关节镜下360°关节囊松解治疗冻结肩的疗效观察

Effectiveness of arthroscopic 360°capsular release for frozen shoulder

目的探讨关节镜下360°关节囊松解治疗冻结肩的疗效。方法2018年4月—2019年4月,采用关节镜下360°关节囊松解治疗42例冻结肩患者。男13例,女29例;年龄45~56岁,平均52.3岁。左肩14例,右肩28例。病程5~18个月,平均11.1个月。主要临床症状为肩关节主、被动活动受限伴严重疼痛。所有患者均排除肩峰撞击综合征及肩关节骨关节炎。术前肩关节活动度为前屈(93.2±15.4)°、体侧外旋(15.9±6.0)°、外展90°外旋(18.4±9.9)°,以及内旋达股骨大转子5例、臀部20例、S1水平17例。疼痛视觉模拟评分(VAS)为(6.7±1.7)分,美国肩肘外科协会(ASES)评分为(41.6±9.3)分。术后定期随访,测量肩关节主动活动度以及疼痛、功能评分,评价肩关节恢复情况。结果术后切口均Ⅰ期愈合,无早期手术相关并发症发生。患者均获随访,随访时间12~24个月,平均15.6个月。术后各时间点肩关节前屈、体侧外旋、外展90°外旋活动度均较术前改善(P<0.05)。术后3周内旋活动度均恢复至T_(6~12)水平,术后12个月与健侧相当(Z=–0.943,P=0.346)。术后各时间点VAS评分均较术前下降、ASES评分上升,差异有统计学意义(P<0.05);且随时间延长,VAS评分及ASES评分均进一步改善(P<0.05)。结论关节镜下360°关节囊松解可显著提高肩关节活动度、减轻疼痛、改善功能,是治疗冻结肩的一种有效方法。

Objective To investigate the effectiveness of arthroscopic 360°capsular release for frozen shoulder.Methods Between April 2018 and April 2019,42 patients with frozen shoulders were treated with arthroscopic 360°capsular release.There were 13 males and 29 females,with an average age of 52.3 years(range,45-56 years).There were 14 left shoulders and 28 right shoulders.The disease duration ranged from 5 to 18 months(mean,11.1 months).The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain.All patients excluded impingement syndrome and shoulder osteoarthritis.Preoperative range of motion was as follows:forward flexion(93.2±15.4)°,external rotation at side(15.9±6.0)°,external rotation at 90°abduction(18.4±9.9)°,and internal rotation reaching the greater trochanter in 5 cases,buttocks in 20 cases,S1 level in 17 cases.The visual analogue scale(VAS)score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery(ASES)score was 41.6±9.3.The active range of motion of shoulder joint,VAS score,and ASES score were recorded during follow-up.Results All incisions healed by first intention,and no early complications occurred.Patients were followed up 12-24 months(mean,15.6 months).After operation,forward flexion,external rotation at side,and external rotation at 90°abduction significantly improved when compared with preoperatively(P<0.05).The range of internal rotation restored to the level of T_(6-12)at 3 weeks,which was equivalent to that of the normal side at 12 months after operation(Z=–0.943,P=0.346).VAS scores decreased and ASES scores increased after operation,and the differences between pre-and post-operation were significant(P<0.05);and with time,the VAS scores and ASES scores improved further(P<0.05).Conclusion Arthroscopic 360°capsular release can significantly increase the range of motion of the shoulder joint,release pain,and improve function.It is an effective method for the treatment of frozen shoulders.