液压扩张联合手法松解治疗粘连性肩关节囊炎的疗效观察

Clinical Study of Treatment for Frozen Shoulder with Manipulation Release and Hydraulic Pressure Distension

目的探讨液压扩张联合手法松解治疗粘连性肩关节囊炎（冻结肩）的疗效。方法78例冻结肩患者随机分为三组，单纯手法松解组28例行臂丛神经阻滞麻醉下手法松解，手法松解＋透明质酸钠组23例行手法松解后患侧肩关节腔内注射透明质酸钠，手法松解＋液压扩张组27例行手法松解后G臂机引导下患侧肩关节穿刺0．9％氯化钠注射液液压扩张。比较三组患者治疗前后及治疗6个月后随访评分、有效率、疼痛与肩功能评分情况。结果三组患者治疗后肩关节评分、疼痛缓解情况等与治疗前比较，差异均有统计学意义（均P〈0．05）；手法松解＋液压扩张组治疗有效率（92．6％）均优于单纯手法松解组（78．6％）和手法松解＋透明质酸钠组（82．6％）（均P〈0．05），三组治疗后肩关节功能评分（83．6、71．8、74．5）之间差异无统计学意义（P〉0．05），未发生严重并发症。结论臂丛神经阻滞麻醉下手法松解联合液压扩张治疗冻结肩有效、安全。

Objective To investigate the effect of treatment for frozen shoulder by manipulation release combined with hydraulic pressure distension. Methods In this randomized trial, 78 patients with frozen shoulder syndrome randomly divided into three groups were enrolled in the study. 28 patients were treated by manipulation release under interscalene brachial plexus anesthesia. 23 patients were treated by sodium hyaluronate injection into glenohumeral joint combined with manipulation release. 27 patients were treated by hydraulic pressure distension combined with manipulation release. All patients were followed for six months. Effective rate evaluation combined with pain evaluation and functional evaluation were adopted for final evaluation. Results There were significant difference between pre-treatment and post-treatment in each group. Effective rate of hydraulic pressure distension combined with manipulation release was 92.6%, which was superior to manipulation release （78.6%） and sodium hyaluronate injection combined with manipulation release （ 82. 6% ）. There were no significant difference in functional evaluation of the three groups. Conclusion Hydraulic pressure distension combined with manipulation release under interscalene brachial plexus anesthesia is a successful treatment for idiopathic frozen shoulder.