Celik Haluk, Seckin Mustafa Faik, Akcal Mehmet Akif, Kara Adnan, Kilinc Bekir Eray, Akman Senol
. Department of Orthopedics and Traumatology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey.
. Department of Orthopedics and Traumatology, Faculty of Medicine, Bilim University, Istanbul, Turkey.
Acta Ortop Bras. 2017 Nov-Dec;25(6):270-274. doi: 10.1590/1413-785220172506174033.
Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment.
A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically.
Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients' values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient.
Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment.
肩周炎通常采用保守治疗,但对于某些病例应讨论手术治疗方案。在本研究中,我们评估了手法治疗和关节镜下松解术对保守治疗无效的肩周炎病例的疗效。
本研究纳入了34例接受手法治疗和关节镜下关节囊松解术的32例患者。平均随访期为49.5个月(范围:24 - 90个月)。8例(25%)患者未发现发病原因,被归类为原发性肩周炎;24例(75%)患者因潜在病变被归类为继发性肩周炎。术前平均主诉期为11个月(范围:3 - 24个月)。关节镜检查后,先进行手法治疗,然后进行关节镜下关节囊松解术。比较手术前和最后一次随访时双肩的活动范围。采用Constant和牛津分类法评估功能结果,并对结果进行统计学评估。
术前评估与随访评估之间,患者的被动抬高、外展、内收 - 外旋、外展 - 外旋和外展 - 内旋的值有统计学意义的增加(p<0.01)。对照测量中患者值相对于术前Constant评分观察到的平均变化为47.97±21.03单位,被确定具有统计学意义(p<0.01)。根据牛津分类法,29个肩关节功能良好。
对于保守治疗无效的肩周炎患者,手法治疗后行关节镜下松解术可取得成功的结果。