关节镜清理联合一期手法松解治疗肩袖撕裂合并冻结肩的临床观察

Clinical observation of arthroscopic debridement combined with one-stage manipulation release to treat rotator cuff tear and frozen shoulder

目的探讨关节镜清理联合一期手法松解治疗肩袖撕裂合并冻结肩的临床效果,为肩袖撕裂合并冻结肩的治疗提供指导。方法选取2016年7月至2018年12月期间于上海市静安区闸北中心医院行肩关节镜手术的肩袖撕裂合并冻结肩患者56例作为研究对象。按照随机数表法分为对照组和观察组各28例。对照组患者仅采取关节镜清理的治疗方法,观察组患者采取关节镜清理联合一期手法松解的治疗方法。随访6个月,比较两组患者的手术时间、术中出血量、术后住院时间和并发症发生情况,术前和术后1、6个月的疼痛视觉模拟评分(VAS)、美国肩肘协会评分系统(ASES)和肩关节外旋和前屈活动度。结果观察组患者的手术时间为(76.25±6.11)min,明显长于对照组的(72.19±5.38)min,术中出血量为(79.76±6.62)mL,明显多于对照组的(65.25±5.42)mL,差异均有统计学意义(P<0.05);术后6个月,两组患者的VAS评分与术前及术后1个月相比均明显降低,且观察组VAS评分为(1.85±0.67)分,明显低于对照组的(2.26±0.68)分,差异均有统计学意义(P<0.05);术后6个月,两组患者的ASES评分与术前及术后1个月相比均明显升高,且观察组ASES评分为(95.28±6.28)分,明显高于对照组的(88.43±6.51)分,差异均有统计学意义(P<0.05);术后6个月,两组患者的外旋和前屈活动度与术前及术后1个月相比均明显升高,且观察组外旋和前屈活动度分别为(54.29±5.23)°和(157.45±9.26)°,明显大于对照组的(50.26±6.17)°和(145.62±9.81)°,差异均有统计学意义(P<0.05);两组患者在术中和术后均未出现肩关节不稳定、神经损伤和与手法松解相关的并发症。结论关节镜清理联合一期手法松解能够更大程度减轻患者疼痛,提高患者肩关节功能,值得临床推广。

Objective To explore the clinical effect of arthroscopic debridement combined with one-stage manipulation release to treat rotator cuff tear and frozen shoulder, and to provide guidance for the disease. Methods A total of 56 patients with rotator cuff tears and frozen shoulders, who admitted to Department of Orthopedics, the Jing’an District Zhabei Central Hospital of Shanghai City from July 2016 to December 2018, were selected as the study subjects.According to random number table method, the patients were divided into the control group and the observation group,with 28 cases in each group. The patients in the control group were only treated with arthroscopic debridement, and the patients in the observation group were treated with arthroscopic debridement combined with one-stage decompression release. After 6 months of follow-up, the operation time, intraoperative blood loss, postoperative hospital stay and complications were compared between the two groups. The pain visual analogue scale(VAS), the American Shoulder and Elbow Association Scoring System(ASES) and the shoulder joint external rotation and flexion mobility were performed before and 1 and 6 months after surgery. Results The operation time of the observation group was(76.25±6.11) min,which was significantly longer than(72.19±5.38) min of the control group, and the intraoperative blood loss was(79.76±6.62) mL, which was significantly higher than(65.25±5.42) mL of the control group(all P<0.05);6 months after operation, the VAS scores of the two groups were significantly lower than those before and 1 month after operation, and the VAS scores of the observation group was(1.85±0.67) points, which was significantly lower than(2.26±0.68) points of the control group(P<0.05);the ASES scores of the two groups were significantly higher than those of the preoperative and postoperative months, and the ASES scores of the observation group was(95.28±6.28) points, which was significantly higher than(88.43±6.51) points of the control group(P<0.05);the activities of pronation and flexion in both groups were significantly higher than that before and 1 month after operation, and the activities of pronation and flexion in the observation group were(54.29±5.23)° and(157.45±9.26)° respectively, which were significantly higher than corresponding(50.26±6.17)° and(145.62±9.81)° in the control group(P<0.05). There was no shoulder instability, nerve injury, and complications associated with manual release during and after surgery in two groups. Conclusion Arthroscopic debridement combined with the one-stage manipulation release can reduce the pain of patients, and improve the shoulder function of patients more, which is worthy of clinical promotion.