麻醉下手法松解治疗冻结期冻结肩的临床研究

A Clinical Study Of Treatment For Frozen Shoulder In The Stiff Phase With Manipulation Under Anaesthesia

目的：观察麻醉下手法松解治疗冻结期冻结肩的临床疗效。方法：自2006年3月至2009年2月对68例（68肩）冻结期冻结肩患者采用麻醉下手法松解治疗，其中男21例，女47例；平均年龄51．65±4．75（43—68）岁，平均病程7．60±1．88（5—13）个月。68例患者均符合Zuckerman提出的冻结肩诊断标准，治疗前均有至少3（3—12）个月的非手术治疗史。治疗前后采用UCLA评分进行评估，应用SPSSl3．0统计软件进行统计学处理。结果：68例患者治疗后2周和3个月进行随访，治疗前UCLA评分为13．04±2．34分；治疗后2周时为31．35±2．28分，3个月时为34．15±1．08分。t检验：2周时：t=-18．31，Pd0．01；3个月时：t=-67．493，P〈0．01）。疗效评定：治疗后2周时：优15例（22．06％），良52例（76．47％）、可1例（1．47％）；3个月时优49例（72．06％），良19例（27．94％）。有35例患者均获得较长时间的随访，平均随访30．77士9．37（16—52）个月。治疗前UCLA评分为13．11土2．34分，最终随访时为34．66±0．64分，t检验：t=-52．36，P〈0．01。疗效评定：优34例（97．14％），良1例（2．86％）。结论：麻醉下手法松解对于非手术治疗无效的冻结期冻结肩患者是一种安全有效的方法，可在短时期内明显地减轻疼痛和恢复关节活动，缩短冻结肩的病程。

Objective：To evaluate the effect of frozen shoulder in the stiff phase treated by manipulation under anaesthesia. Methods：68 cases（68 shoulders）with frozen shoulder in the stiff phase were treated by manipulation under anaesthesia from 2006 to 2009. The 68cases include 21 males and 47 females with age ranging from 43 to 68 years with an average of（51.65±4.75）years. The course was from 5 to 13 months with an average of（7.60±1.88）months. All of the 68 cases fulfilled the Zuckerman＇s diagnostic criteria for frozen shoulder, and had undergone at least 3 （3-12） months of an appropriate nonoperative treatments before the MUA. UCLA score was used to evaluate the effect before and after MUA, and the statistics analysis was carried out with SPSS13.0. Re- suits：All of those patients had been followed up 2 weeks and 3months, the average UCLA scoreincreased from 13.04 ±2.34 preoper- atively to 31.35±2.28 postoperatively 2 weeks and 34. 15 ±1.08 postoperatively 3 months, significant difference were found between preop and postop evaluation, t- test ： 2 weeks ： t= - 18.31, P〈0.01 ; 3 months ： t= - 67. 493, P〈0.01. Therapeutic evalua- tion：excellent results were obtained in 15（22.06%）cases,good in 52（76.47%） ,and fair in one case（1.47%）at 2 weeks ; excellent in 49（72.06%）and good in 19（27.94%）at 3months. 35 cases had been followed up for a longer period,from 16 to 52 months with an average o（（30.77±9.37）months, the average UCLA score increased from 13.11±2.34 preoperatively to 34.66 ±0.64 postoperatively, significant difference was found between preop andpostop evaluation in the last followed up. t-test： t= -52.36, P〈0.01. Therapeutic evaluation：excellent in 34 （97.14 % ）and good in 1 （2.86% ）cases. Conclusion： Manipulation under anaesthesia is a safe and effective procedure in the management of frozen shoulder in the stiff phase which is unresponsive to the nonoperative treatments. It can relief pain and recover the range of motion significantly and rapidly,shorten the duration of the frozen shoulder.