Ⅰ期关节镜治疗肩袖损伤合并冻结肩的疗效评价

目的评价Ⅰ期关节镜下缝线桥技术联合粘连松解术治疗肩袖损伤合并冻结肩患者的疗效.方法选择2014年6月至2017年6月治疗的肩袖损伤合并冻结肩患者75例,根据是否关节镜下Ⅰ期直接行粘连松解、肩袖修补,分为Ⅰ期治疗组(Ⅰ期组,36例)和延迟治疗组(延迟组,39例),比较两组患者手术前后肩关节疼痛视觉模拟评分(VAS)、关节活动范围(ROM)、UCLA和Constant肩关节功能评分,并在术后24个月使用超声或MRI评价两组患者肩袖的完整性.结果延迟组术前ROM和肩关节功能评分优于Ⅰ期组(P<0.05),两组术前其余指标差异无统计学意义(P>0.05);两组术后各时间点的VAS评分、UCLA和Constant肩关节功能评分均明显优于术前(P<0.05);Ⅰ期组术后各时间点ROM均优于术前(P<0.05);延迟组术后6周时ROM与术前比较,差异无统计学意义(P>0.05),其余术后各时间点ROM均优于术前(P<0.05);术后24个月Ⅰ期组术后再撕裂2例,延迟组再撕裂3例,差异无统计学意义(P>0.05).结论对于肩袖损伤合并冻结肩患者,延迟手术治疗并无明显优势,采用Ⅰ期关节镜下缝线桥技术联合粘连松解术治疗肩袖损伤合并冻结肩,可以缩短治疗时间,取得良好的临床疗效.

Objective To evaluate the clinical results of one-stage arthroscopic procedure for the treatment of rotator cufF tears with frozen shoulder by using a suture bridge technique and concomitant glenohumeral joint capsule release.Methods During June 2014 to June 2017,75 patients with rotator cuff tears and frozen shoulder were recruited.36 patients were performed with arthroscopic rotator cuff repair and capsular release simultaneously(one—stage group).39 patients were treated with preoperative rehabilitation for frozen shoulder before arthroscopic rotator cufF repair(delayed group).The visual analogue scale(VAS)score,range of motion(ROM),and University of California at Los Angeles(UCLA)shoulder score,Constant—Murley(Constant)shoulder score were recorded preoperatively,and postoperatively,Repair integrity was determined at 24 months using ultrasound or MRI.Results There was no significant difference in baseline data between two groups preoperatively(P>0.05),excepted for ROM in the delayed group(P<0.05).The VAS score,UCLA and Constant shoulder score at 6 weeks,3 months,6 months and 24 months in both group were improved than that of before surgery(P<0.05),and there was no significant difference between two groups postoperatively(P>0.05).ROM was improved in both groups postoperatively(P<0.05),excepted for that in the delayed group at 6 weeks.There were 2 cases o f retear in the one-stage group,and 3 cases in the delayed group(P>0.05).Conclusion For the patients with rotator cufF injury combined with frozen shoulder,there is no obvious advantage of delayed operation.The treatment of rotator cufF injury combined with frozen shoulder can shorten the treatment time and achieve good clinical effect by using the first stage arthroscopic suture bridge technology combined with adhesion and release operation.