KÖhler H-C, Tischer T, Hacke C, Gutcke A, Schulze C
Department of Orthopaedics, Rostock University Medical Centre, Rostock, Germany.
Acta Chir Orthop Traumatol Cech. 2020;87(5):340-345.
PURPOSE OF THE STUDY Subacromial impingement is one of the most common reasons for shoulder pain. The surgical management of this condition has recently become the focus of criticism because of the rising number of surgical procedures and the lack of superiority of surgical over conservative treatment. In this prospective comparative study, we compared standardised conservative care with surgical treatment and placed special emphasis on the patients' ability to work. MATERIAL AND METHODS A total of 106 patients (25 women, 81 men; mean age: 45.4 12.3 years) were included in this prospective comparative clinical study. Patients in the non-operative arm (n = 42) received standardised physiotherapy. Patients in the surgical arm (n = 38) underwent arthroscopic subacromial decompression. All patients were followed up at 3, 6 and 12 months. Shoulder function (Constant score), pain (Numerical Rating Scale), and the duration of inability to work were assessed. RESULTS Shoulder function and pain improved significantly with both kinds of treatment. At no time of follow up we detected significant differences between the two treatment options. An analysis of the patients' ability to work showed that conservative treatment was superior to surgical treatment at 3-month follow-up (0.3 versus 5.0 weeks; p < 0.001) and between 4 and 6-month after intervention (0.2 versus 1.6 weeks; p = 0.032). DISCUSSION In the study presented here, significant improvements in function (Constant score) and pain (NRS) were achieved in both the non-operative and the surgical arm. There were no significant differences between the two groups at any time point. These results are similar to those reported by other authors in recent studies. Unlike other research work, however, our study demonstrated a major difference in the development and duration of inability to work. CONCLUSIONS Conservative and surgical treatment of subacromial impingement syndrome led to similar outcomes for shoulder pain and function at 3, 6 and 12 months after intervention. However, patients who were managed conservatively returned to work significantly earlier than patients who underwent surgery. Key words: subacromial impingement, shoulder, constant score, pain, ability to work.
研究目的 肩峰下撞击是肩部疼痛最常见的原因之一。由于手术例数的增加以及手术治疗相对于保守治疗缺乏优势，这种疾病的手术治疗最近成为了批评的焦点。在这项前瞻性对照研究中，我们将标准化保守治疗与手术治疗进行了比较，并特别关注患者的工作能力。材料与方法 共有106例患者（25例女性，81例男性；平均年龄：45.4±12.3岁）纳入了这项前瞻性对照临床研究。非手术组（n = 42）的患者接受标准化物理治疗。手术组（n = 38）的患者接受关节镜下肩峰下减压术。所有患者在3个月、6个月和12个月时进行随访。评估肩部功能（Constant评分）、疼痛（数字评分量表）以及无法工作的持续时间。结果 两种治疗方式均使肩部功能和疼痛得到显著改善。在随访的任何时间点，我们均未发现两种治疗方案之间存在显著差异。对患者工作能力的分析表明，在3个月随访时（0.3周对5.0周；p < 0.001）以及干预后4至6个月之间（0.2周对1.6周；p = 0.032），保守治疗优于手术治疗。讨论 在本研究中，非手术组和手术组在功能（Constant评分）和疼痛（NRS）方面均取得了显著改善。两组在任何时间点均无显著差异。这些结果与其他作者近期研究报告的结果相似。然而，与其他研究工作不同的是，我们的研究表明在无法工作的发生发展和持续时间方面存在重大差异。结论 肩峰下撞击综合征的保守治疗和手术治疗在干预后3个月、6个月和12个月时，对于肩部疼痛和功能产生了相似的结果。然而，接受保守治疗的患者比接受手术治疗的患者显著更早恢复工作。关键词：肩峰下撞击，肩部，Constant评分，疼痛，工作能力
