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[经袖套入路关节镜下关节囊松解治疗原发性重度肩周炎的疗效]

[Effectiveness of arthroscopic capsular release to treat primary severe frozen shoulder through trans cuff portal].

作者信息

Lu Zhenfei, Wang Jianhua, Xu Bing, You Weijia, Wang Jianwei

机构信息

Department of Orthopedics, Wuxi Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Wuxi Jiangsu, 214000, P.R.China.

Department of Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200092, P.R.China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jul 15;31(7):773-777. doi: 10.7507/1002-1892.201702012.

Abstract

OBJECTIVE

To assess the effectiveness of arthroscopic capsular release to treat primary severe frozen shoulder through trans cuff portal.

METHODS

Between June 2012 and January 2015, 28 patients with primary severe frozen shoulder were enrolled in the study. There were 8 males and 20 females with an average age of 57 years (range, 42-81 years). The left shoulder was involved in 16 cases and the right one in 12 cases. The mean disease duration was 11 months (range, 7-21 months). Six patients had diabetes. All patients underwent arthroscopic capsular release by trans cuff portal. The range of motion (ROM) of the shoulder were measured at preoperation and at 6 weeks and 24 months after operation; the scores of American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) were used to evaluate the shoulder function and pain.

RESULTS

Primary healing of incision was obtained, and no complications of infection, shoulder instability, and nerve injury were found. All patients were followed up 24 months. Pain of the shoulder was obviously relieved; VAS score was significantly lower at 6 weeks and 24 months after operation than preoperation ( <0.05), and at 24 months than 6 weeks ( <0.05). ROM of the shoulder and ASES score at 6 weeks and 24 months after operation were significantly increased when compared with preoperative ones ( <0.05); significant difference was found in ROM of forward flexion and external rotation and the ASES score between at 6 weeks and 24 months ( <0.05). And internal rotation in-creased from trochanter (9 cases), hip (6 cases), sacrum (7 cases), and L vertebral level (6 cases) before operation to the T -T vertebral level at 6 weeks and 24 months after operation, which were close to normal side.

CONCLUSION

Arthroscopic capsular release through trans cuff portal is an effective and safe management for primary severe frozen shoulder.

摘要

目的

评估经袖口入路关节镜下关节囊松解术治疗原发性重度肩周炎的疗效。

方法

2012年6月至2015年1月,纳入28例原发性重度肩周炎患者。其中男性8例,女性20例,平均年龄57岁(42 - 81岁)。左肩受累16例,右肩受累12例。平均病程11个月(7 - 21个月)。6例患者患有糖尿病。所有患者均行经袖口入路关节镜下关节囊松解术。分别于术前、术后6周和24个月测量肩关节活动度(ROM);采用美国肩肘外科医师学会(ASES)评分和视觉模拟量表(VAS)评估肩关节功能和疼痛情况。

结果

切口一期愈合,未发现感染、肩关节不稳及神经损伤等并发症。所有患者均获24个月随访。肩关节疼痛明显缓解;术后6周和24个月时VAS评分均显著低于术前(P<0.05),且术后24个月低于术后6周(P<0.05)。术后6周和24个月时肩关节ROM及ASES评分均较术前显著增加(P<0.05);术后6周和24个月时前屈和外旋ROM及ASES评分差异有统计学意义(P<0.05)。内旋活动度术前从转子水平(9例)、髋关节水平(6例)、骶骨水平(7例)和L椎体水平(6例)增加至术后6周和24个月时的T - T椎体水平,接近健侧。

结论

经袖口入路关节镜下关节囊松解术治疗原发性重度肩周炎安全有效。

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本文引用的文献

1
Arthroscopic Management of the Stiff Shoulder.僵硬肩关节的关节镜治疗
JBJS Rev. 2016 Apr 5;4(4):e21-7. doi: 10.2106/JBJS.RVW.O.00047.
2
Shoulder Stiffness: Current Concepts and Concerns.肩部僵硬:当前概念与关注点
Arthroscopy. 2016 Jul;32(7):1402-14. doi: 10.1016/j.arthro.2016.03.024. Epub 2016 May 12.

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