial repair of irreparable large tear is of great importance.