冻结肩的诊治研究进展

Advances in the diagnosis and treatment of frozen shoulder

冻结肩是一种常见的肩关节疾病,其特征是肩部疼痛和进行性的活动受限及功能障碍。冻结肩常与免疫性和代谢性等全身性疾病有关,或者在肩关节制动一段时间后发生,并且病程长,对患者造成极大的困扰。冻结肩的病理生理变化主要是纤维组织增生、纤维化,产生Ⅰ型和Ⅲ型胶原的成纤维细胞转化为肌成纤维细胞(平滑肌表型),并伴有炎症、新生血管形成和新的神经支配,导致肩关节囊纤维化、挛缩。诊断需结合病史、体格检查和影像检查进行综合考虑。但因疾病所处的阶段不同或伴随其他肩部病变,确诊常常较困难。目前治疗措施包括物理治疗、口服药物、注射治疗、手术干预等。然而,目前各种治疗的有效性仍不明确。作者就冻结肩的最新诊治研究进展总结概括,旨在为临床诊疗及未来研究方向提供参考。

Frozen shoulder is a common shoulder joint disease characterized by shoulder pain,progressive limitation of movement,and functional impairment.It is often associated with systematical diseases such as immune and metabolic disorders,or occurs after immobilization of the shoulder joint for a period of time,with a long course and causing significant distress to patients.The pathophysiological changes of frozen shoulder mainly include fibrosis tissue proliferation,fibrosis,transformation of fibroblasts producing typeⅠand typeⅢcollagen into myofibroblasts(smooth muscle phenotype),accompanied by inflammation,neovascularization,and new nerve innervation,leading to fibrosis and contraction of the shoulder joint capsule.Diagnosis requires comprehensive consideration based on medical history,physical examination,and imaging.However,diagnosis is often difficult due to the different stages of the disease or concomitant with other shoulder disorders.Current treatment options include physical therapy,oral medications,injections,surgical intervention,etc.However,the effectiveness of various treatments remians unclear.The authors summarize the latest research advances in the diagnosis and treatment of frozen shoulder,aiming to provide reference for clinical diagnosis and treatment and future research.