关节镜下粘连松解术治疗原发性冻结肩患者的临床效果分析

Analysis of the clinical effect of arthroscopic adhesiolysis in the treatment of patients with primary frozen shoulder

目的探究关节镜下粘连松解术对原发性冻结肩患者的临床效果及对患者肩关节功能的影响。方法对民航总医院2017年3月—2018年7月就诊的54例原发性冻结肩患者的临床资料进行回顾性分析,其中男性11例,女性43例;年龄(47.6±12.2)岁,年龄范围41~64岁。依据治疗方案不同分为研究组和对照组,每组27例,对照组患者采用常规的保守治疗措施,研究组在对照组的基础上采用关节镜下粘连松解术进行治疗。比较两组患者的肩关节活动情况(前屈、外展、体侧外旋的活动角度范围),Constant评分、加州大学洛杉矶分校(UCLA)评分、肩关节疼痛视觉模拟(VAS)评分以及两组患者的并发症(主要包括关节感染、关节僵硬、血管神经损伤以及肩周疼痛等)发生情况。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料采用百分比(%)表示,组间比较采用χ^2检验。结果研究组术后前屈(160.2±20.7)°,外展(163.6±20.1)°,体侧外旋(50.5±8.9)°;对照组治疗后前屈(119.5±19.5)°,外展(121.2±19.5)°,体测外旋(35.6±6.4)°,研究组患者的肩关节活动情况与对照组相比显著较好,两组比较差异具有统计学意义(P<0.05)。研究组术后Constant评分为(83.1±9.3)分,UCLA评分为(31.7±3.1)分,VAS评分为(2.8±0.3)分;对照组治疗后Constant评分为(71.7±9.7)分,UCLA评分为(22.8±3.6)分,VAS评分为(4.4±0.3)分,研究组患者的Constant评分、UCLA评分与对照组相比显著较高,VAS评分明显较低,差异均具有统计学意义(P<0.05)。两组患者并发症的发生率比较差异无统计学意义(P>0.05)。结论对于原发性冻结肩的患者采用关节镜下粘连松解术进行治疗,能够明显提升患者的肩功能,同时该手术与常规保守治疗相比较临床效果显著,有利于在临床中应用与推广。

Objective To investigate the elinical outcomes of arthroscopic adhesiolysis on patients with primary frozen shoulder and its effect on shoulder joint funection.Methods The elinical data of 54 patients with primary frozen shoulder who visited Civil Aviation General Hospital from March 2017 to July 2018 were retrospectively analyzed.According to diferent treatment regimens,the patients were divided into a study group and a control group,with 27 patients in each group,there were 11 males and 43 females,aged(47.6±3.4)years,and the age ranged from41 to 64 years.Patients in the control group were treated with conventional conservative treatment measures,and patients in the study group were treated with loose adhesion under arthroscope on the basis of the control group.The shoulder joint activity(range of motion angles for flexion,abduction and lateral rotation),Constant score,UCLA score and VAS score as well as the complications of the two groups were compared.The measurement data were expressed as mean±standard deviation(Mean±SD),the 1 test was used for comparison between groups.The count data were expressed as percentage and the chi-square test was used for comparison between groups.Results In the study group,postoperative anterior flexion,abduction,lateral external rotation were(160.2±20.7)°,(163.6±20.1)°,(50.5±8.9)°,respectively.The patients in the control group experienced(119.5±19.5)°of anterior flexion,(121.2±19.5)°of abduction,(35.6±6.4)°of lateral external rotation.After treatment,the activity of the shoulder joint in the study group was significantly better than that in the control group,there were stistially signifcant difrences between the two groups(P<0.05).In the study group,the postoperative Constant score was(83.1±9.3)scores,VAS score was(2.8±0.3)scores,UCLA score was(31.7±3.1)scores;in the control group,the postoperative Constant score was(71.7±9.7)scores,VAS score was(4.4±0.3)scores,UCLA score was(22.8±3.6)scores(P<0.05).Compared with the control group,the Constant score and UCLA score in the study group were significantly higher,and the VAS score was significantly lower,differences were statistically signifcant(P<0.05).The difference in the incidence of compliceations between the two groups was not statistically significant(P>0.05).Conclusions For patients with primary frozen shoulder,arthroscopie adhesiolysis can significantly improve the shoulder function of patients.At the same time,this operation has significant clinical treatment efect,which is conducive to the clinical application and promotion.