Ogilvie-Harris D J, Myerthall S
Division of Orthopaedic Surgery, Toronto Hospital, Canada.
Arthroscopy. 1997 Feb;13(1):1-8. doi: 10.1016/s0749-8063(97)90203-6.
Seventeen patients who were diabetics developed frozen shoulders which failed to respond to conservative management. They had persistent pain, stiffness, and limited function. An arthroscopic release was performed by progressively releasing the anterior structures from superior to inferior. Starting from the interval area we progressed to the anterior superior glenohumeral ligament, the intra-articular portion of the subscapularis, the anterior capsule, and the inferior capsule. Postoperatively physiotherapy was carried out daily to maintain the range of movement. At a follow up of 1 to 5 years the patients were assessed using the American Shoulder Society scheme. In addition the patients were assessed preoperatively and postoperatively on four criteria; pain, external rotation, abduction, and function. We found that the patients were statistically significantly improved in all four categories. Thirteen of the 17 patients had no pain, full range of motion compared with the opposite side, and full function. There was one poor result with no improvement. The remaining three patients had improved but still had residual abnormalities. We consider arthroscopic release to be an effective treatment for the resistant diabetic frozen shoulder.
17名糖尿病患者患上了肩周炎，且对保守治疗无效。他们持续疼痛、关节僵硬，功能受限。通过从上到下逐步松解前部结构进行关节镜下松解术。从间隙区域开始，我们依次松解了肩肱上韧带前部、肩胛下肌关节内部分、前关节囊和下关节囊。术后每天进行物理治疗以维持活动范围。在1至5年的随访中，使用美国肩肘外科协会的方案对患者进行评估。此外，在术前和术后根据疼痛、外旋、外展和功能这四项标准对患者进行评估。我们发现患者在所有四个类别中均有统计学意义上的显著改善。17名患者中有13名没有疼痛，与对侧相比活动范围正常，功能完全正常。有1例治疗效果不佳，没有改善。其余3名患者有所改善，但仍有残余异常。我们认为关节镜下松解术是治疗难治性糖尿病性肩周炎的有效方法。
