老年肩袖损伤合并肩关节粘连患者关节镜手术或关节腔注射治疗中短期疗效比较

Comparison of short-and mediuni-term efficacy of arthroscopic surgery versus intra-articular injections for rotator cuff tears with concomitant shoulder stiffness in elderly patients

目的比较关节镜手术和关节腔注射对老年肩袖损伤合并肩关节粘连患者的中短期治疗效果。方法回顾性分析2015年1月至2017年6月在北京医院骨科行关节镜手术(手术组,56例)或关节腔注射(对照组,60例)的老年肩袖损伤合并肩关节粘连患者。比较两组患者在治疗前、治疗后3、6及12个月视觉模拟评分(VAS)、肩关节前屈上举和体侧外旋活动度以及美国肩肘协会评分(ASES)和美国加州大学肩关节功能评分(UCLA)的情况。结果两组患者治疗后VAS评分较治疗前降低(P<0.05),肩关节活动度及ASES和UCLA功能评分较治疗前提高(P<0.05)。治疗后3个月,手术组患者VAS评分高于对照组(P<0.05),肩关节活动度差异无统计学意义(P>0.05),ASES及UCLA功能评分低于对照组(P<0.05)。治疗后6及12个月,手术组患者VAS评分低于对照组(P<0.05),肩关节活动度优于对照组(P<0.05),ASES及UCLA功能评分均高于对照组(P<0.05)。结论老年肩袖损伤合并肩关节粘连患者通过关节镜手术或关节腔注射治疗均可缓解疼痛、提高肩关节活动范围、改善关节功能;手术治疗患者6个月后其改善程度优于关节腔注射。

Objective To compare the short and medium-term effects of arthroscopic surgery versus intra-articular injections for rotator cuff tears with concomitant shoulder stiffness in elderly patients.Methods We performed a retrospectively study that included 116 patients with rotator cuff tears combined with shoulder stiffness between January 2015 and June 2017,with 56 patients receiving arthro.scopic.surgery(the surgery group)and 60 patients given intra-articular injections(the control group).The visual analogue scale(VAS)score,range of motion(ROM),American Shoulder and Elbow Surgeons(ASES)score,University of California Los Angeles(UCLA)score were recorded before treatment and 3,6 and 12 months after treatment.Results Compared with pre-treatment,VAS scores were lower and ROM,ASES and UCLA scores were higher in both groups after treatment(P<0.05).At 3 months after treatment.VAS.scores were higher and ASES and UCLA scores were lower in the surgery group than in the control group(P<0.05),while there was no significant difference in ROM between the two groups(P>0.05).At 6 and 12 months after treatment,VAS scores were lower,ROM was larger,and ASES and UCLA scores were higher in the surgery group than in the control group(P<0.05).Conclusions In patients with rotator cuff tears combined with shoulder stiffness,both arthroscopic surgery and intra-articular injections can alleviate pain and improve ROM and shoulder joint function.After 6 months of treatment,greater improvement is achieved in patients undergoing arthroscopic surgery than in patients receiving intra-articular injections.