关节镜下松解治疗冻结肩的疗效观察

目的评价关节镜下肩关节囊松解治疗冻结肩的疗效及安全性。方法采用临床随机对照研究的方法对本组2007年8月至2011年1月间收治的冻结肩患者共47例进行平均1年随访（8～20个月）。其中女25例;男22例,平均年龄52岁（31～69岁）;病程3～18月,平均6.5个月。随机分为保守治疗组（A组）和关节镜治疗（B组）组两组,其中A组24例,B组23例。评价指标采用美国肩肘外科-标准肩关节评分（ASES）、肩关节主动/被动活动范围（ROM）、视觉疼痛评分（VAS）、恢复时间、并发症等。两组在年龄、性别、病程及分期等基线资料差异无统计学意义。结果 B组所有23例均获随访;A组1例在治疗后3个月因疗效不满意而转入B组,另有1例失访;最终有22例获得随访。所有患者治疗期间均无严重并发症发生。（1）与治疗前比较,两组患者在治疗后3个月及最终平均12个月随访时（ASES）评分、肩关节主动/被动ROM及肩关节VSA疼痛评分等方面均有明显改善：但两组比较差异有统计学意义;证明在治疗后3个月及12个月随访时关节镜松解治疗冻结肩在（ASES）评分、肩关节主动/被动活动范围均优于A组（P均小于0.05）。（2）肩关节VAS疼痛视觉评估量表值在治疗后3个月随访时,B组为（2.8±9.3）、A组为（1.0±5.6）,差异有统计学意义,证明A组在治疗后3个月随访时肩关节疼痛小于B组（P〈0.01）;而在最终平均12个月随访时VAS疼痛评分B组为（0.7±2.3）;A组为（2.7±8.1）,差异有统计学意义,证明在最终平均12个月随访时A组患者肩关节疼痛较B组重（P=0.017）。（3）B组23例患者中有20例术后恢复到患病前状况所需时间为（4±3）周,而A组随访22例中只有13例恢复到患病前状况,且所需平均时间为（7±6.0）周,两组比较差异有统计学意义;证明B组术后＂恢复到患病前状况所需时间＂少于A组（P〈0.01）。（4）最终随访时（平均12个月）B组在≤8周以内所有24例患者全部恢复到患病前状况,而A组22例中只有16例患者恢复到患病前状况,且恢复时间均≥12周,仍有6例患者肩关节功能恢复不满意。两组比较差异有统计学意义（P〈0.05）。结论与保守治疗相比较,B组关节镜下肩关节囊松解治疗冻结肩在（ASES）评分、肩关节主动/被动活动范围均优于A组,且恢复时间较A组快,但在治疗后3个月随访时肩关节疼痛B组较A组稍重而术后12个月时B组肩关节疼痛及功能状况恢复,明显优于A组。

The efficacy of arthroscopic arthrolysis for frozen shoulder

Objective To evaluate the results and safety of arthroscopic capsular release for frozen shoulder. Methods A randomized-controlled clinical study was conducted from August 2007 to January 2011. 47 patients (25 women, 22 men; mean age 51 years; range, 31 to 69 years) were divided randomly into two groups. Arthroscopic capsular release was performed in 23 patients (group B) while the other 24 patients (group A) underwent conservative treatment. The average hospital days were 6.5 months (range, three to eighe months). The mean follow-up period was one year (range, eight to 20 months). The outcomes were evaluated according to American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Score (VAS), passive (PROM) and active (AROM) range of motion, recovery time, and complications. Results At the one year follow-up, 23 patients in group B and 22 patients in group A were available for assessment. One patient of group A was unsatisfied with the effect and treated with arthroscopic capsular release three months after the conservative treatment. Another one was failed to be followed up. No complications occurred. The results revealed that both groups had a significant improvement. However, there were statistical differences (P<0.05) in ASES, PROM and AROM between these two groups. Although Score of VAS in group A (1.0±5.6) was lower than group 1 (2.8±9.3) at three months after treatment, it was higher in group A at 12 months of follow-up, which were (2.7±8.1) and (0.7±2.3) respectively. The difference (P=0.017) between the two groups was statistically significant. Recovery time were (4±3) weeks in 20 patients of group B and (7±6) weeks in 13 patients of group A, which showed that patients treated by operation needed less time to restore joint function than those who had conservative treatment. All the patients in group B had restored joint function as before in eight months while only 13 patients in group A had restored function in 12 months. The difference was statistical significant (P<0.01). Other six patients in group 2 were not satisfied with the treatment effect. Conclusions Comparing with conservative treatment, arthroscopic capsular release for the treatment of frozen shoulder has great advantages of less recovery time, better effect and safety.