关节镜下修复联合关节腔灌注治疗肩袖损伤合并继发性冻结肩的疗效分析

Therapeutic effect analysis of arthroscopy combined with intracavitary injection in treatment of rotator cuff injury combined with secondary frozen shoulder

目的探讨关节镜下修复肩袖联合关节腔灌注玻璃酸钠+氨甲环酸+得宝松治疗肩袖损伤合并继发性冻结肩的临床疗效。方法回顾性分析2015年8月-2017年5月该院收治的肩袖损伤合并继发性冻结肩患者41例。其中,男12例,女29例,年龄42～68岁,平均55.5岁,病程6～11个月,主诉肩痛、活动受限,磁共振成像(MRI)提示肩袖有撕裂,全麻下先行手法松解,然后入镜观察,镜下松解,根据肩袖撕裂形态及大小选择相应术式行肩袖缝合,关闭切口后,盂肱关节留置引流管并灌注玻璃酸钠20 mg+氨甲环酸10 ml+得宝松1 ml,肩峰下留置引流管并灌注玻璃酸钠20 mg+氨甲环酸10 ml。术后根据骨质及肩袖撕裂情况,个体化设计康复方案进行患肩功能练习。结果手术均顺利完成,切口均Ⅰ期愈合,1例术后1个月因疼痛未缓解要求再次入院予以消炎止痛、关节腔封闭等治疗并好转出院,其余无相关并发症发生,随访时间平均9个月,术后末次随访时视觉模拟评分(VAS)由术前(7.0±1.2)分下降(1.1±0.1)分。术前:外旋5～50°,平均(29.6±13.4)°;前屈30～135°,平均(82.8±30.4)°,外展30～140°,平均(83.4±29.4)°;术后:外旋25～60°,平均(51.3±8.6)°,前屈85～180°,平均(160.3±22.8)°,外展80～180°,平均(157.1±22.3)°。术前术后VAS评分及活动度比较,差异均有统计学意义(P <0.05)。结论关节镜联合关节腔灌注治疗肩袖损伤合并继发性冻结肩,可有效缓解疼痛,改善关节活动度,加速康复,临床效果满意。

Objective To investigate the effect of arthroscopic repair of rotator cuff combined with intraarticular injection of sodium hyaluronate + tranexamic acid + diprospan in the treatment of rotator cuff injury with secondary frozen shoulder. Methods 41 cases of patients with rotator cuff injury complicated with secondary frozen shoulder were analyzed retrospectively in the department of joint surgery in our hospital From August 2015 to may 2017,12 males and 29 females, aged 42 ~ 68 years(mean 55.5 years), course of disease 6 ~ 11 months. The patient complained of shoulder pain and limited mobility. MRI showed rotator cuff tear.step one is to manipulation release under general anesthesia,Then the arthroscopic release, and according to the shape and size of the rotator cuff tear to choose the corresponding operation of rotator cuff suture.After closing the incision, the glenoid humeral joint was placed in the drainage tube and 20 mg sodium hyaluronate + 10 ml tranexamic acid + 1 ml diprospan was perfused, Drainage tube was placed under the shoulder peak and sodium hyaluronate 20 mg + tranexamic acid 10 ml was perfused. Finally, According to the situation of bone and rotator cuff tear after operation, the rehabilitation program was designed individually. Results The operation was completed successfully. All incisions healed in stage Ⅰ, One patient was discharged from hospital one month after operation because the pain was not relieved and was hospitalized again for anti-inflammatory and analgesic treatment. no related complications occurred in other cases.The average follow-up time was 9 months,(Visual analogue scale(VAS) vas pain score decreased from 5 ~ 10 points(7.0 ± 1.2) to 0 ~ 3 points(1.1 ± 0.1) after operation. reoperative Shoulder range of motion:external rotation 5 ~ 50°(29.6 ± 13.4)°, anterior flexion 30 ~ 135°(82.8±30.4)°, abduction 30 ~ 140°(83.4 ± 29.4)°;Postoperative: external rotation 25 ~ 60°(51.3 ± 8.6) °, anterior flexion 85 ~ 180°(160.3 ± 22.8)°, abduction80 ~ 180°(157.1 ± 22.3)°. Conclusions Arthroscopic combined with joint cavity perfusion in the treatment of rotator cuff injury combined with secondary frozen shoulder can effectively alleviate pain, improve joint mobility, accelerate rehabilitation, clinical effect is satisfactory.