Vezeridis Peter S, Goel Danny P, Shah Anup A, Sung Seung-Yong, Warner Jon J P
Department of Orthopaedic Surgery, The Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA 02114, USA.
Sports Med Arthrosc Rev. 2010 Sep;18(3):198-206. doi: 10.1097/JSA.0b013e3181ec84a5.
Arthrofibrosis after shoulder surgery may be challenging to treat. Certain factors, including diabetes and history of keloid formation, predispose patients to the development of postoperative arthrofibrosis. Etiologies include rotator cuff repair, labral repair, capsulorrhaphy, shoulder arthroplasty, and proximal humerus fracture fixation. Systematic evaluation with thorough history and physical examination is essential to determine the proper treatment and to counsel patients on expectations for recovery. Nonoperative treatment focused on physical therapy is the first step in management. Manipulation under anesthesia may be an effective treatment for failure of physical therapy regimens in idiopathic adhesive capsulitis, however it is less successful in cases of postsurgical adhesions. In cases of postoperative stiffness, treatment options include arthroscopic and open capsular releases. Adequate postoperative pain control and adherence to a rigorous physical therapy regimen are integral to the success of surgical release. Surgical treatment is effective in the majority of patients with postsurgical arthrofibrosis.
肩部手术后的关节纤维化可能难以治疗。某些因素，包括糖尿病和瘢痕疙瘩形成史，使患者易发生术后关节纤维化。病因包括肩袖修复、盂唇修复、关节囊缝合术、肩关节置换术和肱骨近端骨折固定。通过全面的病史和体格检查进行系统评估对于确定适当的治疗方法以及向患者提供恢复预期建议至关重要。以物理治疗为重点的非手术治疗是管理的第一步。麻醉下手法松解对于特发性粘连性关节囊炎物理治疗方案失败可能是一种有效的治疗方法，然而在术后粘连的情况下效果较差。在术后僵硬的病例中，治疗选择包括关节镜下和开放性关节囊松解术。充分的术后疼痛控制和严格遵守物理治疗方案对于手术松解的成功至关重要。手术治疗对大多数术后关节纤维化患者有效。
