Zhou Zhou, Wang Jun, Li Huaisheng, Yang Aining, Tang Kanglai, Zhou You, Zhou Binghua
Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China.
Department of Sports Medicine Center, the First Affiliated Hospital of Army Medical University, Chongqing, 400038, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jul 15;38(7):867-873. doi: 10.7507/1002-1892.202403078.
To compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder.
A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score ( >0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences ( <0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films.
All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B ( >0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups ( <0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups ( <0.05), there was no significant difference in other indicators between the two groups ( >0.05).
Arthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.
比较关节镜下肩关节囊松解联合肩峰下间隙（AHD）恢复术治疗糖尿病继发僵硬性肩关节和原发性冻结肩的中期疗效。
回顾性分析22例糖尿病继发僵硬性肩关节患者（A组）和33例原发性冻结肩患者（B组）的临床资料，这些患者均接受了关节镜下270°囊松解联合AHD恢复术治疗。两组患者在性别、年龄、患侧、病程、术前AHD、肩关节前屈活动度、外展活动度、美国肩肘外科医师学会（ASES）评分、视觉模拟评分法（VAS）评分及Constant评分方面差异均无统计学意义（>0.05）。仅两组患者内旋圆锥分级及外旋活动度差异有统计学意义（<0.05）。采用VAS评分、ASES评分及Constant评分在术前及末次随访时评估肩关节疼痛及功能改善情况。记录并比较主动前屈、外展、外旋活动度及内旋圆锥分级。在X线片上测量AHD。
所有患者均获随访，随访时间24～92个月（中位数为57个月）。A组与B组随访时间差异无统计学意义（>0.05）。术中均未发生骨折或盂唇撕裂，所有切口均一期愈合，随访期间未观察到伤口感染或神经损伤等并发症。末次随访时，两组患者的主动前屈、外展、外旋活动度、内旋圆锥分级、AHD、VAS评分、ASES评分及Constant评分与术前相比均有显著改善（<0.05）。除两组患者外旋活动度变化差异有统计学意义（<0.05）外，其他指标差异均无统计学意义（>0.05）。
关节镜下囊松解联合AHD恢复术治疗糖尿病继发僵硬性肩关节和原发性冻结肩可取得良好的中期疗效。然而，糖尿病继发僵硬性肩关节患者外旋活动度的改善更为显著。
