Dimitri-Pinheiro Sofia, Klontzas Michail E, Pimenta Madalena, Vassalou Evangelia E, Soares Raquel, Karantanas Apostolos H
Radiology Department, Portuguese Institute of Oncology of Porto - Francisco Gentil EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
Biomedicine Department, Unit of Biochemistry, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
Skeletal Radiol. 2023 May;52(5):1005-1014. doi: 10.1007/s00256-022-04141-2. Epub 2022 Jul 30.
The effect of diabetes on adhesive capsulitis (AC) and its impact on the outcomes of ultrasound (US)-guided hydrodistension of the glenohumeral joint are still unclear. We aimed to identify predictors of US-guided hydrodistension outcomes, while assessing the performance of the method in diabetic compared to non-diabetic patients.
A total of 135 patients with AC who underwent US-guided hydrodistension were prospectively included. Demographics and factors linked to chronic inflammation and diabetes were recorded and patients were followed-up for 6 months. Functionality and pain were evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) and the Visual Analogue Scale (VAS) score. Statistical analysis was performed with Mann-Whitney U test, linear, and binary logistic regression.
Diabetes was identified in 25/135 patients (18.5%). Diabetic patients had worse DASH and VAS score at presentation (P < 0.0001) and presented with a higher grade of AC (P < 0.0001) and lower range of motion (P < 0.01) compared to non-diabetics. Higher DASH (P = 0.025) and VAS scores (P = 0.039) at presentation were linked to worse functionality at 6 months. Presence and duration of diabetes, and the number of hydrodistension repeats, correlated with worse VAS and DASH scores at 6 months. The number of procedure repeats was the only independent predictor of complete pain resolution at 6 months (OR 0.418, P = 003).
Diabetes is linked to more severe AC at presentation and worse outcomes in patients undergoing US-guided hydrodistension. In resistant cases, repeating the intervention is independently linked to worse outcomes for at least 6 months post-intervention.
糖尿病对粘连性肩周炎（AC）的影响及其对超声（US）引导下肱盂关节水扩张治疗效果的影响尚不清楚。我们旨在确定US引导下水扩张治疗效果的预测因素，同时评估该方法在糖尿病患者与非糖尿病患者中的应用表现。
前瞻性纳入135例行US引导下水扩张治疗的AC患者。记录人口统计学资料以及与慢性炎症和糖尿病相关的因素，并对患者进行6个月的随访。采用手臂、肩部和手部功能障碍（DASH）评分及视觉模拟量表（VAS）评分评估功能和疼痛情况。采用Mann-Whitney U检验、线性回归和二元逻辑回归进行统计分析。
135例患者中有25例（18.5%）患有糖尿病。与非糖尿病患者相比，糖尿病患者就诊时的DASH和VAS评分更差（P < 0.0001），AC分级更高（P < 0.0001），活动范围更小（P < 0.01）。就诊时较高的DASH评分（P = 0.025）和VAS评分（P = 0.039）与6个月时较差的功能相关。糖尿病的存在、病程以及水扩张重复次数与6个月时较差的VAS和DASH评分相关。操作重复次数是6个月时疼痛完全缓解的唯一独立预测因素（OR 0.418，P = 0.003）。
糖尿病与就诊时更严重的AC相关，且在接受US引导下水扩张治疗的患者中预后更差。在难治性病例中，重复干预与干预后至少6个月的更差预后独立相关。
