Beaufils P, Prévot N, Boyer T, Allard M, Dorfmann H, Frank A, Kelbérine F, Kempf J F, Molé D, Walch G
Centre Hospitalier de Versailles, Le Chesnay, France.
Arthroscopy. 1999 Jan-Feb;15(1):49-55. doi: 10.1053/ar.1999.v15.0150041.
The purpose of this multicenter retrospective study of arthroscopic release of the glenohumeral joint was to evaluate the technical feasibility, the results, and the potential correlations between results and cause of the stiffness. Twenty-six shoulders in 25 patients (19 women and six men) were re-evaluated 3 to 72 months (mean, 21 months) after arthroscopic release of the glenohumeral joint. Diagnoses were primary frozen shoulder in 13 cases, bipolar stiffness (rotator cuff tear plus capsular contraction) in 3 cases, and postinjury or postsurgery stiffness in 10 cases. Results were evaluated on passive range of motion, Constant's score, and subjective assessment. Anterior or anterior inferior capsular release was done at the anterior rim of the glenoid fossa. Posterior capsule release was not performed in this series. There were no intraoperative complications. Mean range of motion gains were 86 degrees for forward elevation, 72 degrees for abduction, 34 degrees for external rotation, and 6 spinal processes for internal rotation. Constant's range of motion score increased from 12.9 out of 40 to 32 out of 40 points. Thirteen patients were very satisfied, 5 satisfied, 5 improved, and 3 unchanged. Range of motion gains were independent from the cause of shoulder stiffness, but global results were better in the primary frozen shoulder group in terms of pain and strength. Arthroscopic release of the glenohumeral joint is feasible and safe. For primary frozen shoulders, in case of failure of the functional treatment, arthroscopic release is a less traumatic alternative to manipulation under general anesthesia. For bipolar stiffness, arthroscopy provides the opportunity for treating concomitant lesions. For postsurgical stiffness, arthroscopic release improves range of motion, but the shoulder often remains painful.
这项关于肩关节镜下松解术的多中心回顾性研究的目的是评估技术可行性、结果，以及结果与僵硬原因之间的潜在关联。对25例患者（19名女性和6名男性）的26个肩部在肩关节镜下松解术后3至72个月（平均21个月）进行了重新评估。诊断为原发性冻结肩13例，双极僵硬（肩袖撕裂加关节囊挛缩）3例，损伤后或手术后僵硬10例。通过被动活动范围、Constant评分和主观评估来评估结果。在肩胛盂前缘进行前侧或前下关节囊松解。本系列未进行后侧关节囊松解。术中无并发症。前屈上举平均活动范围增加86度，外展增加72度，外旋增加34度，内旋增加6个棘突。Constant活动范围评分从40分中的12.9分提高到40分中的32分。13例患者非常满意，5例满意，5例改善，3例无变化。活动范围的增加与肩部僵硬的原因无关，但在疼痛和力量方面，原发性冻结肩组的总体结果更好。肩关节镜下松解术是可行且安全的。对于原发性冻结肩，在功能治疗失败的情况下，关节镜下松解是一种比全身麻醉下手法操作创伤更小的选择。对于双极僵硬，关节镜检查为治疗伴随病变提供了机会。对于术后僵硬，关节镜下松解可改善活动范围，但肩部通常仍会疼痛。
