Department of Orthopaedic Surgery, Wuhan Central Hospital, Huazhong University of Science and Technology, Wuhan, China.
Arch Orthop Trauma Surg. 2013 Nov;133(11):1549-56. doi: 10.1007/s00402-013-1839-x. Epub 2013 Aug 31.
In recent two decades, a novel minimally invasive technique for resistant frozen shoulder, arthroscopic glenohumeral release, has been popularly practiced. However, by far one key point, although being well recognized, has not been tackled at all during the procedure-that is how to safely and smoothly insert the arthroscope into contracted and restricted glenohumeral joint when MUA cannot be performed or work, especially the severe stiff shoulder.
We have developed a new strategy for the treatment of the problem-initial glenohumeral visualization through musculotendinous junction of supraspinatus. Using this accessory portal, the posterior glenohumeral joint could be viewed and an accurate posterior portal was instituted through which the arthroscope could be placed into glenohumeral joint definitely parallel to the glenoid face without injuring the articular cartilage; the arthroscope and electrocautery could move more freely to favor subsequent sequential glenohumeral release as well. In this report we present this technique in detail and intraoperative results in 27 consecutive severe frozen shoulders.
The success rate of initial glenohumeral placement of arthroscope through trans-cuff portal was 100 % without glenoid or humeral head cartilage injury.
For severe frozen shoulder, initial glenohumeral visualization through trans-cuff portal is practical, safe and reproducible.
Level IV, Case Series, Treatment Study.
在最近二十年中，一种新的微创技术用于治疗抵抗性冻结肩，即关节镜下盂肱关节松解术，已得到广泛应用。然而，到目前为止，有一个关键点虽然已被充分认识，但在手术过程中根本没有得到解决，即当手法松解不能进行或无效时，如何安全、顺利地将关节镜插入挛缩和受限的盂肱关节，尤其是严重僵硬的肩部。
我们为解决这个问题开发了一种新策略-通过冈上肌腱肌腹结合部进行初始盂肱关节可视化。使用这个辅助入路，可以观察到盂肱关节的后关节面，并通过该入路准确建立后关节镜入路，使关节镜能够平行于关节盂面准确进入盂肱关节，而不会损伤关节软骨；关节镜和电烙术可以更自由地移动，有利于随后进行连续的盂肱关节松解。在本报告中，我们详细介绍了这项技术，并介绍了 27 例连续严重冻结肩的手术结果。
通过肩袖间隙入路进行初始盂肱关节关节镜放置的成功率为 100%，没有盂肱关节面或肱骨头软骨损伤。
对于严重的冻结肩，通过肩袖间隙入路进行初始盂肱关节可视化是实用、安全和可重复的。
IV 级，病例系列，治疗研究。
