Hagiwara Yoshihiro, Sekiguchi Takuya, Ando Akira, Kanazawa Kenji, Koide Masashi, Hamada Junichiro, Yabe Yutaka, Yoshida Shinichiro, Itoi Eiji
Department of Orthopaedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan.
Department of Orthopaedic Surgery, Iwate Prefectural Centeral Hospital, Morioka, Japan.
Open Orthop J. 2018 Sep 18;12:373-379. doi: 10.2174/1874325001812010373. eCollection 2018.
A thickened coracohumeral ligament is a highly specific manifestation of, and primary restraint against external rotation in frozen shoulders.
The purpose of this study was to evaluate the effects of complete arthroscopic coracohumeral ligament release on range of motion in frozen shoulder.
Fifty-two consecutive shoulders in 52 patients were treated between April 2015 and June 2016. To evaluate solely glenohumeral range of motion, the scapula was fixed by an examiner with one hand (without palpating scapular motion), and range of motion was measured using a goniometer. For the first step, arthroscopic pancapsular release was performed in a beach-chair position with (Group 1) or without (Group 2) complete coracohumeral ligament release. For the final step, the remaining coracohumeral ligaments in Group 2 were released and the ranges of motion were compared to those in Group 1.
The average age of the patients was significantly higher in Group 1, but there were no significant differences between the two groups with respect to sex, affected side, preoperative range of motion, or American Shoulder and Elbow Society Score. Abduction, external rotation at adduction, and external and internal rotations at 90° of flexion in Group 1 were significantly greater than those in Group 2. After the additional release of the remaining coracohumeral ligaments in Group 2, all ranges of motion were significantly recovered and there was no significant difference between the groups.
Complete coracohumeral ligament release is a recommended intraoperative procedure for regaining full range of motion in frozen shoulders.
喙肱韧带增厚是肩周炎的一种高度特异性表现，也是肩周炎外旋的主要限制因素。
本研究旨在评估关节镜下完全松解喙肱韧带对肩周炎活动范围的影响。
2015年4月至2016年6月期间，连续治疗了52例患者的52个肩关节。为了仅评估盂肱关节活动范围，检查者用一只手固定肩胛骨（不触诊肩胛骨运动），并用角度计测量活动范围。第一步，在沙滩椅位进行关节镜下全关节囊松解，其中一组（第1组）进行或不进行（第2组）喙肱韧带完全松解。最后一步，松解第2组剩余的喙肱韧带，并将活动范围与第1组进行比较。
第1组患者的平均年龄显著更高，但两组在性别、患侧、术前活动范围或美国肩肘协会评分方面无显著差异。第1组的外展、内收位外旋以及90°屈曲位的外旋和内旋均显著大于第2组。在第2组额外松解剩余的喙肱韧带后，所有活动范围均显著恢复，两组之间无显著差异。
喙肱韧带完全松解是恢复肩周炎全范围活动的推荐术中操作。
