Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2010 Jun;19(4):580-7. doi: 10.1016/j.jse.2009.08.004. Epub 2009 Dec 11.
The purpose of this study is to report and compare the outcome of arthroscopic capsular release in patients with shoulder stiffness with post-traumatic, postsurgical, and idiopathic etiologies. We hypothesize that patients with idiopathic or post-traumatic stiffness have better outcomes after arthroscopic capsular release than those with shoulder stiffness with a postsurgical etiology.
A retrospective review of 115 patients who underwent arthroscopic capsular release for refractory shoulder stiffness was performed. There were 60 men and 55 women with a mean age of 49 years (range, 27 to 81 years). The patients were divided into 3 groups according to the etiology of stiffness: post-traumatic (26 patients), postsurgical (48 patients), and idiopathic (41 patients). Arthroscopic capsular release was performed in all patients after a mean of 9 months of physical therapy (range, 6 to 13 months).
At a mean follow-up of 46 months (range, 25 to 89 months), the overall subjective shoulder value in all groups improved from 29% to 73% and the age- and gender-adjusted Constant score improved from 35% to 86%. The mean pain score decreased from 7.5 to 1, and mean active forward flexion, external rotation, and internal rotation increased from 97 degrees , 14 degrees , and the L5 vertebral level, respectively, to 135 degrees , 38 degrees , and the T11 vertebral level, respectively (P < .0001). There was no significant difference between the outcomes of idiopathic and post-traumatic stiffness (P = .7). However, the Constant score and subjective shoulder value were significantly lower in the postsurgical group compared with the idiopathic and post-traumatic groups (P = .0001 and P = .006, respectively).
Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness. Patients with idiopathic and post-traumatic shoulder stiffness have better outcomes than patients with postsurgical stiffness.
本研究旨在报告并比较创伤后、手术后和特发性病因导致的肩部僵硬患者行关节镜下囊松解术的结果。我们假设特发性或创伤后肩部僵硬患者行关节镜下囊松解术后的结果优于手术后肩部僵硬患者。
对 115 例行关节镜下囊松解术治疗难治性肩部僵硬的患者进行回顾性研究。患者中男 60 例，女 55 例，平均年龄 49 岁（27 ～ 81 岁）。根据僵硬的病因将患者分为 3 组：创伤后（26 例）、手术后（48 例）和特发性（41 例）。所有患者在接受平均 9 个月的物理治疗（6 ～ 13 个月）后均行关节镜下囊松解术。
平均随访 46 个月（25 ～ 89 个月）时，所有组的总体主观肩部值均从 29%提高至 73%，年龄和性别调整后的 Constant 评分从 35%提高至 86%。平均疼痛评分从 7.5 分降至 1 分，平均主动前屈、外旋和内旋分别从 97°、14°和 L5 椎体水平提高至 135°、38°和 T11 椎体水平（P＜0.0001）。特发性和创伤后僵硬患者的结果无显著差异（P=0.7）。然而，与特发性和创伤后僵硬组相比，手术后僵硬组的 Constant 评分和主观肩部值显著更低（P=0.0001 和 P=0.006）。
关节镜下囊松解术是治疗难治性肩部僵硬的有效方法。特发性和创伤后肩部僵硬患者的结果优于手术后肩部僵硬患者。
