Puah Ken Lee, Salieh Muhammad Sabith, Yeo William, Tan Andrew Hwee Chye
1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
2 Orthopaedic Diagnostic Centre, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499018757572. doi: 10.1177/2309499018757572.
Diabetic patients have been known to have a higher incidence of frozen shoulder. Arthroscopic capsular release has been described for diabetic frozen shoulder refractory to non-surgical treatment. We describe our single-surgeon experience of this procedure done in Asian patients presenting with diabetic frozen shoulder.
Data were prospectively collected from 25 patients from 2007 to 2008, who underwent arthroscopic capsular release for frozen shoulder with diabetes mellitus. This included the University of California-Los Angeles (UCLA) Shoulder Score by an independent observer. Mean follow-up duration was 44.3 ± 22 months with the age of 57.3 ± 10.9 years at the time of surgery. Mean duration of symptoms prior to surgery was 8.9 ± 7.5 months. Ten right shoulders and 15 left shoulders were operated on. Arthroscopic capsular release was performed in the beach chair position with the aid of a 90° electrocautery hook, from the rotator interval to posterior capsule. Significant improvement was observed in the UCLA scores post-operatively (preoperative total score 15.8 ± 3.6 vs. post-operative 33.3 ± 2.5, p < 0.00), including all domains of pain (3.9 ± 1.8 vs. 9.4 ± 0.9, p < 0.00), function (4.8 ± 1.7 vs. 9.4 ± 1.4, p < 0.00), active forward flexion (2.6 ± 0.7 vs. 4.6 ± 0.6, p < 0.00) and satisfaction (0.0 ± 0.0 vs. 5.0 ± 0.0, p < 0.00). No significant correlation between duration of symptoms and UCLA scores. Significant improvement was observed in forward flexion (preoperative 100.4 ± 18.8° vs. post-operative 157.6 ± 15.9°, p < 0.00) and external rotation (preoperative 14.4 ± 6.34° vs. post-operative 63.8 ± 8.3°, p < 0.00). Although the duration of symptoms correlated significantly with preoperative forward flexion ( r = 0.443 and p < 0.027), there was no significant correlation with post-operative forward flexion ( r = 0.023 and p < 0.91). No axillary nerve palsy observed.
The diabetic frozen shoulder can be treated favourably with arthroscopic capsular release and the duration of symptoms prior to surgery does not affect the outcomes.
众所周知，糖尿病患者肩周炎的发病率较高。对于非手术治疗无效的糖尿病性肩周炎，已有关节镜下关节囊松解术的相关描述。我们描述了在亚洲糖尿病性肩周炎患者中开展此手术的单术者经验。
前瞻性收集了2007年至2008年25例接受关节镜下关节囊松解术治疗糖尿病性肩周炎患者的数据。这包括由独立观察者进行的加州大学洛杉矶分校（UCLA）肩关节评分。平均随访时间为44.3±22个月，手术时年龄为57.3±10.9岁。术前症状平均持续时间为8.9±7.5个月。共对10例右肩和15例左肩进行了手术。在沙滩椅位借助90°电灼钩从肩胛下肌间隙至后关节囊进行关节镜下关节囊松解术。术后UCLA评分有显著改善（术前总分15.8±3.6，术后33.3±2.5，p<0.00），包括疼痛（3.9±1.8对9.4±0.9，p<0.00）、功能（4.8±1.7对9.4±1.4，p<0.00）、主动前屈（2.6±0.7对4.6±0.6，p<0.00）和满意度（0.0±0.0对5.0±0.0，p<0.00）等所有领域。症状持续时间与UCLA评分之间无显著相关性。前屈（术前100.4±18.8°，术后157.6±15.9°，p<0.00）和外旋（术前14.4±6.34°，术后63.8±8.3°，p<0.00）有显著改善。虽然症状持续时间与术前前屈显著相关（r=0.443，p<0.027），但与术后前屈无显著相关性（r=0.023，p<0.91）。未观察到腋神经麻痹。
关节镜下关节囊松解术可有效治疗糖尿病性肩周炎，术前症状持续时间不影响治疗效果。
