Miniaci Anthony, Codsi Michael J
Director of Sports Health, Cleveland Clinic Foundation, 9500 Euclid Avenue, A41, Cleveland, OH 44195, USA.
Am J Sports Med. 2006 Aug;34(8):1356-63. doi: 10.1177/0363546506287824. Epub 2006 May 9.
Thermal capsulorrhaphy has been used to treat many different types of shoulder instability, including multidirectional instability, unidirectional instability, and microinstability in overhead-throwing athletes. A device that delivers laser energy or radiofrequency energy to the capsule tissue causes the collagen to denature and the capsule to shrink. The optimal temperature to achieve the most shrinkage without causing necrosis of the tissue is between 65 degrees and 75 degrees centigrade. This treatment causes a significant decrease in mechanical stiffness for the first 2 weeks, and then, after the tissue undergoes active cellular repair from the surrounding uninjured tissue, the mechanical properties return to near normal by 12 weeks. If the thermal energy is applied in a grid pattern, then the tissue heals with more stiffness by 6 weeks. Clinical studies on thermal capsulorrhaphy for the treatment of multidirectional instability have shown a high rate of recurrent instability (12%-64%). The clinical studies on unidirectional instability showed much better recurrence rates (4%-25%), but because most of the patients also underwent concomitant Bankart repairs and superior labral anterior posterior lesion repairs, the efficacy of the thermal treatment cannot be ascertained. A randomized controlled trial would be needed to assess whether instability with Bankart lesions requires augmentation with thermal capsulorrhaphy. For the patients with microinstability who are overhead-throwing athletes, thermal capsulorrhaphy has shown varying results from a 97% rate of return to sports to a 62% rate of return to sports. Complications of this technique include temporary nerve injuries that usually involve the sensory branch of the axillary nerve and thermal necrosis of the capsule, which is rare.
热囊缝合术已被用于治疗多种不同类型的肩关节不稳，包括多向性不稳、单向性不稳以及过头投掷运动员的微不稳。一种将激光能量或射频能量传递至关节囊组织的装置会使胶原蛋白变性，关节囊收缩。在不导致组织坏死的情况下实现最大收缩的最佳温度在65摄氏度至75摄氏度之间。这种治疗在最初2周会使机械刚度显著降低，然后，在组织从周围未受伤组织进行活跃的细胞修复后，机械性能在12周时恢复至接近正常水平。如果以网格模式施加热能，那么到6周时组织愈合后会更僵硬。关于热囊缝合术治疗多向性不稳的临床研究显示复发不稳率较高（12% - 64%）。关于单向性不稳的临床研究显示复发率要好得多（4% - 25%），但由于大多数患者还同时进行了Bankart修复和上盂唇前后部损伤修复，所以无法确定热疗的疗效。需要进行一项随机对照试验来评估伴有Bankart损伤的不稳是否需要热囊缝合术增强疗效。对于微不稳的过头投掷运动员患者，热囊缝合术的结果各不相同，从恢复运动的比例为97%到恢复运动的比例为62%不等。该技术的并发症包括通常累及腋神经感觉支的暂时性神经损伤以及关节囊的热坏死，后者较为罕见。
