关节镜下肩关节囊松解合并肩峰下间隙恢复治疗创伤性肩关节功能障碍与冻结肩的中期疗效比较

Comparison of mid-term clinical outcomes between traumatic stiff shoulder and frozen shoulder after arthroscopic capsule release combined with subacromial space recovery

目的比较关节镜下肩关节囊松解合并肩峰下间隙恢复治疗创伤性肩关节功能障碍与冻结肩的中期疗效。方法回顾性分析2014年1月至2019年12月在陆军军医大学第一附属医院运动医学中心治疗的55例肩关节活动受限患者资料。创伤性肩关节功能障碍22例(男7例,女15例)(A组),冻结肩33例(男10例,女23例)(B组),均采用关节镜下关节囊270°松解和肩峰下间隙恢复术治疗。术前和末次随访时均采用疼痛视觉模拟评分(VAS)和Constant评分分别评价肩关节疼痛和功能情况,同时记录并比较两组肩关节前屈、外展、外旋及内旋活动度改善情况。结果两组患者性别、年龄、病程、术前肩关节内旋和外旋功能比较差异均无统计学意义(P>0.05),具有可比性。术前A组患者VAS评分[2.5(2.0,3.3)分]和Constant评分[(33.7±9.6)分]均显著低于B组[4.0(3.0,5.5)、(45.8±12.3)分],两组间比较差异均有统计学意义(P<0.05)。所有患者随访期间未出现切口感染、神经损伤等并发症。术后切口均一期愈合。所有患者术后获平均37.0个月(20~79个月)随访。末次随访时A、B组肩关节VAS评分[均为1.0(1.0,1.0)分]、Constant评分[(87.0±3.2)、(85.7±4.3)分]均较术前显著改善,差异均有统计学意义(P<0.05)。与术前比较,末次随访时A、B组患者肩关节前屈改善幅度分别为99.3°±19.9°、83.3°±27.7°,外展改善幅度分别为102.0°±21.5°、83.9°±32.8°,A组较B组前屈和外展改善幅度更大;A、B组VAS评分改善幅度分别为1.0(1.0,2.3)、3.0(2.0,4.5)分,B组较A组改善更显著;Constant评分改善幅度分别为(53.3±9.5)、(39.8±12.9)分,A组较B组改善更显著。以上项目两组间比较差异均有统计学意义(P<0.05)。结论关节镜下关节囊270°松解和肩峰下间隙恢复治疗创伤性肩关节功能障碍和冻结肩均可获得较好的中期疗效,但创伤性肩关节功能障碍的肩关节前屈、外展活动和Constant评分改善幅度更明显。

Objective To compare the mid-term clinical outcomes between traumatic stiff shoulder and frozen shoulder after arthroscopic capsule release combined with subacromial space recovery.Methods From January 2014 to December 2019,55 patients were treated at Sports Medicine Center,The First Affiliated Hospital,Army Medical University for limited range of shoulder motion.Of them,22 suffered from traumatic stiff shoulder(7 males and 15 females)(group A)and 33 from frozen shoulder(10 males and 23 females)(group B).All patients were treated with arthroscopic 270°capsule release combined with subacromial space recovery.Shoulder pain was evaluated by visual analogue scale(VAS)and shoulder function by Constant score before operation and at the final follow-up.The 2 groups were compared in improvements in flexion,abduction,external rotation and internal rotation of the shoulder.Results No significant difference was observed between the 2 groups in gender,age,course of disease,preoperative internal rotation or external rotation of the shoulder(P>0.05).Preoperative VAS score[2.5(2.0,3.3)points]and Constant score[(33.7±9.6)points]in group A were significantly lower than those in group B[4.0(3.0,5.5)points and(45.8±12.3)points](P<0.05).No complication like infection or nerve injury was found during follow-ups.All the incisions healed at the first stage.The follow-up time averaged 37.0 months(from 20 to 79 months).At the last follow-up,VAS scores[1.0(1.0,1.0)points and 1.0(1.0,1.0)points]and Constant scores[(87.0±3.2)points and(85.7±4.3)points]for both groups were significantly improved compared with their preoperative values[2.5(2.0,3.3)分points and 4.0(3.0,5.5)points for VAS;(33.7±9.6)points and(45.8±12.3)points for Constant score](P<0.05).Compared with preoperation,the improvements at the last follow-up were 99.3°±19.9°and 83.3°±27.7°in shoulder anteflexion and 102.0°±21.5°and 83.9°±32.8°in abduction for groups A and B,with greater improvements in group A;the improvements in VAS score for groups A and B were 1.0(1.0,2.3)points and 3.0(2.0,4.5)points,with greater improvements in group B;the improvements in Constant score were(53.3±9.5)points and(39.8±12.9)points for groups A and B,with greater improvements in group A.The above comparisons all showed a significant difference between the 2 groups(P<0.05).Conclusions Arthroscopic 270°capsule release combined with subacromial space recovery can lead to good mid-term clinical outcomes similar for both traumatic stiff shoulder and frozen shoulder.However,the improvements in flexion,abduction and Constant score may be greater for traumatic stiff shoulder than for frozen shoulder.