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三联疗法治疗粘连性关节囊炎：关节内注射皮质类固醇、液压扩张及在镇静下进行肩部手法治疗。

TREATMENT OF ADHESIVE CAPSULITIS WITH THE TRIPLE PROCEDURE: INTRA-ARTICULAR INJECTION WITH CORTICOSTEROIDS, HYDRODILATION AND SHOULDER MANIPULATION UNDER SEDATION.

作者信息

Gracitelli Mauro Emilio Conforto, Assunção Jorge Henrique, Paiva Micael de Mesquita, de Andrade E Silva Fernando Brandão, Ferreira Arnaldo Amado, Malavolta Eduardo Angeli

机构信息

Universidade de Sao Paulo, Hospital das Clinicas HC-FMUSP, Faculdade de Medicina, Sao Paulo, SP, Brazil.

Hospital do Coração HCor, Sao Paulo, SP, Brazil.

出版信息

Acta Ortop Bras. 2025 Jan 10;32(6):e281046. doi: 10.1590/1413-785220243206e281046. eCollection 2024.

DOI:10.1590/1413-785220243206e281046
PMID:39802572
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11723518/
Abstract

OBJECTIVE

There are several conservative treatment options for adhesive capsulitis (AC), but no previous study combines hydrodilation, corticosteroid injection and joint manipulation under sedation (triple procedure), followed by daily home exercises.

METHODS

Patients included were evaluated before the procedure, at 30 days, 3, 6 and 12 months after treatment in prospective cohort. The outcomes used were the ASES, UCLA, SANE, VAS scales and passive range of motion (ROM).

RESULTS

65 shoulders of 63 patients were included. The mean ASES score progressed from 37.7 ± 17.9 to 94.1 ± 10.3 at 12 months after the procedure (p < 0.001). The mean UCLA went from 15.9 ± 5 to 33.2 ± 2.8 and SANE from 50.4 ± 18.3 to 94.3±9.0. At 12 months, the passive elevation improved from 114°±24° to 176° ± 6°, external rotation in neutral from 29° ± 17° to 72° ± 11° and internal rotation in neutral from 18.6 ± 3.6 points to 9.4 ± 2.4 points. No patient presented a fracture after manipulation.

CONCLUSIONS

Treatment with the triple procedure resulted in a statistically and clinically relevant improvement in functional results and gains in shoulder range of motion, with no reports of complications.

摘要

目的

粘连性关节囊炎（AC）有多种保守治疗方法，但此前尚无研究将液压扩张、皮质类固醇注射和镇静下的关节手法治疗（三联疗法）相结合，并在之后进行每日家庭锻炼。

方法

纳入的患者在手术前、治疗后30天、3个月、6个月和12个月进行前瞻性队列评估。使用的结果指标包括ASES、UCLA、SANE、VAS量表以及被动活动范围（ROM）。

结果

纳入了63例患者的65个肩部。术后12个月时，平均ASES评分从37.7±17.9提高到94.1±10.3（p<0.001）。平均UCLA评分从15.9±5提高到33.2±2.8，SANE评分从50.4±18.3提高到94.3±9.0。12个月时，被动抬高从114°±24°提高到176°±6°，中立位外旋从29°±17°提高到72°±11°，中立位内旋从18.6±3.6分提高到9.4±2.4分。手法治疗后无患者出现骨折。

结论

三联疗法治疗在功能结果和肩关节活动范围增加方面取得了统计学和临床意义上的改善，且无并发症报告。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/f38a5761f971/1809-4406-aob-32-06-e281046-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/a5e58c700237/1809-4406-aob-32-06-e281046-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/9c9d8072cc97/1809-4406-aob-32-06-e281046-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/6b7c2b448617/1809-4406-aob-32-06-e281046-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/f38a5761f971/1809-4406-aob-32-06-e281046-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/a5e58c700237/1809-4406-aob-32-06-e281046-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/9c9d8072cc97/1809-4406-aob-32-06-e281046-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/6b7c2b448617/1809-4406-aob-32-06-e281046-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e265/11723518/f38a5761f971/1809-4406-aob-32-06-e281046-f4.jpg

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