Warner J J, Allen A, Marks P H, Wong P
Shoulder Service, Center for Sports Medicine, University of Pittsburgh, Pennsylvania 15213, USA.
J Bone Joint Surg Am. 1996 Dec;78(12):1808-16. doi: 10.2106/00004623-199612000-00003.
Idiopathic adhesive capsulitis usually responds to gentle physical therapy or, if that fails, to closed manipulation with the patient under anesthesia. In some patients, however, loss of motion may be refractory to either of these treatments and an operative release may be indicated. We are reporting on the technique and results of arthroscopic capsular release as a new alternative for the management of such patients. During a three-year period, we managed twenty-three patients who had idiopathic adhesive capsulitis that had failed to respond to physical therapy or closed manipulation. These patients had an arthroscopic anterior capsular release and received forty-eight hours of intensive physical therapy as inpatients. During the physical therapy, the patients received an interscalene regional analgesic with use of repeated nerve blocks or with a continuous infusion through an interscalene catheter. This was followed by a supervised outpatient physical-therapy program. Six patients also had an arthroscopic acromioplasty for the treatment of impingement. There were no complications related to any of the procedures. At a mean of thirty-nine months (range, twenty-four to sixty-four months) after the arthroscopic procedure, the improvement in the score of Constant and Murley averaged 48 points (range, 13 to 77 points). The mean improvement in motion was 49 degrees (range, 0 to 105 degrees) for flexion; 42 degrees (range, 10 to 80 degrees) and 53 degrees (range, 0 to 100 degrees) for external rotation in adduction and abduction, respectively; and eight spinous-process levels (range, three to fourteen levels) and 33 degrees (range, 30 to 60 degrees) for internal rotation in adduction and abduction, respectively. These gains in motion were all significant (p < 0.01) compared with the preoperative values and were within a mean of 7 degrees of the values for the contralateral, normal shoulder. We concluded that, in patients who have loss of motion that is refractory to closed manipulation, arthroscopic capsular release improves motion reliably with little operative morbidity.
特发性粘连性关节囊炎通常对轻柔的物理治疗有效，若治疗失败，则可在麻醉下对患者进行闭合手法治疗。然而，部分患者的活动受限对这两种治疗均无效，此时可能需要进行手术松解。我们报告关节镜下关节囊松解技术及其结果，作为治疗此类患者的一种新选择。在三年期间，我们治疗了23例对物理治疗或闭合手法治疗无效的特发性粘连性关节囊炎患者。这些患者接受了关节镜下前方关节囊松解，并作为住院患者接受了48小时的强化物理治疗。在物理治疗期间，患者通过重复神经阻滞或经肌间沟导管持续输注接受肌间沟区域镇痛。随后是有监督的门诊物理治疗计划。6例患者还接受了关节镜下肩峰成形术以治疗撞击症。未发生与任何手术相关的并发症。关节镜手术后平均39个月（范围为24至64个月），Constant和Murley评分平均提高48分（范围为13至77分）。活动度的平均改善为：屈曲49度（范围为0至105度）；内收和外展时外旋分别为42度（范围为10至80度）和53度（范围为0至100度）；内收和外展时内旋分别为8个棘突水平（范围为3至14个水平）和33度（范围为30至60度）。与术前值相比，这些活动度的增加均具有显著意义（p < 0.01），且与对侧正常肩部的值平均相差7度以内。我们得出结论，对于闭合手法治疗无效的活动受限患者，关节镜下关节囊松解能可靠地改善活动度，且手术并发症少。
