Pearsall A W, Osbahr D C, Speer K P
Department of Orthopaedic Surgery, University of South Alabama, Mobile, USA.
Arthroscopy. 1999 Jan-Feb;15(1):2-11. doi: 10.1053/ar.1999.v15.0150002.
Forty-three patients with a diagnosis of primary or secondary frozen shoulder who had symptoms for an average of 12 months and failed conservative treatment of at least 12 weeks of physical therapy, were treated with an arthrosopic capsular release. On completion of standard shoulder arthroscopy, intra-articular cautery was used to completely divide the anterior-inferior capsule, the intra-articular portion of the subscapularis tendon, and the middle glenohumeral, the superior glenohumeral, and the coracohumeral ligaments. The subacromial space was inspected in all patients. Eighteen patients had extensive subacromial fibrosis that required debridement. Subacromial decompression was reserved for patients with evidence of an acromial spur seen at the time of arthroscopy. Postoperatively, all patients showed substantial gains in shoulder range of motion, as well as diminished shoulder pain. Thirty-five patients completed a telephone survey at an average of 22 months after surgery. The average modified shoulder score was 19 (scale, 13 to 65), with 83% of patients indicating that their shoulder was normal or caused only mild symptoms. In conclusion, the authors believe that arthroscopic capsular release is an effective and safe alternative to manipulation in patients with a recalcitrant frozen shoulder.
43例诊断为原发性或继发性肩周炎的患者，平均症状持续12个月，经至少12周的保守物理治疗无效，接受了关节镜下关节囊松解术。在完成标准肩关节镜检查后，使用关节内烧灼术完全切断肩胛下肌腱的关节内部分、前下关节囊以及肱盂中韧带、肱盂上韧带和喙肱韧带。所有患者均检查了肩峰下间隙。18例患者存在广泛的肩峰下纤维化，需要进行清创。对于关节镜检查时发现有肩峰骨刺证据的患者，行肩峰下减压术。术后，所有患者的肩关节活动范围均有显著增加，肩部疼痛也减轻。35例患者在术后平均22个月完成了电话调查。改良后的肩关节平均评分为19分（评分范围为13至65分），83%的患者表示其肩部正常或仅引起轻微症状。总之，作者认为关节镜下关节囊松解术对于难治性肩周炎患者是一种有效且安全的替代手法治疗的方法。
