Rush University Medical Center, 720 N Larrabee, Chicago, IL 60654, U.S.A.
Arthroscopy. 2010 Nov;26(11):1451-5. doi: 10.1016/j.arthro.2010.02.026. Epub 2010 Sep 27.
The purpose of this study was to examine the results of arthroscopic debridement for isolated degenerative joint disease of the shoulder.
We retrospectively identified 81 patients who had arthroscopic debridement to treat glenohumeral arthritis. Of these patients, 71 (88%) were available for follow-up. The preoperative Simple Shoulder Test score, American Shoulder and Elbow Surgeons score, Short Form 12 score, visual analog scale score for pain, and range of motion were recorded. These were compared against postoperative scores by use of the statistical paired t test. In addition, patients completed postoperative University of California, Los Angeles; Constant; and Single Assessment Numeric Evaluation scores. Forty-six preoperative radiographs were blindly evaluated and classified. Finally, the need for subsequent shoulder arthroplasty was recorded.
The mean follow-up for the 55 patients who did not progress to arthroplasty was 27 months. The mean preoperative and postoperative American Shoulder and Elbow Surgeons, Simple Shoulder Test, and pain visual analog scale scores all significantly improved (P < .05). Furthermore, range of motion significantly improved (P < .05) in flexion, abduction, and external rotation. Additional postoperative scores were as follows: University of California, Los Angeles, 28.3; Single Assessment Numeric Evaluation, 71.1; Constant score for affected shoulder, 72.0; and Constant score for unaffected shoulder, 78.5. Of the patients, 16 (22%) underwent arthroplasty at a mean of 10.1 months after debridement. Radiographic review showed that 13 shoulders with a mean joint space of 1.5 mm and grade 2.4 arthrosis went on to have shoulder arthroplasty. In contrast, 33 shoulders with a mean joint space of 2.6 mm and grade 1.9 arthrosis did not go on to have shoulder arthroplasty.
Patients with residual joint space and an absence of large osteophytes can avoid arthroplasty and have increased function with decreased pain after arthroscopic debridement for degenerative joint disease. Significant risk factors for failure include the presence of grade 4 bipolar disease, joint space of less than 2 mm, and large osteophytes.
Level IV, case series.
本研究旨在探讨关节镜下清理术治疗孤立性肩关节退行性关节病的疗效。
我们回顾性分析了 81 例行关节镜下清理术治疗肩关节炎的患者。其中 71 例（88%）获得随访。记录术前的简易肩部测试评分、美国肩肘外科医师评分、简化健康调查量表 12 项评分、疼痛视觉模拟评分和活动范围，采用统计学配对 t 检验比较术后评分。此外，患者还完成了术后加利福尼亚大学洛杉矶分校评分、Constant 评分和单评估数字评估评分。46 张术前 X 线片进行了盲法评估和分类。最后，记录了后续肩关节置换的需求。
55 例未进展为关节置换的患者平均随访 27 个月。术前和术后美国肩肘外科医师评分、简易肩部测试评分和疼痛视觉模拟评分均显著改善（P <.05）。此外，屈伸、外展和外旋活动范围均显著改善（P <.05）。术后其他评分结果如下：加利福尼亚大学洛杉矶分校评分 28.3，单评估数字评估评分 71.1，患肩Constant 评分 72.0，健肩 Constant 评分 78.5。其中 16 例（22%）患者在清理术后平均 10.1 个月行关节置换。X 线片复查显示，13 例关节间隙 1.5mm，关节退变Ⅱ°～Ⅳ°的患者行肩关节置换，而 33 例关节间隙 2.6mm，关节退变Ⅰ°～Ⅱ°的患者未行肩关节置换。
对于存在关节间隙和小骨赘的患者，关节镜下清理术可避免关节置换，并通过减轻疼痛来改善功能。失败的显著危险因素包括存在 4 级双极病变、关节间隙小于 2mm 和大骨赘。
Ⅳ级，病例系列研究。
