Loew Markus, Heichel Thomas O, Lehner Burkhard
Department of Shoulder and Elbow Surgery, University Hospital for Orthopaedic Surgery, Heidelberg, Germany.
J Shoulder Elbow Surg. 2005 Jan-Feb;14(1):16-21. doi: 10.1016/j.jse.2004.04.004.
The aim of this study was to find intraarticular lesions after manipulation under general anesthesia in patients with primary frozen shoulder. In a prospective trial conducted between 2001 and 2003 in 30 patients with primary frozen shoulder, the affected shoulders were manipulated while the patients were under general anesthetia. Exclusion criteria were secondary stiffness caused by rotator cuff tears and glenohumeral arthritis. After manipulation, each patient was examined by arthroscopy, and any intraarticular lesions were documented. In all patients, during manipulation, a significant improvement in the range of motion was achieved. Under anesthesia, flexion improved on average from 70 degrees +/- 33 degrees to 180 degrees +/- 15 degrees, abduction from 50 degrees +/- 20 degrees to 170 degrees +/- 25 degrees, and external rotation from -5 degrees +/- 10 degrees to +40 degrees +/- 20 degrees. Arthroscopy revealed hemarthrosis in all patients after manipulation. In 22 patients, localized synovitis was detected in the area of the rotator interval, whereas in 8 patients, disseminated synovitis was observed as a feature of adhesive capsulitis. After manipulation, the capsule was seen to be ruptured superiorly in 11 patients, the anterior capsule was ruptured up to the infraglenoid pole in 24 patients, and 16 patients each had a capsular lesion located posteriorly. In 18 patients no additional joint damage was found after manipulation. In 4 patients, iatrogenic superior labrum anterior-posterior lesions were observed. Further injuries detected were 3 fresh partial tears of the subscapularis tendon, 4 anterior labral detachments (1 with a small osteochondral defect), and 2 tears of the middle glenohumeral ligament. Even though manipulation under anesthesia is effective in terms of joint mobilization, the method can cause iatrogenic intraarticular damage.
本研究的目的是探寻全麻下手法治疗原发性冻结肩患者后的关节内损伤情况。在2001年至2003年间对30例原发性冻结肩患者进行的一项前瞻性试验中，在患者全麻状态下对患侧肩部进行手法治疗。排除标准为肩袖撕裂和盂肱关节炎所致的继发性僵硬。手法治疗后，对每位患者进行关节镜检查，并记录任何关节内损伤情况。所有患者在手法治疗过程中，活动范围均有显著改善。在麻醉状态下，前屈平均从70°±33°改善至180°±15°，外展从50°±20°改善至170°±25°，外旋从-5°±10°改善至+40°±20°。关节镜检查显示，手法治疗后所有患者均出现关节积血。22例患者在旋转间隙区域检测到局限性滑膜炎，而8例患者观察到弥漫性滑膜炎，这是粘连性关节囊炎的一个特征。手法治疗后，11例患者的关节囊上方破裂，24例患者的前关节囊破裂至肩胛下极，16例患者各有一个位于后方的关节囊损伤。18例患者在手法治疗后未发现其他关节损伤。4例患者观察到医源性上盂唇前后部损伤。检测到的其他损伤包括3例肩胛下肌腱新鲜部分撕裂、4例前盂唇附着处分离（1例伴有小的骨软骨缺损）以及2例肱二头肌中头韧带撕裂。尽管全麻下手法治疗在关节活动方面有效，但该方法可导致医源性关节内损伤。
