一期手法松解关节镜下肩袖修补术治疗肩袖撕裂合并冻结肩的临床疗效

目的探讨一期手法松解联合关节镜下清理肩袖修补术治疗肩袖撕裂合并冻结肩的疗效。方法回顾分析2014年1月—2015年12月采用一期手法松解联合关节镜下清理肩袖修补术治疗的15例肩袖撕裂合并冻结肩患者(冻结肩组)临床资料,并与同期关节镜下肩袖修补术治疗的24例肩袖撕裂不合并冻结肩患者(非冻结肩组)进行比较。冻结肩组患者年龄大于非冻结肩组(P0.05);两组患者性别、肩袖撕裂分型、损伤侧别、合并糖尿病例数比较,差异均无统计学意义(P0.05)。术后肩关节疼痛程度采用疼痛视觉模拟评分(VAS),关节功能采用美国加州大学肩关节功能评分系统(UCLA)以及美国肩肘协会评分系统(ASES)评价。结果两组术后切口均Ⅰ期愈合,无手术早期相关并发症发生。两组患者均获随访,其中冻结肩组随访时间为13~31个月,平均19.2个月;非冻结肩组为12~33个月,平均20.3个月;两组随访时间比较,差异无统计学意义(t=–0.573,P=0.570)。冻结肩组术前VAS评分高于非冻结肩组(t=–2.166,P=0.037);术后3、6、12个月及末次随访时,两组间比较差异无统计学意义(P0.05)。冻结肩组术前及术后3个月肩关节活动范围(肩外旋及前屈)低于非冻结肩组(P0.05),术后6、12个月及末次随访时组间比较差异无统计学意义(P0.05)。末次随访时两组患者内旋均超过L3。两组术后UCLA、ASES评分均较术前明显改善(P0.05)。其中冻结肩组术前UCLA评分低于非冻结肩组(P=0.037),但末次随访时两组比较差异无统计学意义(P=0.786)。两组手术前后ASES评分比较差异均无统计学意义(P0.05)。结论一期手法松解联合关节镜下清理肩袖修补术治疗肩袖撕裂合并冻结肩,早期疗效略差于肩袖撕裂不合并冻结肩,但6个月后可获得相似疗效。     

早期康复训练与术后制动对关节镜下肩袖修复患者肩关节功能恢复的影响

目的 观察肩袖中度撕裂和肩袖较小撕裂患者关节镜下肩袖修复术后早期康复训练与肩关节制动对其肩关节功能及肌腱愈合的影响。方法 纳入自2021-01—2021-12完成的62例关节镜下肩袖修复术,其中31例术后未制动并早期进行康复训练（早期康复组）,31例术后制动6周并进行合适的康复训练（术后制动组）。比较两组术后疼痛VAS评分、肩关节活动度、肩关节ASES评分与肩袖再撕裂发生率。结果 62例均获得随访,随访时间12～15个月,平均12.97个月。早期康复组与术后制动组术后3个月、6个月疼痛VAS评分比较差异无统计学意义（P>0.05）。早期康复组术后3个月、6个月肩关节活动度及肩关节ASES评分优于术后制动组（P<0.05）。随访至术后12个月,早期康复组肩袖再撕裂发生率为9.68%(3/28),术后制动组肩袖再撕裂发生率为6.45%(2/29),组间差异无统计学意义（P>0.05）。结论 对于肩袖中度撕裂和肩袖较小撕裂患者,关节镜下肩袖修复术后早期康复训练在肩关节活动度及肩关节功能改善方面具有明显效果,而且并没有增加术后肩袖再撕裂发生风险,可以不考虑术后早期肩关节制动。     

糖尿病对关节镜下肩袖修复术后病人肩关节功能恢复影响的临床研究

目的 探讨糖尿病对关节镜下肩袖修复术后病人肩关节功能恢复的影响。方法 回顾性分析我科自2019年5月至2022年5月接受关节镜下肩袖修复术的62例肩袖损伤病人的临床资料和随访结果,其中糖尿病组30例,男18例,女12例,年龄为（62.10±11.87）岁;对照组32例,男18例,女14例,年龄为（63.78±12.98）岁。手术方式均为关节镜下缝线桥技术缝合肩袖。分别记录两组病人术前1周、术后3个月、6个月和12个月各时间点肩关节最大外展角度值,以及肩关节功能评分,包括疼痛视觉模拟量表（visual analogue scale,VAS）评分、美国肩肘外科协会（American Shoulder Elbow Surgeon,ASES）评分、加州大学洛杉矶分校（University of California at Los Angeles,UCLA）肩关节评分以及Constant-Murley评分。据此对手术效果进行评估。结果 62例病人均未出现伤口感染、术后僵硬、术后再撕裂等并发症。两组病人的肩关节最大外展角度值、VAS评分、ASES评分、UCLA评分以及Constant-Murley...     

关节镜辅助下小切口修补术与全关节镜下修补术治疗肩袖损伤的病例对照研究

目的:探讨关节镜辅助下小切口修补术与全关节镜下修补术治疗肩袖损伤的临床疗效。方法:对2012年1月至2015年1月治疗的肩袖损伤86例临床资料进行回顾性分析,依据治疗方式的不同分为两组,即关节镜辅助下小切口修补组(A组)和全关节镜下修补组(B组)。A组46例,男25例,女21例;平均年龄(52.8±7.8)岁;采用关节镜辅助下小切口肩袖修补术治疗。B组40例,男23例,女17例;平均年龄(53.2±9.5)岁;采用全关节镜下肩袖修补术治疗。比较两组治疗前后肩关节活动度、肌力情况以及ASES、UCLA、VAS评分。结果:所有患者获随访,随访时间18~35个月,平均20.8个月。A组患者术后肩关节外展活动度(131.4±18.8)°,外旋(64.9±8.8)°,内旋(63.7±7.3)°;B组患者术后外展活动度(132.3±16.9)°,外旋(65.1±9.4)°,内旋(64.4±8.1)°;两组术后肩关节活动度均较治疗前显著增加(P0.05),但术后两组患者肩关节活动度比较差异无统计学意义(P0.05)。治疗后,A组患者ASES评分88.4±8.9,UCLA评分29.6±3.6,VAS评分1.4±0.3;B组患者ASES评分89.5±9.6,UCLA评分30.8±4.1,VAS评分1.3±0.4;治疗后两组ASES、UCLA评分较治疗前增加,VAS评分较治疗前下降(P0.05);但治疗后两组间比较差异无统计学意义(P0.05)。结论:关节镜辅助下小切口修补术与全关节镜下修补对于肩袖损伤均具有一定的临床疗效,可以提升手术治疗安全性及可靠性。     

肩关节镜下“尾端下压固定+桥式缝合”技术治疗原发性肩袖止点区内侧撕裂疗效分析

目的 探讨肩关节镜下“尾端下压固定+桥式缝合”技术治疗原发性肩袖止点区内侧撕裂的可行性与临床疗效。方法 回顾性分析2020年10月—2022年10月收治的11例符合选择标准的原发性肩袖止点区内侧撕裂患者临床资料，男3例，女8例；年龄39～79岁，平均61.0岁。8例因跌倒致肩袖损伤，受伤至入院时间1～4个月，平均2.0个月；余3例无明显诱因。肩关节主动活动均受限，患肩主动活动度前屈（64.1±10.9）°、外展（78.1±6.4）°、内旋（48.2±6.6）°、外旋（41.8±10.5）°；其中5例出现肩关节僵硬症状。术前疼痛视觉模拟评分（VAS）为（7.8±0.8）分，美国肩肘外科医师协会（ASES）评分为（23.9±6.4）分。采用肩关节镜下“尾端下压固定+桥式缝合”技术治疗，末次随访时采用VAS评分、ASES评分及肩关节主动活动度评价疼痛和功能恢复情况；术后行MRI检查，通过Sugaya分类系统评估肩袖完整性。结果 术后11例患者均获随访，随访时间2～22个月，平均13.5个月。患者切口均Ⅰ期愈合，均未出现感染、肩袖再次撕裂以及锚钉脱落等并发症。末次随访时，VAS评分为（0.8±...     

关节镜下直接松解后行肩袖修复术治疗老年冻结肩合并肩袖损伤的临床疗效研究分析

目的研究分析肩关节镜直接松解法联合肩袖修复术治疗老年冻结肩合并肩袖损伤的临床疗效。方法选取2015年1月至2017年1月本院收治的肩袖损伤伴合并冻结肩老年患者106例,治疗医师按照治疗方法不同将患者平分为两组:其中A组行肩关节镜下直接松解、肩袖修复术治疗;B组行手法松解、肩关节镜肩袖修复术治疗。观察A组、B组患者治疗前、治疗后1、3、6个月的VAS评分,ASES评分,Constant-Muley肩关节功能评分。记录并比较A、B两组患者手术时间、术中出血量、住院时间、术后疾病减轻时间。结果 A组与B组在术后1个月、术后6个月的VAS评分无显著差异(P0.05);A组在术后3个月的VAS评分略高于B组,差异具有统计学意义(P0.05);A组在治疗后3个月、6个月的ASES评分略低于B组,差异具有统计学意义(P0.05);A组患者术后3个月、6个月的Constant-Muley肩关节功能评分略低于B组患者、差异具有统计学意义(P0.05)。结论本研究两种方法治疗老年冻结肩合并肩袖损伤均可获得比较满意的临床效果,关节镜下直接松解联合肩袖修复术对患者的创伤度更小,术后恢复速度更快,适合应用于手术后关节功能预期要求尚可,且需要完全微创治疗的老年患者。     

关节镜松解术结合麻醉下手法松解治疗冻结肩

背景：冻结肩是临床常见疾病,治疗方法较多,大部分患者可以通过保守治疗治愈。而对于保守治疗无效的患者,目前有文献报道应用关节镜下松解结合麻醉下手法松解治疗,效果满意。目的：通过术前和术后肩关节活动度及疼痛程度的变化来评估关节镜松解术结合麻醉下手法松解治疗冻结肩的效果。方法：回顾性分析2011年1月至2013年12月接受关节镜松解术结合麻醉下手法松解治疗的21例冻结肩患者的病例资料。年龄48-67岁,平均55.85岁;男6例,女15例;左侧14例,右侧7例;原发性12例,继发性9例。所有患者均经6-18个月,平均11.23个月的保守治疗无效后行关节镜松解术结合麻醉下手法松解。结果：全部获得随访,随访时间为7-32个月,平均15.57个月。被动前屈、外展、外旋活动度由术前平均86.0°±10.8°,47.4°±7.5°,4.3°±7.8°提升至术后平均142.1°±11.8°,92.6°±12.1°,57.6°±19.8°（P〈0.001）。Constant-Murley肩关节功能评分从术前平均（12.9±2.1）分提高至术后平均（26.2±2.4）分。所有患者术后肩关节疼痛均有不同程度减轻。VAS评分由术前平均（7.4±1.1）分降至术后平均（2.5±1.0）分（P〈0.001）。结论：关节镜松解术结合麻醉下手法松解是治疗冻结肩的有效手段。     

关节镜手术治疗创伤性复发性肩关节前脱位的疗效研究

目的研究分析关节镜手术治疗创伤性复发性肩关节前脱位患者的临床疗效。方法选取2013年1月至2017年6月本院收治的创伤性复发性肩关节前脱位患者共80例,治疗医师按照数字表法将所有患者随即评分为A、B两组,A组行关节镜手术治疗,B组行常规开放手术治疗。观察两组患者术前、术后6个月,术后12个月视觉疼痛模拟评分(VAS);根据Bigliani肩关节失稳修复术后稳定评分系统和Rowe评分量表对患者术后12个月的肩关节功能恢复进行评估,Rowe评分后分数越高,肩关节功能恢复效果越好。结果 80例患者均获得随访,随访时间12~36个月,平均19.71±2.49个月,术后所有切口均已Ⅰ期愈合,手术治疗后并未肩关节脱位复发。两组患者术后12个月Bigliani肩关节稳性评分比较,A组各项评分与总分数均明显高于B组(P0.05);A、B两组患者术前VAS评分无显著差异(P0.05),术后6个月及12个月,A组的VAS评分均明显低于B组,差异具有统计学意义(P0.05);术后12个月的Rowe肩关节评分比较,A组的Rowe评分总分明显高于B组,差异具有统计学意义(P0.05)。结论然肩关节镜的操作难度要高于常规开放手术方法,但是应用关节镜Bankart修复术可以有效降低创伤性复发性肩关节前脱位患者的术后疼痛、使肩关节功能、活动程度及范围的恢复效果更佳,适合临床医师选择应用。     

关节镜下双滑轮缝线桥修补冈上肌腱撕裂的早期疗效

目的 探讨关节镜下双滑轮缝线桥修补冈上肌腱撕裂的早期疗效。方法 回顾分析2020年9月—2022年7月收治且符合选择标准的38例冈上肌腱撕裂患者,均采用关节镜下双滑轮缝线桥修补。其中男15例,女23例;年龄43～77岁,平均61.5岁。左肩15例,右肩23例。7例有外伤史,余31例无明显诱因。患者主要临床症状为肩关节上举疼痛,抱抬抗阻试验（+）。出现症状至入院时间6～19个月,平均10.3个月。记录术前及术后3、12个月肩关节前屈、外展和外旋活动度;术前及术后12个月采用疼痛视觉模拟评分（VAS）、美国加州大学洛杉矶分校（UCLA）肩关节评分和美国肩肘外科医师协会（ASES）评分评价肩关节疼痛及功能。术后3～6个月MRI评估肌腱愈合情况、肌腱连续性和张力,末次随访时统计患者满意度。结果 术后切口均Ⅰ期愈合,无切口感染、神经损伤等并发症发生。38例患者均获随访,随访时间12～34个月,平均23.3个月。术后12个月VAS评分、UCLA肩关节评分及ASES评分均优于术前（P<0.05）。术后3、12个月肩关节外旋活动度均较术前明显改善,术后12个月较3个月时进一步改善,差异均有统计学...     

糖尿病及黏连性肩关节囊炎时长对手术治疗患者的影响分析

目的 分析糖尿病及黏连性肩关节囊炎症状持续时间对关节镜下肩关节松解术患者预后的影响。方法 本研究共纳入安徽医科大学第三附属医院2019年6月至2022年4月45例黏连性肩关节囊炎患者，其中男18例，女27例；年龄47～66岁，平均(53.4±6.1)岁。所有纳入患者完善术前检查及围手术期准备后行关节镜手术治疗。根据术前肩关节症状持续总时间将患者分为A组(3个月以内)、B组(3～6个月)、C组(6个月以上)。通过分析对比患者患侧肩关节各方向活动度，术后臂、肩、手功能障碍(disabilities of the arm, shoulder and hand, DASH)评分，美国肩肘外科协会(American shoulder and elbow surgeons, ASES)评分，疼痛视觉模拟评分(visual analogue score, VAS),疼痛缓解时间(手术后至患肩疼痛感消失用时),总病程时间(首发症状至手术后患肩疼痛消失及活动度恢复如常时)的组间不同，探究糖尿病及黏连性肩关节囊炎症状持续时间对肩关节镜下手术治疗黏连性肩关节囊炎患者的预后影响。结果 患者均获随访，随访时间1...     

Arthroscopic capsular release for stiff shoulders

Purpose: The etiology, pathogenesis, time course, and response to treatment of stiff shoulder pathology is still under investigation and debate. This prospective study evaluated arthroscopic capsular release to treat stiff shoulder pathology that was resistant to conservative management. The etiology of the shoulder stiffness was categorized and analyzed for effect on outcomes. Type of Study: Operative technique and prospective evaluation. Methods: In 68 stiff shoulders (41 in women, 27 in men) that underwent arthroscopic capsular release, 5 distinct etiologies were identified: postsurgical in 20, idiopathic in 17, post-traumatic in 15, diabetic in 8, and impingement syndrome (prior primary impingement developing stiffness) in 8. Average age was 50 years (range, 29 to 72), and follow-up averaged 3 years (range, 2 to 8). Prior to this procedure, duration of symptoms averaged 7.3 months (range, 3 to 48), and formal physical therapy averaged 3.7 months (range, 1 to 12). Preoperative average American Shoulder and Elbow Surgeons Score (ASES) was 35.5 (range, 10 to 77), median Simple Shoulder Test (SST) was 3 (0 to 10), and median Visual Analog Score (VAS) for pain was 6 (0 to 10). Average active forward elevation (FE) was 92°, external rotation (ER) at side was 12°, and median internal rotation (IR) was to the buttock. All patients underwent arthroscopic capsular release with a standard aftercare protocol. Results: The study population showed significant improvement (P < .0001) for all outcome scores and active motion parameters. Average and median outcome parameters for the population, with improvement in parenthesis were: ASES 93 (+57.5), SST 10 (+7), VAS 0 (−6), FE 165° (+73°), ER at side 56° (+44°), and IR to T −12 (+7 spinal segments). The time in formal physical therapy averaged 2.3 months (2 to 20 weeks) and time to attain final, pain-free range of motion averaged 2.8 months (1 to 6). Outcomes for, and between, each etiology were analyzed. There was no difference in time to final motion between the etiologic groups. Conclusions: Stiff shoulder pathology can result from a variety of differing etiologic factors. Arthroscopic capsular release was equally effective across the 5 identified etiologic groups, and provided significant pain relief, restoration of motion, and function within an average of 3 months.     

一期手术治疗肩袖损伤合并肩关节僵硬的疗效分析

目的探讨肩袖损伤合并肩关节僵硬一期手术治疗的疗效。方法回顾性分析2017年1月至2019年11月应用关节镜下手术修补冈上肌损伤合并肩关节僵硬患者20例(僵硬组)的临床资料,男9例,女11例;年龄(62.2±8.7)岁(范围:45~80岁);病史(5.2±4.3)个月(范围:1~12个月)。以同期应用关节镜下手术修补冈上肌损伤不合并关节僵硬患者54例(非僵硬组)作为对照,男16例,女38例;年龄(60.9±9.1)岁(范围:46~81岁);病史(8.2±13.0)个月(范围:1~60个月)。术后1、3、6个月及末次随访时评估患者疼痛程度、肩关节功能评分及活动度,末次随访时评价患者对治疗的主观满意度。主要观察指标包括疼痛视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科(American Shoulder and Elbow Surgeons,ASES)评分、美国加州大学肩关节功能评分(the University of California at Los Angeles shoulder rating scale,UCLA)、Constant-Murley评分、肩关节活动度和患者满意度。结果僵硬组术后随访时间为(19.7±4.6)个月(范围:12~30个月),非僵硬组为(18.6±4.4)个月(范围:12~29个月)。两组患者术后肩关节疼痛评分较术前明显下降,肩关节功能及活动度均明显改善,差异有统计学意义。术后1个月僵硬组VAS评分为(4.2±1.5)分,非僵硬组为(3.4±1.1)分,差异有统计学意义(t=2.381,P=0.020);术后3个月两组VAS评分的差异无统计学意义。术后3个月僵硬组ASES评分、UCLA评分、Constant-Murley评分分别为(52.3±10.2)分、(17.8±4.2)分、(51.7±9.7)分,非僵硬组为(57.4±7.4)分、(21.6±3.8)分、(63.2±13.5)分,差异有统计学意义(t=2.363,P=0.021;t=3.713,P<0.001;t=3.484,P<0.001)。术后6个月及末次随访时两组VAS评分、ASES评分、UCLA评分、Constant-Murley评分的差异均无统计学意义。僵硬组和非僵硬组术后满意度分别为95.0%和96.3%,差异无统计学意义(χ2=0.2511,P=0.802)。结论一期手术治疗肩袖损伤合并肩关节僵硬与不合并肩关节僵硬患者的最终疗效相当,但合并肩关节僵硬的患者术后早期恢复较慢。     

关节镜松解术结合手法治疗肩凝症的病例对照研究

目的：比较关节镜松解术后采用常规康复方法及结合应用手法治疗难治性肩凝症的疗效,评价手法治疗的应用价值.方法：自2007年3月至2010年7月,对符合肩凝症诊断标准、接受关节镜下粘连松解术的48例48肩（左肩23例,右肩25例）,分为手法治疗组和常规康复治疗组.常规康复治疗组26例,男11例,女15例;手法治疗组22例,男9例,女13例.手法治疗组除术后常规康复外接受手法推拿干预,手法治疗原则初期为活血止痛,后期为松解粘连、滑利关节,推拿治疗时间每次20 min,每日2次,共治疗10d.对所有患者进行随访,记录术前、术后各随访点的ASES评分及肩关节活动范围.结果：48例均获随访,时间4～25个月,平均（12.54±5.78）个月.术后1个月时,手法治疗组ASES评分和肩关节前屈活动度优于常规康复治疗组,末次随访时两组的各项随访指标差异均无统计学意义.结论：关节镜松解术结合术后手法治疗,有助于加快肩凝症患者的早期康复进程,帮助其尽早重返社会,但其远期关节功能与术后常规康复治疗相比无明显差异.     

Diabetic and non-diabetic patients report equal symptom relief after arthroscopic capsular release of frozen shoulder

BackgroundFrozen shoulder is a painful joint disease. Patients with diabetes seem to have worse clinical symptoms and surgery in this patient population is believed to be more common.The objective postoperative evaluation indicates inferior results when surgically treating diabetics, but no previous studies have investigated exclusively the subjective patient satisfaction with arthroscopic capsular release.Materials and methodsA total of 93 patients were included. All had persistent symptoms despite conservative treatment for at least six months. The patients were retrospectively divided into two groups based on diabetes status: Group 1 consisted of patients with type 1 or type 2 diabetes (18) and group 2 consisted of the remaining patients (75). Evaluation was performed prior to arthroscopic capsular release and at six months follow-up. The web-based questionnaire consisted of two different evaluation forms: The Oxford Shoulder Score (OSS) and a visual quality scale (VQS).ResultsBoth groups reported a statistically significant improvement in both evaluations. OSS in group 1 improved by 11.5 [95% CI: 6.2 ; 16.4] and by 15.8 [95% CI: 13.6 ; 17.9] in group 2. The improvement was more pronounced in group 2, though not statistically significant (p = 0.09). The VQS improved 39.6 in group 1 and 44.5 in group 2, (p = 0.50).ConclusionDiabetic and non-diabetic patients reported equal symptom relief after arthroscopic capsular release of frozen shoulder when selected for operation without considering diabetic status. We will continue to select patients for arthroscopic release without differences in preoperative counseling between diabetics and non-diabetics.     

Arthroscopic capsular release for the treatment of refractory postoperative or post-fracture shoulder stiffness.

BACKGROUND: Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) that is refractory to nonoperative treatment or manipulation under anesthesia. The role of arthroscopic capsular release in the treatment of frozen shoulder after shoulder surgery or fracture is less clearly understood. The purposes of this study were to define the outcome of arthroscopic capsular release in the management of frozen shoulder after surgery or fracture and to compare these results with those of arthroscopic capsular release in the treatment of idiopathic frozen shoulder. METHODS: We evaluated the results of arthroscopic capsular release in three different groups of patients with shoulder contracture refractory to nonoperative management and manipulation under anesthesia. The three groups consisted of patients who had an idiopathic frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness after fracture. We evaluated pain, function, patient satisfaction, and range of motion in all three groups before and after the study treatment. RESULTS: At a mean of twenty months (range, twelve to forty-six months) after the operation, fifty patients were available for assessment of function and range of motion of the involved shoulder. At the time of follow-up, each group had a significant improvement in the scores for pain, patient satisfaction, and functional activity as well as in the overall outcome score (p < 0.01). Comparison of the scores among the different groups revealed that all had a similar degree of improvement in range of motion of the involved shoulder, but patients with postoperative frozen shoulder had significantly (p < 0.05) lower scores for pain (p < 0.03), patient satisfaction (p < 0.004), and functional activity (p < 0.002) than did those with idiopathic or post-fracture frozen shoulder. CONCLUSIONS: Arthroscopic capsular release was as effective for improving range of motion in patients with postoperative contracture of the shoulder as it was in patients with idiopathic and post-fracture contracture. However, there was less improvement in the subjective scores for pain, function, and patient satisfaction in the postoperative group.     

Arthroscopic capsular release for contracture of the wrist: a new technique.

SUMMARY: Stiffness of the wrist can occur following trauma or surgery. In some patients, loss of motion may be refractory to conservative treatment and operative treatment may thus be indicated. The authors report the results and technique of arthroscopic capsular release of the wrist. A cadaveric study was performed to assess the safety of arthroscopic capsular release. Arthroscopic capsular release was performed on 2 patients with limited wrist mobility. The average distance from the radiocarpal joint capsule to the neurovascular structures were 6.9 mm to the median nerve, 6.7 mm to the ulnar nerve and 5.2 mm to the radial artery. At 6 months follow-up, the average range of motion had improved from 17 degrees flexion and 10 degrees extension to 47 degrees flexion and 50 degrees extension. The average grip strength had improved from 13 to 31 kg. Pain measured on a visual analogue score (0-10) had improved from 1.5 to 1.0. There were no complications. Arthroscopic capsular release of the wrist is a safe and minimally invasive technique that provides good improvement to range of motion.     

关节镜下非打结型与打结型缝合锚钉Bankart重建治疗复发性肩关节前向不稳

目的探讨关节镜下非打结型与打结型缝合锚钉对复发性肩关节前向不稳Bankart损伤的临床效果。方法回顾性分析2006年3月至2009年1月广州军区广州总医院收治的44例复发性肩关节脱位Bankart损伤患者的临床资料,根据关节镜下修复方式的不同分为非打结组（可吸收非打结型缝合锚钉修复,20例）和打结组（打结型缝合锚钉修复,24例）。采用美国肩肘外科医师（ASES）评分及Constant-Murley功能评分对患者术前、末次随访时肩关节功能进行评估,记录肩关节活动范围,观察并发症发生情况。结果所有患者获得随访,随访时间20～46个月,平均随访时间30个月。非打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（163±9）°和（170±4）°、（58±14）°和（90±6）°,术后外展90°时患侧外旋角度较健侧受限（8±6）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（77.4±3.7）分和（94.3±2.6）分、（78.1±4.6）分和（93.9±3.7）分,两者比较,差异有统计学意义（P〈0.05）。打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（162±8）°和（170±6）°、（61±13）°和（91±6）°,术后外展90°时患侧外旋角度较健侧受限（5±3）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（75.8±2.9）分和（95.1±3.7）分、（76.2±5.9）分和（92.8±5.2）分,两者比较,差异有统计学意义（P〈0.05）。两组间术前、术后各项指标比较,差异无统计学意义（P〉0.05）。患者均未出现术后再脱位,均重返伤前工作岗位。结论肩关节镜下Bankart重建手术是治疗复发性肩关节前向不稳的有效方法,非打结型和打结型缝合锚钉修复Bankart损伤疗效相似。     

Early arthroscopic release in refractory shoulder stiffness

Frozen shoulder is still an enigma in shoulder surgery. It is reported that at 2 years after onset most patients will have recovered whether treated or not. To decrease time to recovery and improve the results of this condition, a number of different treatment modalities have been used. In our unit, all patients with frozen shoulder were selected for the arthroscopic release technique if a conservative program of physical therapy had failed to restore motion after 6 months and if they had no known extra-articular contractures. A prospective study was undertaken of 36 patients with refractory frozen shoulder who were treated with an arthroscopic capsulotomy between November 1997 and October 1999. There were 22 women and 14 men with an average age of 49 years (range 32-63 years). All of the patients were assessed for pain, function, and range of motion before surgery. Five patients were diabetic. An arthroscopic capsular release improved motion in all patients, with substantial relief of pain. Follow-up averaged 18 months (range 10-26 months). The median preoperative Constant score rose from 29 to 66 at the time of follow-up. By a mean of 8 weeks after treatment, 75% of the patients had returned to work. One patient developed recurrent refractory stiffness. There were no complications related to the procedure. This study demonstrates that arthroscopic capsular release can be a safe and effective tool in the management of refractory shoulder stiffness and is an effective way of shortening the course of an apparently self-limiting disease.     

Functional results and patient satisfaction after arthroscopic capsular release of idiopathic and post-traumatic stiff shoulder

Purpose

The purpose of this prospective study was to compare the functional results and patient satisfaction after arthroscopic shoulder capsular release in patients with idiopathic and posttraumatic stiff shoulder.

Methods

The study included 50 patients who underwent arthroscopic capsular release after failure of conservative treatment. The etiology of stiffness was either idiopathic (25 patients) or post-traumatic (25 patients). There were 28 women and 22 men with an average age of 49 years (range, 32–70 years). All patients were treated with physical therapy for a mean of six months (range, 3–12 months) before surgery. Range of motion was measured three times: 48 hours after surgery, then one month and six months after surgery.

Results

Constant score showed improvement for both groups of patients in the period of six months after surgery. In the group with idiopathic stiffness the score increased from 36 to 86, while in the group with post-traumatic stiff shoulder the score advanced from 32 to 91. The idiopathic stiff shoulder group had an improved active forward flexion from 90 to 161°, external rotation from 10 to 40°, and internal rotation from L5 to L1. In the post-traumatic stiff shoulder groupthe forward flexion was improved from 95 to 170°, external rotation from 13 to 40° and internal rotation from L4 to L1.

Conclusion

There was an improvement of range of motions and patients' satisfaction after arthroscopic shoulder capsular release and manipulation under anesthesia, equally in idiopathic and post-traumatic stiff shoulder, compared to the situation before surgery. Post-traumatic contracture patients expressed higher level of satisfaction with their shoulder function than the idiopathic stiff shoulder patients.