Lancaster Sarah T, Grove Thomas N, Woods David A
Department of Orthopaedics, Great Western Hospital, Marlborough Road, Swindon, UK.
Shoulder Elbow. 2017 Oct;9(4):258-265. doi: 10.1177/1758573217693974. Epub 2017 Feb 20.
A proportion of patients who sustain upper limb fractures develop post-traumatic stiffness (PTS), which may progress in a similar way to primary frozen shoulder (PFS). We have had success in treating PFS with manipulation under anaesthetic (MUA) and therefore treated PTS using MUA. Oxford Shoulder Scores (OSS), range of motion (ROM) data pre- and post-MUA, and the need for repeat procedure were compared.
Sixty-four patients with PTS following an upper limb fracture, unresponsive to conservative measures, were seen between 1 January 1999 and 1 November 2015. Thirty-two patients had sustained a proximal humeral fracture, six of whom had a concurrent shoulder dislocation. MUA was performed using a standard technique. The results were compared with 487 PFS patients undergoing the same procedure.
There was no significant difference in ROM change between the groups. Improvement in OSS was slightly greater in the PFS group (17 versus 14, = 0.005) but, upon subgroup analysis of the PTS group, no significant difference was found for patients presenting with humeral fractures alone.
MUA results for PTS following upper limb fracture are comparable to MUA for PFS. We therefore recommend MUA in PTS cases where conservative methods have failed.
一部分上肢骨折患者会发生创伤后僵硬（PTS），其发展方式可能与原发性冻结肩（PFS）相似。我们在使用麻醉下手法松解（MUA）治疗PFS方面取得了成功，因此采用MUA治疗PTS。比较了牛津肩部评分（OSS）、MUA前后的活动范围（ROM）数据以及重复手术的必要性。
1999年1月1日至2015年11月1日期间，共诊治了64例上肢骨折后发生PTS且对保守治疗无效的患者。32例患者发生肱骨近端骨折，其中6例合并肩关节脱位。采用标准技术进行MUA。将结果与487例接受相同手术的PFS患者进行比较。
两组之间ROM变化无显著差异。PFS组的OSS改善略大（17比14，P = 0.005），但在对PTS组进行亚组分析时，仅出现肱骨骨折的患者未发现显著差异。
上肢骨折后PTS的MUA结果与PFS的MUA结果相当。因此，我们建议在保守治疗失败的PTS病例中采用MUA。
