Massoud Samir N, Pearse Eyiyemi O, Levy Ofer, Copeland Stephen A
Royal Berkshire Hospital, Reading.
J Shoulder Elbow Surg. 2002 Nov-Dec;11(6):609-13. doi: 10.1067/mse.2002.127301.
Forty-three patients with diabetes (47 shoulders) who had a manipulation under anesthesia only (24 shoulders), a manipulation under anesthesia followed by an arthroscopy (12 shoulders), or an arthroscopic release (11 shoulders) for a frozen shoulder were followed-up for a mean period of 35 months. The mean Constant score improved from 20.3 to 63.7 points (P <.001). The mean improvement in forward flexion was 71.7 degrees, in abduction 78.5 degrees, in external rotation with the arm at the side 36.3 degrees, and in internal rotation from the buttock to the first lumbar vertebra (P <.001 for all). When gentle manipulation with the patient under anesthesia was possible, the outcome was satisfactory in 13 of 15 shoulders (86.7%) in patients with non-insulin-dependent diabetes and in 17 of 21 shoulders (81%) in patients with insulin-dependent diabetes (P >.5). Insulin-dependent patients with diabetes were more likely to require an arthroscopic release than patients with non-insulin-dependent diabetes (P <.05). Most of our patients obtained their maximum relief of pain and functional recovery within 3 months of surgery. We recommend manipulation under anesthesia for the resistant frozen shoulder in patients with diabetes. Arthroscopic release is required when mobilization under anesthesia is not possible.
43例患有糖尿病的患者（47个肩部）因肩周炎接受了仅在麻醉下进行的手法治疗（24个肩部）、麻醉下手法治疗后行关节镜检查（12个肩部）或关节镜下松解术（11个肩部），平均随访35个月。Constant评分均值从20.3分提高到63.7分（P<.001）。前屈平均改善71.7度，外展78.5度，上肢在体侧时的外旋36.3度，从臀部到第一腰椎的内旋（所有均P<.001）。当在麻醉下对患者进行轻柔手法治疗可行时，非胰岛素依赖型糖尿病患者的15个肩部中有13个（86.7%）效果满意，胰岛素依赖型糖尿病患者的21个肩部中有17个（81%）效果满意（P>.5）。与非胰岛素依赖型糖尿病患者相比，胰岛素依赖型糖尿病患者更有可能需要关节镜下松解术（P<.05）。我们的大多数患者在手术后3个月内获得了最大程度的疼痛缓解和功能恢复。我们建议对糖尿病患者的顽固性肩周炎采用麻醉下手法治疗。当无法在麻醉下进行活动时，则需要关节镜下松解术。
