Impact of Combined Skin Sparing Mastectomy and Immediate Subpectoral Prosthetic Reconstruction on the Pectoralis Major Muscle Function A Preoperative and Postoperative Comparative Study
Impact of Combined Skin Sparing Mastectomy and Immediate Subpectoral Prosthetic Reconstruction on the Pectoralis Major Muscle Function A Preoperative and Postoperative Comparative Study
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DOI：
10.1097/sap.0b013e318269e4ee
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发表时间：
2014-06-01
影响因子：
1.5
通讯作者：
Veeger, H. E. J.
中科院分区：
文献类型：
--
作者：
Hage, J. Joris;van der Heeden, Jorine F.;Veeger, H. E. J.
背景：我们评估了胸大肌脱离引起的主观和客观功能损失，以及邻近肌肉的协同功能是否可以补偿这种损失。方法：对22例接受双侧预防性乳房手术的女性进行术前和术后手臂、肩部和手部残疾评分的比较，运动范围的三维视频分析，以及肌电图登记的动力力评估。结果：虽然术后手臂、肩和手的残疾评分有统计学意义的增加（P = < 0.01），表明主观残疾更多，但这种差异与日常生活活动无关。这与术后观察到的肩部活动范围缺乏限制一致。术后反映胸大肌功能的4个方向测得的最大平均力为7.13 N，比术前低3.8% （P = 0.079）。术后2个挛缩方向的平均最大力为15.5 N，比术前大14% （P = 0.04）。肌电图显示，术前和术后三角肌各部位在6个方向上均出现相同的峰值。相反，胸大肌锁骨部分术后4个方向中3个方向肌肉活动峰值升高，反映胸大肌功能，2个方向肌肉活动峰值升高，提示代偿活动，具有统计学意义。结论：胸大肌部分脱离对患者日常生活的影响是可以接受的。
Background: We assessed the subjective and objective functional loss induced by detachment of the pectoralis major muscle and whether synergistic function of adjacent muscles compensates for such loss.Methods: A preoperative to postoperative comparison of the Disability of the Arm, Shoulder and Hand score, 3-dimensional video-analysis of the range of motion, and dynamometric force assessment with electromyography registration were prospectively conducted in 22 women who underwent bilateral preventive breast surgery.Results: Although the statistically significant postoperative increase of the Disability of the Arm, Shoulder and Hand score (P = < 0.01) was indicative of more subjective disability, this difference is irrelevant for activities of daily life. This is in line with the observed postoperative lack of restrictions of range of motion of the shoulder. The mean postoperative maximum force measured in 4 directions reflective of the pectoralis major muscle function was 7.13 N, or 3.8%, lower than the preoperative force (P = 0.079). The mean postoperative maximum force in the 2 contramovement directions was 15.5 N, or 14%, higher than the preoperative force (P = 0.04). Electromyographically, both parts of the deltoid muscle preoperatively and postoperatively showed the same peaks in the 6 directions. Contrastingly, the clavicular part of the pectoralis major muscle postoperatively showed a statistically significant increase of peak of muscle activity in 3 of 4 directions reflective of pectoralis major function and in both contramovement directions, indicating compensatory activity.Conclusions: Daily life consequences of partial detachment of the pectoralis major muscle were acceptable in our patients.