先后顺序不同的手法松解和关节镜下松解 治疗原发性冻结肩的对比分析

A Comparative Analysis about Treatment of Primary Frozen Shoulder by Manual Lysis andArthroscopic Lysis Performed in Different Order

目的:探讨施行先后顺序不同的手法松解和关节镜下松解对治疗原发性冻结肩的手术过程和术后康复是否存在差别.方法:将2011年7月~2015年12月间48例经过手术治疗的病人归纳分成2组,先关节镜下松解后手法松解为观察组、先手法松解后关节镜下松解为对照组,观察组25例,男性13例, 女性12例, 平均年龄59±7.2岁 ,对照组23例,男性11例, 女性12例, 平均年龄60±2.2岁,病程均超过6个月,均经过3个月保守治疗无效,用Constant评分和ASES评分评估治疗效果;用多个指标来观察2种方法施行顺序不同对手术过程和术后康复的影响情况.结果:48例 患 者 均 获 随 访, 平均随访时间8个月~30个月(21±2.4个月).虽然术后经过相同的康复方案肩关节都达到了满意的状态,但是2种方法施行顺序不同对手术过程和术后康复的影响存在显著差异, 差异有统计学意义(P<0.01).结论:2种方法施行顺序先后不同,会影响整个手术过程和术后康复锻炼,先关节镜下松解再辅以手法松解对治疗原发性冻结肩更为合理.

Objective: Manual lysis and arthroscopic lysis were usually performed to deal the primary frozen shoulder at the same time , sometimes manual lysis was first performed ,and then the arthroscopic lysis in the same treatment process, sometimes the order was just the opposite.In terms of surgical procedure and postoperative rehabilitation, whether there were differences between the two different sequential methods in the same treatment process.Methods: 48 patients who were operated on were divided into two groups , 25 patients were divided into group A , among group A arthroscopic lysis was first performed , and then the manual lysis , 23 patients were divided into group B , among group B manual lysis was first performed , and then the arthroscopic lysis.13 male cases and 12 female cases were in the group A , their average age was (59±7.2)years old.11 male cases and 12 female cases were in the group B , their average age was (60±2.2)years old.The course of disease of all 48 patients was more than 6 months;conservative treatment did no clinical effect among all 48 patients.Constant evaluation method and ASES evaluation method were used to evaluate clinical effect , a number of indexes were used to describe the process of surgical procedure and postoperative rehabilitation.Results: All 48 patients were followed up for 8~30 months with an average of (21±2.4)months.Although the result of the shoulder condition was satisfied after the same rehabilitation program , there existed significant difference on influence of surgical procedure and postoperative rehabilitation after the two different sequential methods in the same treatment process , the difference was statistically significant(P<0.01).Conclusion: The two different sequential methods in the same treatment process could affect surgical procedure and postoperative rehabilitation , It was more reasonable that arthroscopic lysis was supplemented with manual lysis to deal the primary frozen shoulder.