冻结肩治疗——麻醉下手法松解是否足够?

Treatment of frozen shoulder: is manipulation under anesthesia enough?

目的评价麻醉下手法松解(MUA)结合肩关节镜技术治疗冻结肩的临床疗效和技术特点。方法我院自2007年2月至2009年3月采用MUA结合肩关节镜治疗100例原发性冻结肩患者。其中男性35例,女性65例;平均年龄45.24±4.2岁;平均病程为8个月(3～20个月)。术前和术后均采用美国肩肘外科医师协会(ASES)评分和Constant-Murley评分对患者进行临床评估。结果术后2周、1个月、3个月、6个月和12个月定期随访,87例完成6个月随访,13例失访;35例完成12个月随访。根据ASES评分和Constant-Murley评分,术前、术后3个月及6个月评分有显著性差异(P<0.001),术后3个月与术后6个月评分无显著差异(P>0.05)。肩关节镜下发现,MUA对关节囊前方及前上方的松解程度不够,对关节囊下方的松解效果较好。结论 MUA结合肩关节镜技术治疗冻结肩的疗效肯定。肩关节镜技术有助于MUA后对前方关节囊的进一步松解,同时可明确诊断关节内伴有损伤,并进行处理。

Objective To evaluate the efficacy and technical aspects of manipulation under anesthesia （MUA） combined with shoulder arthroscopy for treating frozen shoulder. Methods From Feb. 2007 to Mar. 2009, 100 frozen shoulder patients （male 35, female 65） with an average course of 8 months （3 20 months） and an average age of 45.24 ± 4. 2 years had been treated with MUA technique combined with shoulder arthroscopy in our hospital. The American Shoulder and Elbow Surgeons （ASES） score and Constant-Murley score assessed before and after operation were used to evaluate the efficacy of the treatment. Results Follow-up assessments were taken at 2 weeks, 1 month, 3 months, 6 months and 12 months, respectively. Eighty-seven patients had finished the 6 months follow-up, of them 35 finished the 12 months follow-up. Thirteen patients were lost during follow up. Significant differences of ASES score and Constant-Murley score were seen before and either 3 or 6 months after operation （P〈 0. 001）, while no significant differences were found between the 3 and 6 months scores （P〉0. 05）. Shoulder arthroscopy showed that there was no enough release of anterior and superior adhesion of the joint capsule by MUA, in contrast the release of inferior adhesion was better. Conclusions MUA combined with arthroseopy is an excellent approach for treating frozen shoulder. Shoulder arthroseopy can further release the anterior adhesion. Meanwhile, it can also clearly define and manage the intrinsic injury of shoulder.