Department of Radio-diagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
Skeletal Radiol. 2020 May;49(5):795-803. doi: 10.1007/s00256-019-03316-8. Epub 2019 Dec 17.
To assess the benefit offered by capsular hydrodilatation in addition to intra-articular steroid injections in cases of adhesive capsulitis, assess outcomes in diabetic patients with capsular hydrodilatation as compared to non-diabetics and correlate duration of symptoms with outcome based on the type of intervention given.
This prospective double-blinded randomized control trial included patients presenting with clinical features of adhesive capsulitis with no evidence of rotator cuff pathology and randomized them into two groups-intra-articular steroid with hydrodilatation (distension group) and only intra-articular steroid (non-distension group) with intervention being performed as per the group allotted. Primary outcome measure was Shoulder Pain and Disability Index (SPADI) scores which were taken pre-intervention, at 1.5, 3 and 6 months post-intervention, which were assessed by generalized linear model statistics and Pearson correlation.
Although there was statistically significant drop in SPADI in both groups over time [F(1.9, 137.6) = 112.2; p < 0.001], mean difference in SPADI between the 2 groups was not statistically significant (1.53; CI:-3.7 to 6.8; p = 0.56). There was no significant difference between both groups among diabetics [F(1,38) = 0.04; p = 0.95] and no significant difference between diabetic and non-diabetic patients who received hydrodilatation [F(1.8, 60) = 2.26; p = 0.12]. There was no significant correlation between the reduction in SPADI scores and duration of symptoms in any subset of the study population.
Shoulder joint hydrodilatation offered no additional benefit compared to intra-articular steroid injections for shoulder adhesive capsulitis. Outcome for diabetics and non-diabetics were similar and there was no correlation between duration of symptoms and outcome.
评估在粘连性肩关节囊炎中，关节囊内注水扩张术联合关节内类固醇注射与单纯关节内类固醇注射相比所带来的益处，评估糖尿病患者与非糖尿病患者行关节囊内注水扩张术的治疗效果，并根据所给予的治疗方式将症状持续时间与治疗结果进行相关性分析。
本前瞻性双盲随机对照试验纳入了临床表现为粘连性肩关节囊炎且无肩袖病变证据的患者，并将其随机分为两组：关节内类固醇注射联合关节囊内注水扩张术（扩张组）和单纯关节内类固醇注射（非扩张组），并根据分组进行相应的干预。主要观察指标为肩关节疼痛和功能障碍指数（SPADI）评分，分别在干预前、干预后 1.5、3 和 6 个月进行评估，采用广义线性模型统计和 Pearson 相关性进行分析。
尽管两组的 SPADI 评分均随时间呈统计学显著下降[F（1.9，137.6）= 112.2；p < 0.001]，但两组间 SPADI 的平均差值无统计学意义（1.53；CI：-3.7 至 6.8；p = 0.56）。在糖尿病患者中，两组间[F（1，38）= 0.04；p = 0.95]和接受关节囊内注水扩张术的糖尿病患者和非糖尿病患者间[F（1.8，60）= 2.26；p = 0.12]差异均无统计学意义。在研究人群的任何亚组中，SPADI 评分的降低与症状持续时间均无显著相关性。
与单纯关节内类固醇注射相比，肩关节囊内注水扩张术对粘连性肩关节囊炎并无额外益处。糖尿病患者和非糖尿病患者的治疗效果相似，且症状持续时间与治疗结果之间无相关性。
