关节镜下肩袖修复术后对僵硬患者进行皮质类固醇注射与修复联合关节囊松解术的临床结局相似：一项前瞻性随机临床试验。
Postoperative Corticosteroid Injection After Arthroscopic Rotator Cuff Repair in Patients With Stiffness Has Similar Clinical Outcome Compared With Repair Combined With Capsular Release: A Prospective Randomized Clinical Trial.
作者信息
Lee Hyo-Jin, Yoon Eun-Ji, Lee Jung-Woo, Kim Jong-Ik, Kim Jong-Ho
机构信息
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
出版信息
Arthroscopy. 2025 Aug;41(8):2809-2818. doi: 10.1016/j.arthro.2025.02.014. Epub 2025 Feb 25.
PURPOSE
To investigate whether 2 months of a postoperative intra-articular corticosteroid injection after arthroscopic rotator cuff repair (ARCR) in rotator cuff tear (RCT) patients with stiffness would improve the functional scores and range of motion of the operated shoulder without capsular release during ARCR.
METHODS
From March 2020 to September 2021, a total of 73 patients who had RCT with stiffness and were scheduled for ARCR were enrolled prospectively and randomly allocated into 2 groups. The patients who underwent ARCR with capsular release were allocated to group 1 (n = 37). The patients who underwent ARCR without capsular release and were injected with 1 mL triamcinolone acetate (40 mg/1 cc) into the glenohumeral joint 2 months after surgery were allocated to group 2 (n = 36). Functional scores and shoulder range of motion were evaluated before surgery; 3, 6, and 12 months after surgery; and at the last follow-up. Magnetic resonance imaging was performed at 12 months postoperatively.
RESULTS
The mean follow-up period was 26.5 months. The functional and visual analog score (VAS) pain scores in both groups were significantly improved at the last follow-up (P < .001). The 3-month postoperative VAS pain score of group 2 was significantly lower than that of group 1 (group 1, 3.4 ± 1.5; group 2, 2.1 ± 1.0; P <.001). VAS pain scores at 6 months or 12 months or at the last follow-up and functional scores and ROM at 3, 6, or 12 months or at the last follow-up were not significantly different between the 2 groups (P > .05). The retear rate of repaired rotator cuff during follow-up was not significantly different between the 2 groups (P = .71).
CONCLUSIONS
Corticosteroid injection in the glenohumeral joint performed 2 months after ARCR in RCT patients with stiffness is as effective as capsular release during ARCR for improving the clinical outcome of the operated shoulder.
LEVEL OF EVIDENCE
Level I, prospective randomized clinical trial.
目的
探讨在关节镜下肩袖修补术（ARCR）后，对存在僵硬的肩袖撕裂（RCT）患者进行2个月的术后关节内注射皮质类固醇，是否能在不进行ARCR期间关节囊松解的情况下，改善手术肩部的功能评分和活动范围。
方法
从2020年3月至2021年9月，共有73例患有僵硬的RCT且计划进行ARCR的患者被前瞻性地纳入并随机分为2组。接受关节囊松解的ARCR患者被分配到第1组（n = 37）。接受无关节囊松解的ARCR且在术后2个月向盂肱关节注射1 mL醋酸曲安奈德（40 mg/1 cc）的患者被分配到第2组（n = 36）。在手术前、术后3、6和12个月以及最后一次随访时评估功能评分和肩部活动范围。术后12个月进行磁共振成像。
结果
平均随访期为26.5个月。两组在最后一次随访时的功能和视觉模拟评分（VAS）疼痛评分均显著改善（P <.001）。第2组术后3个月的VAS疼痛评分显著低于第1组（第1组，3.4 ± 1.5；第2组，2.1 ± 1.0；P <.001）。两组在6个月或12个月或最后一次随访时的VAS疼痛评分以及在3、6或12个月或最后一次随访时的功能评分和活动范围均无显著差异（P >.05）。两组在随访期间修复的肩袖再撕裂率无显著差异（P =.71）。
结论
对于存在僵硬的RCT患者，在ARCR后2个月进行盂肱关节内皮质类固醇注射，在改善手术肩部的临床结果方面与ARCR期间进行关节囊松解一样有效。
证据水平
I级，前瞻性随机临床试验。
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