关节镜下盂肱关节前方松解对原发性冻结肩的早期疗效

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。

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

ObjectiveTo define the benefit of arthroscopic release of the anterior glenohumeral joint in frozen shoulder. MethodsSixty 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. ResultsNone 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). ConclusionThe arthroscopic release of the anterior glenohumeral joint may significantly improveboth of the function and ROM in IAC patients.