不同时机行肩关节麻醉下手法松解术治疗原发性冻结肩的疗效对比

A comparison study of the effect of manipulation under anesthesia on primary frozen shoulder patients at different opera⁃tion time points

目的探讨不同时机行肩关节麻醉下手法松解术(manipulation under anesthesia,MUA)治疗原发性冻结肩(pri⁃mary frozen shoulder,PFS)的临床疗效。方法回顾性分析2020年1月至2021年6月接受MUA治疗的PFS患者临床资料,根据手术时的病程分为病程<3个月组(A组)、3个月≤病程<6个月组(B组)、6个月≤病程<9个月组(C组)、9个月≤病程<12个月组(D组)。比较术前和术后1个月、3个月及6个月时疼痛数字分级评分法(Numerical Rating Scale,NRS)评分、肩关节主动活动范围(active range of motion,AROM)、日常生活活动量表(Activity of Daily Living Scale,ADL)评分及恢复满意度。同时比较4组患者术后镇痛药物使用率和术后12个月内二次粘连的发生率。结果共纳入129例患者资料进行统计分析,其中A组33例、B组35例、C组32例、D组29例。与术前比较,4组术后各时点NRS评分、AROM和ADL评分均明显改善(P<0.05);术后各时点NRS评分、AROM和ADL评分4组间差异均无统计学意义(P>0.05);A组术后1个月内的镇痛药物使用率明显高于D组,D组术后1个月恢复满意度明显高于A组(P<0.05);4组间二次粘连发生率差异均无统计学意义(P>0.05)。结论不同时机行MUA治疗PFS不存在明显的疗效差异。

Objective To compare the therapeutic effects of manipulation under anesthesia(MUA)on primary frozen shoulder(PFS)patients at different operation time points.Methods PFS patients who underwent MUA from June 2019 to June 2021 were enrolled and their clinical data were retrospectively analyzed.According to their surgical duration,they were divided into four groups:group within 3 months(group A),group 3 to 6 months(group B),group 6 to 9 months(group C)and group 9 to 12 months(group D).The Numerical Rating Scales(NRS)pain scores,active range of motion(AROM),Activity of Daily Living Scale(ADL)scores and satisfaction with recovery were compared before surgery and at postoperative 1,3 months and 6 months.Meanwhile,the use of analgesics and the incidence of recurrent adhesion within 12 months after surgery were recorded.Results A total of 129 patients were selected for statistical analysis,including 33 in group A,35 in group B,32 in group C,and 29 in group D.Compared with those before surgery,the four groups showed remarkable improvement in NRS,AROM and ADL scores(P<0.05).There were no statistical differences in NRS,AROM and ADL scores among the four groups at each postoperative time point(P>0.05).Compared with group D,Group A showed a significantly increased usage rate of analgesics within 1 month after surgery(P<0.05).Meanwhile,patient satisfaction with recovery in group D within 1 month after surgery was significantly higher than that in Group A(P<0.05).There were no statistical differences in the incidence of recurrent adhesion among the four groups(P>0.05).Conclusion There is no significant difference in the therapeutic effect of MUA on PFS patients at different operation time points.