微创手术与药物治疗对早期原发性冻结肩患者近期和远期效果的比较

Comparison of short-term and long-term efficacy of minimally invasive surgery and medication for early primary frozen shoulder

目的比较微创手术与药物治疗对早期原发性冻结肩(PFS)患者的近期和远期效果。方法选取2014年6月-2015年9月该科收治入院的82例PFS患者为研究对象,随机分为药物组与手术组两组,各41例。对照组患者行关节腔内固醇激素注射治疗,观察组患者行关节镜下盂肱关节与肩峰下间隙的清理松解术。比较两组的基线资料、治疗前后的视觉模拟评分(VAS)、Constant肩关节评分、内旋、外旋、外展、前屈的主动关节活动度(ROM)。结果两组的基线资料、治疗前的VAS评分、Constant肩关节评分、主动ROM比较,差异无统计学意义(P>0.05),具有可比性。与治疗前相比,两组患者治疗后的VAS评分均明显降低,Constant肩关节评分、主动ROM均明显升高,差异有统计学意义(P<0.05)。在治疗后4周,手术组患者的VAS评分明显高于药物组,Constant肩关节评分、主动ROM明显低于药物组,差异有统计学意义(P<0.05)。在治疗后12周、半年和1年,手术组患者的VAS评分明显低于药物组,Constant肩关节评分、主动ROM明显高于药物组,差异有统计学意义(P<0.05)。结论肩关节镜下微创手术与药物注射都是早期PFS患者的有效治疗方法,药物注射的近期疗效显著,但远期疗效较差,而微创手术的远期效果更加突出,配合术后的药物口服和康复锻炼能显著改善其肩关节功能和生活质量,值得临床推广应用。

Objective To compare the short-term and long-term efficacy of minimally invasive surgery and medication for early primary frozen shoulder （PFS）. Methods 82 patients with PFS from June 2014 to September 2015 were enrolled in the study and randomly divided into drug group and operation group, 41 cases in each. Patients in drug group were given steroid hormone intraarticular injection therapy while in operation group, patients were given arthroscopic clearance and release for glenohumeral joint and subacromial space. The baseline data, scores of visual analogue scale （VAS） and constant shoulder joint, active range of motion （ROM） of internal rotation, external rotation, abduction and flexion. Results There were no significant differences in baseline data, scores of VAS and constant shoulder joint, active range of motion （ROM） before treatment between the two groups （P 〉 0.05）. Compared with them before treatment, the VAS scores of the two groups decreased significantly after treatment while constant shoulder score and active ROM increased significantly （P 〈 0.05）. At 4 weeks after treatment, VAS scores in operation group was significantly higher than that in drug group, constant shoulder score and active ROM was significantly lower than that in drug group （P 〈 0.05）. At 12 weeks, 6 months and 1 year after treatment, VASscore in the operation group was significantly lower than that in drug group, constant shoulder score and active ROM was significantly higher than that in drug group （P 〈 0.05）. Conclusions Arthroscopic minimally invasive surgery and drug injection are all effective treatments for early PFS patients. The short-term efficacy of drug injection was significantly better, but the long-term effect was poor. Instead, the long-term effect of minimally invasive surgery was more prominent, and combined with oral drugs and postoperative rehabilitation could significantly improve shoulder joint function and the quality of life, which is worthy of promoting clinical application.