Service de chirurgie orthopédique, hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France; Service de chirurgie orthopédique, Clinique Monticelli-Vélodrome Groupe RGDS (Ramsay Générale de Santé), 10, allée Marcel-Leclerc, 13008 Marseille, France; Service de chirurgie orthopédique, Nouvelle Clinique de La Ciotat, groupe ESM (Établissements Sainte Marguerite), boulevard Lamartine, 13600 La Ciotat, France.
Service de chirurgie viscérale, hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
Orthop Traumatol Surg Res. 2021 Jun;107(4):102915. doi: 10.1016/j.otsr.2021.102915. Epub 2021 Mar 31.
Arthroscopic surgery has earned its place as the reference standard treatment for rotator cuff calcific tendinopathy refractory to conservative medical treatment. Adhesive capsulitis of the shoulder is the most common complication (12%). Standard practice involves routine gleno-humeral exploration before calcification removal. The objective of this study was to identify risk factors for adhesive capsulitis.
The development of adhesive capsulitis is associated with gleno-humeral exploration.
We conducted a multicentre, multi-surgeon, retrospective cohort study of 340 consecutive patients who underwent arthroscopic removal of rotator cuff calcifications between 1 January 2012 and 1 January 2018. We collected epidemiological data (age, sex, work-related physical activity), the history of previous treatments (local injections, needling), the type and location of the calcifications as assessed radiologically, the clinical findings (Constant score before and 6 months after surgery, diagnosis of adhesive capsulitis defined as shoulder pain with motion range limitation in all directions), and the surgical details (type of anaesthesia, gleno-humeral exploration).
Of the 340 patients, 251 underwent routine gleno-humeral exploration and 89 did not. Adhesive capsulitis developed in 40 (12%) patients. By multivariate analysis, gleno-humeral exploration was an independent risk factor for adhesive capsulitis (p=0.022; odds ratio, 5.60). Of the 251 gleno-humeral explorations, 8% identified concomitant lesions and only 4% led to a curative procedure.
Given our results and the data in the literature, we believe that routine gleno-humeral exploration during the arthroscopic treatment of rotator cuff calcific tendinopathy is inadvisable.
III; case-control study.
关节镜手术已成为治疗对保守治疗药物无反应的肩袖钙化性肌腱炎的标准治疗方法。肩关节粘连是最常见的并发症（12%）。标准治疗方法是在去除钙化前常规进行盂肱关节探查。本研究的目的是确定肩关节粘连的危险因素。
肩关节粘连的发展与盂肱关节探查有关。
我们对 2012 年 1 月 1 日至 2018 年 1 月 1 日期间接受关节镜下肩袖钙化切除术的 340 例连续患者进行了多中心、多外科医生回顾性队列研究。我们收集了人口统计学数据（年龄、性别、与工作相关的体力活动）、既往治疗史（局部注射、针灸）、影像学评估的钙化类型和位置、临床发现（手术前和手术后 6 个月的 Constant 评分、定义为各个方向运动范围受限的肩部疼痛的粘连性肩关节囊炎诊断）和手术细节（麻醉类型、盂肱关节探查）。
在 340 例患者中，251 例行常规盂肱关节探查，89 例未行。40 例（12%）患者发生粘连性肩关节囊炎。多变量分析显示，盂肱关节探查是粘连性肩关节囊炎的独立危险因素（p=0.022；优势比，5.60）。在 251 例盂肱关节探查中，8%发现伴发病变，仅 4%导致治愈性手术。
根据我们的结果和文献数据，我们认为在关节镜治疗肩袖钙化性肌腱炎时常规进行盂肱关节探查是不可取的。
III；病例对照研究。
