肩关节镜松解术联合关节腔内几丁糖注射治疗原发性冻结肩

Arthroscopic release combined with intraarticular injection of chitosan for primary frozen shoulder

[目的]比较关节腔内注射医用几丁糖联合肩关节镜下松解术与单纯肩关节镜下松解术治疗原发性冻结肩的临床疗效。[方法]选取2014年6月～2015年12月本院收治的原发性冻结肩患者46例,均采用肩关节镜下行松解术,根据关节腔内是否注射医用几丁糖将患者分为两组,其中23例患者接受关节镜松解术联合几丁糖关节腔内注射治疗(几丁糖组);另外23例患者仅接受单纯关节镜松解术治疗,未行几丁糖关节腔内注射(非几丁糖组),比较两组术后肩关节疼痛视觉模拟评分(VAS)、美国肩肘外科医师协会(ASES)肩关节功能评分和UCLA肩关节功能评分等评估指标。[结果] 46例患者均顺利完成肩关节镜下松解术。术后1个月随访时,几丁糖组和非几丁糖组患者术后VAS评分、ASES评分、UCLA评分均较术前明显改善,差异有统计学意义(P<0.05)。两组间比较丁糖组VAS评分、ASES评分及UCLA评分均优于非几丁糖组,差异具有统计学意义(P<0.05);术后1年时,两组间VAS评分、ASES评分及UCLA评分差异均无统计学意义(P>0.05)。[结论]肩关节镜下松解术治疗冻结肩可显著提高术后肩关节功能,术中及术后多次联合关节腔内注射医用几丁糖可在一定程度上提高冻结肩短期治疗效果。

[Objective] To compare the clinical outcomes of arthroscopic release combined with or without intra-articular injection of chitosan for primary frozen shoulder. [Methods] From June 2014 to December 2015, 46 patients with primary frozen shoulder underwent arthroscopic release. According to whether or not ehitosan injected intraarticularly, the patients were divid- ed into 2 groups, including the chitosan group in which 23 patients received arthroscopic release combined the intraarticular in-jection of chitosan, the non-chitosan group in which another 23 patients had arthroscopic release only. The visual analogue scales （VAS） of pain, American Shoulder and Elbow Surgeons （ASES） score, as well as University of California at Los Angeles （UCLA） score were compared between the two groups. [Results] All the 46 patients had surgical procedures performed smooth- ly. At 1 month after operation, the VAS significantly decreased, while the ASES score and UCLA score significantly increased compared with those before operation in the both groups, where were statistically significant between the two time points （P〈 0.05） . Compared between the two groups, the ehitosan group was statistically superior to the non-chitosan group regarding to VAS, ASES and UCLA scores at 1 month postoperatively （P〈0.05） . However, there were on statistical differences in VAS, ASES and UCLA scores between the two groups at 1 year after operation （P〉0.05）. [Conclusion] Arthroscopic release does sig- nificantly enhance the shoulder function for primary frozen shoulder, while it combined with intraarticular injection of chitosan further improve the short term outcome to a certain extent.