Pollock R G, Duralde X A, Flatow E L, Bigliani L U
Shoulder Service, New York Orthopaedic Hospital, Columbia Presbyterian Medical Center, New York, NY.
Clin Orthop Relat Res. 1994 Jul(304):30-6.
Arthroscopy serves as a useful adjunct to manipulation under anesthesia in the treatment of resistant frozen shoulder. In this technique the shoulder is manipulated under interscalene brachial plexus block anesthesia, followed by arthroscopic examination and debridement of the glenohumeral joint and the subacromial space. The addition of arthroscopy allows the identification and treatment of associated pathology, such as impingement lesions and secondary subacromial space inflammation, calcific deposits, and acromioclavicular arthritis. Range of motion can also be increased by arthroscopically guided sectioning of the coracohumeral ligament. This treatment regimen has yielded overall satisfactory results in 25 (83%) of 30 shoulders in this series. The subgroup with diabetes mellitus fared less well than the other groups, with only 64% satisfactory results. While most patients with frozen shoulder will respond to nonoperative treatment, the technique of manipulation under anesthesia followed by arthroscopy offers a safe and reliable treatment for the resistant frozen shoulder.
关节镜检查是治疗难治性肩周炎时麻醉下手法治疗的有用辅助手段。在该技术中，在肌间沟臂丛神经阻滞麻醉下对肩部进行手法操作，随后进行关节镜检查以及对盂肱关节和肩峰下间隙进行清创。关节镜检查的加入使得能够识别和治疗相关病变，如撞击性损伤、继发性肩峰下间隙炎症、钙化沉积物和肩锁关节炎。通过关节镜引导下切断喙肱韧带，还可以增加活动范围。在本系列的30个肩部中，这种治疗方案在25个（83%）肩部取得了总体满意的结果。糖尿病亚组的效果不如其他组，只有64%的结果令人满意。虽然大多数肩周炎患者对非手术治疗有反应，但麻醉下手法操作后再进行关节镜检查的技术为难治性肩周炎提供了一种安全可靠的治疗方法。
