The Influence of Functional Shoulder Biomechanics as a Mediator of Patient-Reported Outcomes following Mastectomy and Breast Reconstruction.
The Influence of Functional Shoulder Biomechanics as a Mediator of Patient-Reported Outcomes following Mastectomy and Breast Reconstruction.
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DOI：
10.1097/prs.0000000000007486
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发表时间：
2021-01-01
影响因子：
3.6
通讯作者：
Momoh AO
中科院分区：
文献类型：
--
作者：
Leonardis JM;Lyons DA;Kidwell KM;Giladi AM;Lipps DB;Momoh AO
乳房切除术后乳房重建技术对患者报告的身体和心理健康的影响不同。肩关节生物力学的客观测量，这是唯一的重建技术的影响，可以提供深入了解重建技术对患者报告的结果的影响。从46名既往接受过乳房切除术和联合背阔肌皮瓣+胸大肌下植入体（LD +胸大肌下植入体）、胸大肌下植入体或DIEP皮瓣乳房再造的女性中获得了机器人辅助的肩关节强度和刚度测量以及患者报告结局调查（PROMIS-UE、SPADI、QuickDASH、SF 12-PCS、SF 12-MCS）。中介分析研究了肩关节功能生物力学作为重建技术和患者报告结果之间的中介的作用。重建技术对肩关节生物力学有独特的影响，与胸大肌下植入物和DIEP皮瓣患者相比，LD+胸大肌下植入物患者的肩关节强度和刚度降低。增加外旋强度可预测PROMIS-UE评分增加（p=0.04），表明上肢功能改善。静息时肩关节僵硬度增加可预测QuickDASH评分增加（p=0.03），表明上肢功能恶化，而静息和收缩时僵硬度增加可表明SF 12-MCS评分降低（所有p≤0.02），表明心理社会健康状况恶化。重建技术不能直接预测功能的调查评分，也不能通过功能性肩关节生物力学来预测。在当前队列中，与其他技术相比，LD+胸大肌下植入体乳房重建显著降低了肩关节强度和刚度。此外，肩关节生物力学的客观测量可预测患者报告的身体和心理健康。我们的研究结果强调，需要改善围手术期筛查肩关节功能缺陷的患者接受乳房再造。
Post-mastectomy breast reconstruction techniques differentially influence patient-reported physical and psychosocial well-being. Objective measures of shoulder biomechanics, which are uniquely influenced by reconstruction technique, may provide insight into the influence of reconstruction technique on patient-reported outcomes. Robot-assisted measures of shoulder strength and stiffness, and patient-reported outcomes surveys (PROMIS-UE, SPADI, QuickDASH, SF12-PCS, SF12-MCS) were obtained from 46 women who had previously undergone mastectomy and a combined latissimus dorsi flap + subpectoral implant (LD + subpectoral implant), subpectoral implant, or DIEP flap breast reconstruction. Mediation analyses examined the role of functional shoulder biomechanics as a mediator between reconstruction technique and patient-reported outcomes. Reconstruction technique uniquely affected shoulder biomechanics, with LD+subpectoral implant patients exhibiting reduced shoulder strength and stiffness compared to subpectoral implant and DIEP flap patients. Increasing external rotation strength was predictive of increasing PROMIS-UE score (p=0.04), indicating improved upper extremity function. Increasing shoulder stiffness while at rest was predictive of increasing QuickDASH score (p=0.03), indicating worsened upper extremity function, while increasing stiffness at rest and during contraction was indicative of decreasing SF12-MCS score (all p≤0.02), indicating worsened psychosocial well-being. Reconstruction technique did not predict survey scores of function directly, or when mediated by functional shoulder biomechanics. In the current cohort, LD+subpectoral implant breast reconstructions significantly reduced shoulder strength and stiffness when compared to the other techniques. Additionally, objective measures of shoulder biomechanics were predictive of patient-reported physical and psychosocial well-being. Our results emphasize the need for improved peri-operative screening for shoulder functional deficits in patients undergoing breast reconstruction.