肩关节镜下360°关节囊松解治疗原发性冻结肩的中期疗效

doi:10.3877/cma.j.issn.1674-134X.2019.01.002

目的

探讨肩关节镜下360°关节囊松解术治疗原发性冻结肩的可行性与临床疗效。

方法

回顾性分析自2010年1月至2014年8月苏州大学第三附属医院收治患者23例，其中男性8例，女性15例，所有患者术前排除颈椎病、胸廓出口综合症、肩部肿瘤等病变，排除肩部手术、创伤、外固定等继发性肩关节僵硬。手术方法为肩关节镜下360°关节囊松解，所有患者于治疗前后采用Constant肩关节功能评分和视觉模拟评分(VAS)进行疗效评估，并且评估患侧及健侧术前术后关节活动度。计量资料术前术后各不同时间点结果的比较采用配对t检验。

结果

所有手术均顺利完成，手术切口均Ⅰ期愈合，无相关并发症发生。所有患者中获得随访20例，平均年龄(58±10)岁，随访率86.7%。随访时间为24～79个月，平均(46±18)个月。术前患者Constant肩关节功能评分为(52.1±5.5)，术前VAS评分为9(8，9)。术后3个月患者Constant肩关节功能评分为(90.2±1.3)，VAS评分为1(1，2)，二者与术前相比具有统计学差异，统计值分别为(t＝38，P<0.05)(t＝－4.0，P<0.01)。术后12个月患者Constant肩关节功能评分为(92.2±1.1)分，VAS评分为0(0，1),二者与术后3个月相比差异具有统计学意义(t ＝5.2，P < 0.05；t ＝－3.7，P < 0.01)。术后24个月患者Constant肩关节功能评分为(92.4±0.9)分，VAS评分为0(0，1)，二者与术后12个月相比无统计学差异，统计值分别为(t＝0.8，P>0.05)(t＝－1.4，P > 0.05)。术后肩关节活动度较术前亦明显改善。

结论

关节镜下360°关节囊松解术治疗原发性冻结肩具有良好的中期临床疗效。

关键词: 关节镜, 肩关节

Objective

To investigate the feasibility and effectiveness of 360 degrees arthroscopic capsular release for the treatment of primary frozen shoulder.

Methods

Twenty three patients with primary frozen shoulder from January 2010 to September 2014, including eight males and 15 females with an average age of (58±10) years were enrolled in this study. Cases with cervical spondylopathy, tumor, thoracic outlet syndrome as well as the secondary shoulder stiffness following shoulder injury, surgery or external fixation of shoulder were excluded. Arthroscopic capsular release was performed under general anesthesia in all patients. VAS pain score and Constant score of patients were assessed and compared before and after surgery by paired t test. The joint activity of the affected side was also analyzed.

Results

All the operations were successfully completed, the incisions healed well and no complications were observed. Twenty of 23 cases were followed up, accounting for a follow-up rate of 86.7%, with an average follow-up time of (46±18) months. The Constant score of shoulder three months after operation was (90.2±1.3) and the the VAS score was 1(1, 2); both were statistically significant compared with the preoperation data(t=38, P<0.05; Z=-4.0, P<0.01). The Constant score of shoulder 12 months after operation was (92.2±1.1) and the VAS score was 0(0, 1); both were statistically significant compared with preoperation state(t=5.2, P<0.05)(t=-3.7, P <0.01). The Constant score of shoulder 24 months after operation was (92.4±0.9) and the media of the VAS score was 0(0, 1); both were not statistically significant compared with preoperation data(t=0.8, t=-1.4, both P>0.05). The mean range of motion of forward flexion, abduction, external rotation and interal rotation also improved significantly postoperatively compared with preoperative ones.

Conclusion

Three hundred and sixty degrees arthroscopic capsule release is an effective method for the treatment of primary frozen shoulder of which the mid-term clinical effect is satisfied.

Key words: Arthroscopy, Shoulder joint

表1 手术前后肩关节活动度对比[n＝20，°，(±s)]

?	前驱	外展	内旋	外旋
术前	71.5±3.2	71.6±3.0	49.8±2.4	38.7±2.7
术后3个月	148.1±5.4	133.3±2.6	65.3±2.2	48.1±2.2
术后12个月	168.8±3.9	147.9±3.9	79.7±3.1	77.1±1.5
术后24个月	170.5±4.9	148.4±4.3	80.7±2.9	80.0±1.7
t值	55.9^a，14.2^b，1.3^c	71.5^a，14.4^b，0.4^c	21.9^a，17.2^b，1.1^c	12.5^a，50.5^b，1.8^c
P值	<0.05^ab	<0.05^ab	<0.05^ab	<0.05^ab

表1 手术前后肩关节活动度对比[n＝20，°，(±s)]

?	前驱	外展	内旋	外旋
术前	71.5±3.2	71.6±3.0	49.8±2.4	38.7±2.7
术后3个月	148.1±5.4	133.3±2.6	65.3±2.2	48.1±2.2
术后12个月	168.8±3.9	147.9±3.9	79.7±3.1	77.1±1.5
术后24个月	170.5±4.9	148.4±4.3	80.7±2.9	80.0±1.7
t值	55.9^a，14.2^b，1.3^c	71.5^a，14.4^b，0.4^c	21.9^a，17.2^b，1.1^c	12.5^a，50.5^b，1.8^c
P值	<0.05^ab	<0.05^ab	<0.05^ab	<0.05^ab

表2 手术前后肩关节VAS及Constant评分对比(n＝20)

?	Constant评分(±s)	VAS评分M(P₂₅，P₇₅)
术前	52.1±5.5	9(8，9)
术后3个月	90.2±1.3	1(1，2)
术后12个月	92.2±1.1	0(0，1)
术后24个月	92.4±0.9	0(0，1)
统计值	t ＝38^a，5.2^b，0.8^c	Z＝－4.0^a，－3.7^b，－1.4^c
P值	< 0.05^{a b}	< 0.01^{a b}

表2 手术前后肩关节VAS及Constant评分对比(n＝20)

?	Constant评分(±s)	VAS评分M(P₂₅，P₇₅)
术前	52.1±5.5	9(8，9)
术后3个月	90.2±1.3	1(1，2)
术后12个月	92.2±1.1	0(0，1)
术后24个月	92.4±0.9	0(0，1)
统计值	t ＝38^a，5.2^b，0.8^c	Z＝－4.0^a，－3.7^b，－1.4^c
P值	< 0.05^{a b}	< 0.01^{a b}

[1]	Binder AI, Bulgen DY, Hazleman BL, et al. Frozen shoulder: a long-term prospective study[J]. Ann Rheum Dis, 1984, 43(3): 361-364.
[2]	Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up[J]. J Bone Joint Surg Am, 1992, 74(5): 738-746.
[3]	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder[J]. Clin Orthop Relat Res, 1987, 214: 160-164.
[4]	Maund E, Craig D, Suekarran S, et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis[J]. Health Technol Assess, 2012, 16(11): 261-264.
[5]	Prodromidis AD, Charalambous CP. Is there a genetic predisposition to frozen shoulder? A systematic review and meta-analysis[J]. JBJS Rev, 2016, 4(2):1-9.
[6]	Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence[J]. Muscles Ligaments Tendons J, 2016, 6(1): 26-34.
[7]	Itoi E, Arce G, Bain GI, et al. Shoulder stiffness: current concepts and concerns[J]. Arthroscopy, 2016, 32(7):1402-1414.
[8]	Arce G. Primary frozen shoulder syndrome: arthroscopic capsular release [J]. Arthrosc Tech, 2015, 4(6): e717-e720.
[9]	Rizk TE, Pinals RS. Frozen shoulder[J]. Semin Arthritis Rheum, 1982, 11(4): 440-452.
[10]	Mcgahan PJ, Patel H, Dickinson E, et al. The effect of biceps adhesions on glenohumeral range of motion: a cadaveric study[J]. J Shoulder Elbow Surg, 2013, 22(5): 658-665.
[11]	Izumi T, Aoki M, Tanaka Y, et al. Stretching positions for the coracohumeral ligament: strain measurement during passive motion using fresh/frozen cadaver shoulders[J]. Sports Med Arthrosc Rehabil Ther Technol, 2011, 3(1): 1-11.
[12]	Ozaki J, Nakagawa Y, Sakurai G, et al. Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment[J]. J Bone Joint Surg Am, 1989, 71(10): 1511-1515.
[13]	Mengiardi B, Pfirrmann CW, Gerber C, et al. Frozen shoulder: Mr arthrographic findings[J]. Radiology, 2004, 233(2): 486-492.
[14]	Park C, Lee S, Yi CW, et al. The effects of extracorporeal shock wave therapy on frozen shoulder patients＇ pain and functions[J]. J Phys Ther Sci, 2015, 27(12): 3659-3661.
[15]	Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions-systematic review[J]. Br J Sports Med, 2011, 45(1): 49-56.
[16]	Saeidian SR, Hemmati AA, Haghighi MH. Pain relieving effect of short-course, pulse prednisolone in managing frozen shoulder[J]. J Pain Palliat Care Pharmacother, 2007, 21(1): 27-30.
[17]	Lorbach O, Anagnostakos K, Scherf C, et al. Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections[J]. J Shoulder Elbow Surg, 2010, 19(2): 172-179.
[18]	Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia[J]. J Shoulder Elbow Surg, 2005, 14(1): 16-21.
[19]	Kivimäki J, Pohjolainen T, Malmivaara A, et al. Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized, controlled trial with 125 patients[J]. J Shoulder Elbow Surg, 2007, 16(6): 722-726.
[20]	Snow M, Boutros I, Funk L. Posterior arthroscopic capsular release in frozen shoulder[J]. Arthroscopy, 2009, 25(1): 19-23.
[21]	Pollock RG, Duralde XA, Flatow EL, et al. The use of arthroscopy in the treatment of resistant frozen shoulder[J]. Clin Orthop Relat Res, 1994, 304: 30-36.
[22]	Fernandes MR. Arthroscopic treatment of refractory adhesive capsulitis of the shoulder[J]. Rev Col Bras Cir, 2014, 41(1): 30-35.
[23]	Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation[J]. Ann R Coll Surg Engl, 2014, 96(1): 55-60.
[24]	Evans JP, Guyver PM, Smith CD. Frozen shoulder after simple arthroscopic shoulder procedures: what is the risk？[J]. Bone Joint J, 2015, 97-B(7): 963-966.
[25]	Segmüller HE, Taylor DE, Hogan CS, et al. Arthroscopic treatment of adhesive capsulitis[J]. J Shoulder Elbow Surg, 1995, 4(6): 403-408.
[26]	Bennett WF. Addressing glenohumeral stiffness while treating the painful and stiff shoulder arthroscopically[J]. Arthroscopy, 2000, 16(2): 142-150.
[27]	Chen J, Chen S, Li Y, et al. Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder？[J]. Arthroscopy, 2010, 26(4): 529-535.
[28]	Jerosch J. 360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint-indication, surgical technique, results[J]. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 178-186.
[29]	陆军，王宸．冻结肩的诊疗进展[J/CD]．中华关节外科杂志(电子版)，2015，9(4):527-531.

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Mid term effects of 360 degrees arthroscopic capsular release for primary frozen shoulder

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Mid term effects of 360 degrees arthroscopic capsular release for primary frozen shoulder