关节镜下双后入路结合前方入路盂肱关节囊松解治疗重度原发性冻结肩

目的研究肩关节镜双后入路结合前方入路盂肱关节囊松解治疗重度原发性冻结肩的临床效果。 方法2013年1月至2016年12月南京中医药大学附属医院对16例重度原发性冻结肩患者行关节镜下双后入路结合前方入路盂肱关节囊松解术，男2例、女14例，平均年龄46.6岁，左肩4例、右肩12例。所有患者术前均拍摄肩关节正位片、冈上肌出口位X线片和肩关节MRI检查，全部患者均行双后入路关节镜下盂肱关节囊松解术，所有病例均同时行肩峰下滑囊清理术，分别在术前和末次随访时采用视觉模拟评分（visual analogue scale,VAS）、Constant-Murley评分和美国加利福尼亚大学（University of California, Los Angeles，UCLA）肩关节评分标准进行评价。 结果随访时间10~37个月，平均26个月。术前、术后即刻和末次随访平均UCLA评分分别为（10.3±3.2）分、（28.2±3.3）分和（31.2±5.3）分，差异有统计学意义（P<0.01）；平均Constant-Murley评分为（38.3±4.2）分、（89.2±4.5）分和（95.2±3.3）分；VAS评分平均为（6.3±1.9）分、（1.3±0.3）分和（1.0±0.2）分（P<0.01）。所有患者均对手术效果表示满意。 结论关节镜下双后入路结合前方入路盂肱关节囊松解治疗重度原发性冻结肩，便于术中操作，可以显著地缓解疼痛、恢复肩关节功能。关节镜下双后入路结合前方入路盂肱关节囊松解为治疗重度原发性冻结肩提供有效方法。

Treatment of severe primary frozen shoulder with arthroscopic glenohumeral capsule release via double posterior approaches combined with anterior approach

BackgroundFrozen shoulder is a common clinical disease of shoulder joint, which occurs frequently in women around 50 years old. The incidence of normal people is about 2% - 5%. Frozen shoulder is a multiple bursal disease, involving glenohumeral joint capsule, subacromial or deltoid muscle, bursa of long head tendon of biceps brachii, etc. The early lesions were hyperemia, edema and exudation of the bursa. Therefore, the early treatment of this disease is mainly conservative. With the functional exercise and the use of nonsteroidal anti-inflammatory drugs, most of the patients can obtain satisfactory results after conservative treatment within 6 months; for patients who fail to respond to conservative treatment, arthroscopic release is an effective treatment method. However, in clinical arthroscopic release, for a few severe patients, the glenohumeral joint adhesion is severe and the joint space is extremely narrow. It is not only difficult to complete manual release under preoperative anesthesia, but also impossible for arthroscopy to enter the glenohumeral joint space through posterior approach. At this point, it is necessary to use double posterior approaches to release the glenohumeral joint capsule under arthroscopy. Objective To study the effectiveness of shoulder arthroscopic double posterior approaches combined with anterior approach in the treatment of severe primary frozen shoulder. MethodsFrom January 2013 to December 2016, 16 patients with severe primary frozen shoulder underwent arthroscopic glenohumeral capsule release through double posterior approaches combined with anterior approach. There were 2 males and 14 females (4 left shoulders and 12 right shoulders) with an average age of 46.6 years. Six patients had a history of diabetes mellitus. Two patients had a history of hypothyroidism. X-ray films of shoulder joint and supraspinatus outlet as well as shoulder MRI were taken before operation. All patients underwent arthroscopic glenohumeral capsule release through double posterior approaches and subacromial decompression as well. VAS pain score, Constant-Murley score and UCLA score were used for assessment before operation and at the final follow-up after operation. ResultsThe follow-up time w as 10-37 months with an average of 26 months. The mean UCLA scores before and after operation and at the last follow-up were (10.3±3.2) , (28.2±3.3) and (31.2±5.3) . The difference was statistically significant (P<0.01) . The mean Constant-Murley scores were (38.3±4.2) , (89.2±4.5) and (95.2±3.3) (P<0.01) . The mean VAS scores were (6.3±1.9) , (1.3±0.3) and (1.0±0.2) (P<0.01) . There were 12 excellent cases and 4 good cases. All patients were satisfied with the results of operation. ConclusionsArthroscopic glenohumeral joint release through double posterior approaches combined with anterior approach is an effective method for treatment of severe primary frozen shoulder.