关节镜下关节囊松解联合术后早期封闭治疗冻结肩的疗效研究

Efficacy of regional block after arthroscopic release and manipulation in treatment of frozen shoulder

背景:冻结肩临床十分常见,肩关节的疼痛及活动受限严重影响患者的生活质量。患者可长期残留功能障碍。国内部分运动医学医师开始尝试用关节镜下关节囊松解清理治疗冻结肩。目的:探讨术后早期封闭联合关节镜下关节囊松解术治疗冻结肩的临床疗效。方法:回顾性研究2018年9月至2019年7月在我院因冻结肩行关节镜手术患者35例,均行全身麻醉下手法结合关节镜下关节囊松解术,术后早期予局部封闭结合被动活动度锻炼16例为研究组,另19例不行局部封闭治疗为对照组。记录所有患者的一般资料,包括年龄、性别、体重指数与病程。术前及术后1个月、3个月、6个月随访时Constant评分。结果:两组年龄、病程、体重指数和性别差异无统计学意义。所有患者术后Constant功能评分及患肩主动外展角度均较术前显著改善,两组Constant功能评分及患肩主动外展角度在术前、术后3个月、6个月时差异无统计学意义,但在术后1个月时,研究组Constant评分[(68.3±8.7)vs.(59.2±4.7),P<0.05]和患肩主动外展角度[(128.3±7.2)vs.(109.7±8.4),P<0.05]也显著高于对照组。结论:全身麻醉下手法结合关节镜下关节囊松解术治疗冻结肩临床疗效满意,且术后早期局部封闭能显著促进患者术后康复和较快改善关节活动度,提高生活质量。

Background: Frozen shoulders are very common in clinic, and pain and limited mobility of the involved shoulder severely affect patients’ quality of life. The literatures report that a considerable number of patients may have long-term residual dysfunction. In view of the current situation, some domestic sports medicine doctors have begun to try to release the frozen shoulder arthroscopically. Objective: To explore the clinical efficacy of regional block after arthroscopic release and manipulation in treatment of frozen shoulder under general anesthesia. Methods: A total of 35 patients, who were admitted for arthroscopic release and manipulation under general anesthesia between September 2018 and July 2019 were retrospectively reviewed including 16 patients with early regional block(study group) and 19 patients without regional block(control group). Patients’ data including age, gender, body mass index(BMI) and disease duration were recorded. Constant scores were recorded before operation and one, three and six months after operation. Results: There were no statistical differences in age, disease duration,BMI and gender between two groups. All Constant scores and abduction angles of the operation shoulder after the operation showed significant improvement compared with that before the operation in both groups. One month after operation, Constant score([68.3±8.7] vs. [59.2±4.7], P<0.05) and abduction angle of the operation shoulder([128.3±7.2] vs. [109.7±8.4],P<0.05)were significantly higher in study group than in control group. However, Constant scores and abduction angles of the operation shoulder at other time points after the operation showed no statistical differences between the two groups. Conclusions: Arthroscopic release and manipulation under general anesthesia can be a good choice for frozen shoulder patients with satisfactory clinical results and early postoperative regional block can significantly enhance recovery after operation and improve joint rangle of motion so as to promote the quality of life.