射频消融技术在肩峰撞击症治疗中的作用

 目的 通过前瞻性随机对照研究, 总结射频消融技术在肩峰撞击症关节镜下治疗中的作 用。 方法50 例应用肩关节镜治疗的肩峰撞击症患者, 术前疼痛视觉模拟评分(visual analogue scale, VAS)为5.3±1.8;肩关节前屈上举(forward elevation, FE)为127.4°±40.1°, 体侧外旋(external rotation, ER) 为34.4°±23.1°, 内旋(internal rotation, IR)平均达L1 水平。Constant-Murley 评分为65.6±16.2, 加州大学 洛杉矶分校(University of California at Los Angeles, UCLA)评分为15.8±4.2, 肩关节简单评分(Simple Shoulder Test, SST)评分为6.5±3.3。治疗前随机将患者分为接受关节镜下肩峰下减压并射频消融辅助治 疗组(26例)和仅行关节镜下肩峰下减压的对照组(24 例)。术后不同时间段评估VAS、UCLA、ConstantMurley、SST 评分以及FE、ER 和IR 活动度, 并进行两组间及手术前后比较。 结果 末次随访时VAS 为 0.4±1.1, FE 为161.5°±13.7°, ER 为52. 2°±10.9°, IR 平均达T7 水平。Constant-Murley 评分为96.4±5.1, UCLA评分为32.9±3.0, SST 评分为11.3±1.2;与术前相比各指标差异均有统计学意义(P <0.05)。射频消 融辅助治疗组与对照组各指标在不同时间段组间差异均无统计学意义。 结论 对于经保守治疗无效的 肩峰撞击症患者, 应用肩峰成形术结合广泛的肩峰下滑囊清理术可获得较为满意的临床效果;是否使 用Topaz 射频消融技术对临床结果无明显影响。

Application of radiofrequency technology in the treatment of subacromial impingement syndrome: a prospective randomized control study

Objective To evaluate the effect of radiofrequency therapy in the arthroscopic treatment of subacromial impingement syndrome. Methods Fifty patients with subacromial impingement syndrome treated arthroscopically were enrolled in the study. Preoperatively, the average visual analogue scale (VAS) score of all 50 patients was 5.3±1.8; the average UCLA score was 15.8±4.2; the average Constant score was 65.6±16.2; the average Simple Shoulder Test (SST) score was 6.5±3.3; the forward elevation was averagely 127.4°±40.1°; the external rotation was averagely 34.4°±23.1°; the internal rotation was averagely at L1 level.
Patients were randomly assigned to radiofrequency group which received subacromial decompression and Topaz radiofrequency treatment, or control group which only underwent subacromial decompression. The VAS score, UCLA score, Constant score, and SST score were used to evaluate the clinical outcomes 3 weeks, 6 weeks, 3 months, 6 months and 1 year after operation. The assessment of shoulder range of motion included forward elevation、external rotation and internal rotation. The clinical outcome data were compared between the radiofrequency group and the control group, as well as before and after operation within each group. Results At the final follow-up, the average VAS score of all 50 patients was 0.4±1.1; the average UCLA score was 32.9±3.0; the average Constant score was 96.4±5.1; the average SST score was 11.3±1.2; the forward elevation was averagely 161.5°±13.7°; the external rotation was averagely 52.2°±10.9°; the internal rotation was averagely at T7 level. There were statistical differences between preoperative and postoperative indexes mentioned above. However, there were no statistical differences in indexes between the radiofrequency group and the control group at any time point. Conclusion The Topaz radiofrequency therapy has no significant impact on clinical outcome of arthroscopic treatment of subacromial impingement syndrome.