- 期刊
早期復健介入對於旋轉肌腱撕裂修補手術住院日之影響－簡介復健內容
Early Rehabilitation Intervention Can Reduce the Admission Duration of Rotator Cuff Repair-Introducing the Rehabilitation Protocol
摘要
旋轉肌腱修補之術後的復健方式目前仍無明確標準，尤其以急性期的復健更是見解分歧。本研究的目的在於探討此類病人術前衛教及術後急性期的復健對預後之成效，希望能建立最合適的復健指引。本研究採前瞻性方法，三個月內蒐集20名接受旋轉肌腱修補術之病人。復健內容包括手術前的衛教、手術後的擺位、被動關節活動及連續被動關節活動機（continuous passive motion）使用等，並統計病人住院天數，以及滿意程度。手術後三到五個月追蹤病人的疼痛指數（visual analogue scale）、日常生活功能（activities of daily living）等，並安排超音波檢查評估肌腱完整程度。結果顯示在病人之疼痛指數，手術前為5.65±1.39，手術後在訪問時為1.76±0.85，平均下降幅度為3.81±1.50；在肩膀日常生活功能方面，大部分的病人均有明顯改善，僅有兩位患者出現關節僵硬，功能下降之情況。超音波的追蹤發現兩名患者出現旋轉肌再斷裂（re-tear）的現象。在住院天數方面，復健介入後住院天數平均下降將近一天，前來復健科門診治療比率則和介入前無差異；病人整體滿意度高。本研究顯示早期介入能讓病人有更好的住院滿意度，減少住院天數，且病人日常生活功能有顯著改善，但對於術後的肌腱癒合無明顯影響。
並列摘要
Currently, there is no standardized rehabilitation protocol for postoperative rotator cuff repair, particularly at acute stage. The purpose of the study was to evaluate the efficiency of preoperative patient education and acute stage rehabilitation, which may contribute in constructing a suitable rehabilitation protocol. The prospective observational study was conducted in a local teaching hospital over a period of 3 months. Twenty patients including 11 men and 9 women with a history of supraspinatus tear were enrolled in this study. The rehabilitation protocol involved preoperative patient education, postoperative proper positioning, passive range of motion exercises, and the usage of continuous passive motion device. The average preoperative pain (VAS) was 5.65 ± 1.39, and postoperative pain (VAS) was 1.76 ± 0.85 with average pain difference (VAS) of 3.81 ± 1.50. A total of 18 patients showed remarkable improvement of shoulder disability scale, and 2 patients showed marked shoulder stiffness. Sonography performed at a 3-month postoperative follow-up period showed tendon retear in 2 patients. The admission duration diminished for nearly 1 day after the preoperative patient education and acute stage rehabilitation. However, the percentage of patients visiting physiatrist's OPD remained the same. Our study suggested that combination of preoperative patient education and acute stage rehabilitation could diminish the admission duration for nearly 1 day, without jeopardizing the tendon healing. All patients were satisfied with the program and showed improvement in their shoulder range of motion and daily activities.