关节镜下盂肱关节前方松解对原发性冻结肩的早期疗效

doi:10.3877/cma.j.issn.1674-134X.2019.01.003

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 11 -16. doi: 10.3877/cma.j.issn.1674-134X.2019.01.003

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临床论著

关节镜下盂肱关节前方松解对原发性冻结肩的早期疗效

冯敏¹, 崔雅清², 张睿锐³, 刘时璋¹, 田昕¹, 姬乐¹, 强辉¹^,^†(

)

^1. 710068　西安，陕西省人民医院骨科
^2. 710068　西安，陕西省人民医院手术室
^3. 710065　西安，兵器工业521卫生研究所重症医学科

收稿日期:2018-05-30 出版日期:2019-02-01
通信作者: 强辉
基金资助:
陕西省社会发展攻关项目(2017SF－205)

Early effects of arthroscopic release of anterior glenohumeral joint on idiopathic adhesive capsulitis

Min Feng¹, Yaqing Cui², Ruirui Zhang³, Shizhang Liu¹, Xin Tian¹, Le Ji¹, Hui Qiang¹^,^†()

^1. Department of Orthopaedics, Shanxi Provincial People’s Hospital, Xi’an 710068, China
^2. Department of Operation, Shanxi Provincial People’s Hospital, Xi’an 710068, China
^3. Department of ICU, 521 Healthy Institutes of North Industries, Xi’an 710065, China

Received:2018-05-30 Published:2019-02-01
Corresponding author: Hui Qiang
About author:
Corresponding author: Qiang Hui, Email: qianghui359@163.com

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引用本文：

冯敏, 崔雅清, 张睿锐, 刘时璋, 田昕, 姬乐, 强辉. 关节镜下盂肱关节前方松解对原发性冻结肩的早期疗效[J]. 中华关节外科杂志(电子版), 2019, 13(01): 11-16.

Min Feng, Yaqing Cui, Ruirui Zhang, Shizhang Liu, Xin Tian, Le Ji, Hui Qiang. Early effects of arthroscopic release of anterior glenohumeral joint on idiopathic adhesive capsulitis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(01): 11-16.

目的

观察应用关节镜进行关节囊前方松解术对原发性冻结肩的治疗效果。

方法

2015年3月至2017年3月陕西省人民医院收治的60例原发性冻结肩患者，所有患者经术前MRI检查或术中探查确诊，排除由其余肩部疾病(骨折、肩峰撞击、肩袖损伤、钙化性肌腱炎)引起的继发性冻结肩，所有患者应用关节镜行盂肱关节前方松解术。采集术前及术后的疼痛视觉评分(VAS)、Constant评分、复旦大学肩关节功能评分系统(FUSS)，应用单因素重复测量方差分析对结果进行统计学分析评估，对肩关节各方向的被动活动度应用配对t检验方法进行统计学分析。

结果

所有患者术后均未出现腋神经损伤或肩关节不稳等并发症。与术前相比，术后12周时患者的VAS评分[(0.7±0.6)vs (8.1±0.7)，F ＝38.01]、Constant评分[(93.9±3.0)vs (34.2±3.4)，F ＝121.42]及FUSS评分[(93.8±1.3)vs (40.1±2.2)，F ＝220.09]差异有统计学意义(均为P <0.01)；同时，与术前相比，患肩被动外展[(152±13)° vs (74±9)°，t ＝37.678]、前屈[(156±12)° vs (60±10)°，t ＝46.469]、体侧外旋[(66±11)° vs (8±3)°，t ＝37.762]及内旋在术后12周时明显改善(均为P <0.01)。

结论

应用关节镜对盂肱关节囊前方结构进行彻底松解，可有效改善原发性冻结肩患者肩关节功能。

关键词: 滑囊炎, 肩关节, 关节镜, 关节囊松解

Objective

To define the benefit of arthroscopic release of the anterior glenohumeral joint in frozen shoulder.

Methods

Sixty idiopathic adhesive capsulitis (IAC) patients were diagnosed by magnetic resonance imaging or intraoperative arthroscopic findings in Shaanxi Provincial People’s Hospital from March 2015 to March 2017. The exclusion criteria included fractures, subacromial impingement, rotator cuff tear and calcifying tendinitis. All the patients underwent arthroscopic capsular release. The extent of release focused on the rotator interval, subscapularis tendon and inferior glenohumeral ligaments (IGHL). Visual analogue scale (VAS), Constant functional scores, the Fudan University shoulder score (FUSS) and the range of motion (ROM) in various directions were recorded preoperatively and postoperatively. Statistical analysis was performed with one-way repeated measures ANOVA and paired t-test.

Results

None of the patients had postoperative complication such as axillary nerve injury or shoulder instability. At 12 weeks postoperatively, both of VAS [(0.7±0.6)vs(8.1±0.7), F =38.01], Constant score [(93.9±3.0)vs (34.2±3.4), F=121.42]and FUSS [(93.8±1.3)vs (40.1±2.2), F=220.09] increased significantly compared with the preoperative ones(all P<0.01). ROM showed satisfactory results at the final follow-up: abduction [(152±13)° vs (74±9)°, t=37.678], flexion[(156±12)° vs (60±10)°, t=46.469], external rotation at 90° of abduction[(66±11)° vs (8±3)°, t=37.762], internal rotation at 0°of abduction, and internal rotation at 90° of abduction recovered 12 weeks after the surgery(all P<0.01).

Conclusion

The arthroscopic release of the anterior glenohumeral joint may significantly improveboth of the function and ROM in IAC patients.

Key words: Bursitis, Shoulder joint, Arthroscope, Joint capsule release

图1 IAC患者肩关节镜下观察图像，示肩袖间隙及盂肱下韧带增厚、充血、水肿，关节腔容量减小。HH-肱骨头；RI-肩袖间隙；GL-关节盂；IGHL-盂肱下韧带

图2 肩关节软组织松解术后关节镜下观察图像，示松解肩袖间隙、切断盂肱下韧带后可见关节腔容量明显增大。HH-肱骨头；RI-肩袖间隙；GL-关节盂；IGHL-盂肱下韧带；BT-肱二头肌腱；SSC-肩胛下肌腱

表1 原发性冻结肩行关节松解术前后疗效对比[n＝60, (±s)]

?	VAS	Constant	FUSS
术前	8.1±0.7	34.2±3.4	40.1±2.2
术后2周	4.5±0.8^a	51.4±3.7^b	70.9±1.6^c
术后4周	3.4±0.6^a	70.7±4.6^b	75.3±2.1^c
术后8周	2.1±0.8^a	86.7±5.5^b	88.1±3.2^c
术后12周	0.7±0.6^a	93.9±3.0^b	93.80±1.3^c
F值	38.01	121.42	220.09
P值	<0.05	<0.05	<0.05

表1 原发性冻结肩行关节松解术前后疗效对比[n＝60, (±s)]

?	VAS	Constant	FUSS
术前	8.1±0.7	34.2±3.4	40.1±2.2
术后2周	4.5±0.8^a	51.4±3.7^b	70.9±1.6^c
术后4周	3.4±0.6^a	70.7±4.6^b	75.3±2.1^c
术后8周	2.1±0.8^a	86.7±5.5^b	88.1±3.2^c
术后12周	0.7±0.6^a	93.9±3.0^b	93.80±1.3^c
F值	38.01	121.42	220.09
P值	<0.05	<0.05	<0.05

表2 原发性冻结肩行关节松解术前后肩关节活动度对比[°，n＝60, (±s)]

?	外展	前屈	外旋
术前	74±9	60±10	8±3
术后12周	152±13^*	156±12^*	66±11^*
非手术侧	172±12	170±11	72±10
t值	37.678	46.469	37.762
P值	<0.01	<0.01	<0.01

表2 原发性冻结肩行关节松解术前后肩关节活动度对比[°，n＝60, (±s)]

?	外展	前屈	外旋
术前	74±9	60±10	8±3
术后12周	152±13^*	156±12^*	66±11^*
非手术侧	172±12	170±11	72±10
t值	37.678	46.469	37.762
P值	<0.01	<0.01	<0.01

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