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肩关节粘连性关节囊炎关节镜下关节囊松解术后的临床结果

Clinical Outcome after Arthroscopic Capsular Release for Adhesive Capsulitis of the Shoulder.

作者信息

Yoo Jae Chul, Koh Kyoung Hwan, Shon Min Soo, Bae Kyu Hwan, Lim Tae Kang

机构信息

Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Clin Shoulder Elb. 2018 Sep 1;21(3):127-133. doi: 10.5397/cise.2018.21.3.127. eCollection 2018 Sep.

Abstract

BACKGROUND

This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder.

METHODS

This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up.

RESULTS

Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34-74). Mean follow-up duration was 24 months (range, 12-40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up (≤0.001 for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up.

CONCLUSIONS

Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.

摘要

背景

本研究旨在评估关节镜下肩关节囊松解术治疗肩周炎的效果。

方法

本研究回顾性调查了29例患有顽固性肩周炎并接受关节镜治疗的患者的30个肩关节。除了肩周炎的典型表现外,通过关节镜评估了盂肱关节和肩峰下间隙的合并病变。在术前、术后6个月和最终随访时,使用Constant评分和活动范围(ROM)进行临床评估。

结果

我们的研究包括17名女性和12名男性,平均年龄53.8岁(范围34 - 74岁)。平均随访时间为24个月(范围12 - 40个月)。对合并病变的评估显示,厚度小于25%的部分肩袖撕裂最为常见(总体83.3%;滑囊侧57%,关节侧23%)。肩峰下滑膜炎和粘连也很常见(53.3%)。与术前水平相比,最终随访时Constant评分和活动范围显著改善。然而,发现术后6个月的临床结果明显低于最终随访时的结果(所有因素均≤0.001)。在6个月随访时,59.3%的患者主要抱怨功能障碍。

结论

尽管在平均24个月的随访中关节镜下关节囊松解术取得了良好的效果,但超过50%的患者在术后6个月仍存在疼痛和活动受限。虽然在关节镜检查中经常遇到合并病变,但在本研究中,它们对肩周炎手术结果的影响仍不清楚。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7229/7726396/d0e9226a7b83/cise-2018-21-3-127f1.jpg

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