Lanciego Carlos, Puentes-Gutierrez Ana, Sánchez-Casado Marcelino, Cifuentes-Garcia Irene, Fernández-Tamayo Ana, Dominguez-Paillacho David, Ciampi-Dopazo Juan J, Marquina-Valero Maria A
Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
Rehabilitation and Physical Medicine Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
J Vasc Interv Radiol. 2024 Apr;35(4):550-557. doi: 10.1016/j.jvir.2023.12.572. Epub 2024 Jan 8.
To determine the safety and potential effectiveness of transarterial embolization for adhesive capsulitis of the shoulder.
This prospective study analyzed consecutive adult patients with adhesive capsulitis referred for embolization between January 2018 and May 2023 after a poor response to treatment (symptoms and limitation of motion in ≥2 axes; ≤120° flexion, ≤50° external rotation and/or internal rotation with the shoulder abducted 90°) persisting for >3 months after having completed ≥6 weeks of analgesics and physical therapy. Different types of pain and mobility were measured before embolization and 1, 3, and 6 months after embolization. Overall upper limb function (Quick Disabilities of Arm, Shoulder, and Hand) and patient satisfaction were measured before and 6 months after embolization. Long-term follow-up comprised telephone interviews and clinical history reviews.
A total of 20 patients (12 [60%] women; median age, 50.7; interquartile ranges [IQR], 45‒55 years) were included; 6 (30%) had diabetes and 15 (75%) were off work. Median duration of symptoms before embolization was 39.4 weeks (IQR, 28‒49 weeks), and median duration of rehabilitation therapy was 12.8 weeks (IQR, 8‒16 weeks). Six months after embolization, significant improvements were observed in nocturnal pain (P = .003), pain on moving (P = .001), external rotation (P < .001), internal rotation (P < .001), active flexion (P < .001), passive flexion (P = .03), active abduction (P < .001), passive abduction (P < .001), and overall function (P < .001). Despite objective improvements, patient satisfaction was nearly unchanged. Only 1 patient experienced a mild adverse event.
Transarterial embolization is safe and potentially effective in treating adhesive capsulitis of the shoulder refractory to conventional treatment. Clinical improvements were maintained in the mid to long term.
确定经动脉栓塞治疗肩周炎的安全性和潜在有效性。
本前瞻性研究分析了2018年1月至2023年5月期间因治疗效果不佳（症状及≥2个轴的活动受限；屈曲≤120°，外旋和/或内旋（肩关节外展90°时）≤50°）而转诊进行栓塞治疗的连续性成年肩周炎患者，这些症状在完成≥6周的止痛药物治疗和物理治疗后持续>3个月。在栓塞前以及栓塞后1、3和6个月测量不同类型的疼痛和活动度。在栓塞前和栓塞后6个月测量上肢整体功能（手臂、肩部和手部快速残疾评定量表）和患者满意度。长期随访包括电话访谈和临床病史回顾。
共纳入20例患者（12例[60%]为女性；中位年龄50.7岁；四分位间距[IQR]为45 - 55岁）；6例（30%）患有糖尿病，15例（75%）已停工。栓塞前症状的中位持续时间为39.4周（IQR为28 - 49周），康复治疗的中位持续时间为12.8周（IQR为8 - 16周）。栓塞后6个月，夜间疼痛（P = 0.003）、活动时疼痛（P = 0.001）、外旋（P < 0.001）、内旋（P < 0.001）、主动屈曲（P < 0.001）、被动屈曲（P = 0.03）、主动外展（P < 0.001）、被动外展（P < 0.001）和整体功能（P < 0.001）均有显著改善。尽管有客观改善，但患者满意度几乎未变。仅1例患者发生轻微不良事件。
经动脉栓塞治疗对常规治疗难治的肩周炎是安全且可能有效的。中长期临床改善得以维持。
