关节镜松解术结合麻醉下手法松解治疗冻结肩

Arthroscopic therapy combined with painless manipulation in patients with frozen shoulder

背景：冻结肩是临床常见疾病,治疗方法较多,大部分患者可以通过保守治疗治愈。而对于保守治疗无效的患者,目前有文献报道应用关节镜下松解结合麻醉下手法松解治疗,效果满意。目的：通过术前和术后肩关节活动度及疼痛程度的变化来评估关节镜松解术结合麻醉下手法松解治疗冻结肩的效果。方法：回顾性分析2011年1月至2013年12月接受关节镜松解术结合麻醉下手法松解治疗的21例冻结肩患者的病例资料。年龄48-67岁,平均55.85岁;男6例,女15例;左侧14例,右侧7例;原发性12例,继发性9例。所有患者均经6-18个月,平均11.23个月的保守治疗无效后行关节镜松解术结合麻醉下手法松解。结果：全部获得随访,随访时间为7-32个月,平均15.57个月。被动前屈、外展、外旋活动度由术前平均86.0°±10.8°,47.4°±7.5°,4.3°±7.8°提升至术后平均142.1°±11.8°,92.6°±12.1°,57.6°±19.8°（P〈0.001）。Constant-Murley肩关节功能评分从术前平均（12.9±2.1）分提高至术后平均（26.2±2.4）分。所有患者术后肩关节疼痛均有不同程度减轻。VAS评分由术前平均（7.4±1.1）分降至术后平均（2.5±1.0）分（P〈0.001）。结论：关节镜松解术结合麻醉下手法松解是治疗冻结肩的有效手段。

Background： Frozen shoulder is a common disorder, which is described as a self-limiting condition with spontaneous tendency to recover. To those patients in whom conservative treatment is failed, arthroscopic treatment combined with manipulation has been proven to be effective.Objective： To assess the changes of should joint range of motion and pain and investigate the clinical efficacy of frozen shoulder treated by arthroscopy and painless manipulation.Methods： Twenty one patients who underwent arthroscopic capsular release and painless manipulation for frozen shoulder between January 2011 and December 2013 were enrolled in the retrospective study. There were 6 males and 15 females with a mean age of 55.85 years（range; 48 to 67 years）. The left shoulder was involved in 14 cases and the right was involved in 7cases. Of them, 12 patients suffered from primary disease and 9 with secondary disease. Arthroscopic capsular release and painless manipulation was performed in all patients after a mean of 11.23 months of physical therapy（range, 6 to 18 months）.Results： The mean duration of follow-up was 15.57 months（range, 7 to 32 months）. The mean ROM of forward flexion, abduction, external rotation were significantly increased postoperatively as compared with preoperative ones（86.0°±10.8° vs.142.1°±11.8°, 47.4°±7.5° vs. 92.6°±12.1°, 4.3°±7.8° vs. 57.6°±19.8°, P〈0.001）. Preoperative Constant-Murley functional score was 12.9±2.1 and postoperative one was 26.2±2.4. Shoulder pain relieved to some extent. VAS score decreased from7.4±1.1（preoperative mean） to 2.5±1.0（postoperative mean, P〈0.001）.Conclusions： Arthroscopic capsule release and painless manipulation is an effective method for the treatment of frozen shoulder.