术前肩关节功能训练对合并冻结肩的肩袖损伤患者手术效果的影响

背景:目前对合并冻结肩的肩袖损伤患者的手术时机有一定争议,部分研究认为应先通过肩关节功能训练在一定程度上缓解冻结肩后再手术,也有研究认为推迟修复肩袖的手术可能会导致肩袖损伤进一步扩大,影响修复效果.目的:探讨合并冻结肩的肩袖损伤患者术前肩关节功能训练后行关节镜下肩袖修复关节松解术与入院后一期行关节镜手术的临床疗效差别....

Effect of preoperative shoulder joint functional training on operative results of rotator cuff injury combined with frozen shoulder

Background:At present,there is some controversy about the timing of operation for patients with rotator cuff injury combined with frozen shoulder.Some studies believe that it is necessary to take functional training of the shoulder joint before operation.Other studies believe that delaying the operation time of rotator cuff injury may lead to intensive injury and affect the effect of rotator cuff repair.Objective:To compare the clinical efficacy between arthroscopic rotator cuff repair and joint release surgery after preoperative functional training and one-stage arthroscopic operation after admission in patients with rotator cuff injury combined with frozen shoulder.Methods:A total of 51 patients with rotator cuff injury combined with frozen shoulder admitted in our hospital from June 2016 to June 2019 were divided into two groups according to therapeutic method.Patients in preoperative rehabilitation group received shoulder joint function training and oral celecoxib for 6 weeks before arthroscopic rotator cuff repair and joint release surgery.Patients in one-stage operation group received arthroscopic surgery after admission.Postoperative rehabilitation training program was carried out in both groups.VAS pain score,shoulder joint passive mobility(flexion,abduction,lateral rotation)and Constant-Muriey shoulder joint function score were recorded at 3 weeks,6 weeks,3 months and 6 months postoperatively.Results:The shoulder joint passive mobility and Constant-Murley score continuously increased,and VAS scores continuously increased in both groups during follow-up.There were significant differences in the shoulder joint passive mobility,Constant-Murley score and VAS scores between two groups at 3 weeks postoperatively(P<0.05).There were significant differences in the Constant-Muriey score,VAS scores,passive abduction and lateral rotation between two groups at 6 weeks postoperatively(P<0.05),but no significant difference was found in the passive flexion(P>0.05).There were significant difference between the two groups in the passive lateral rotation and Constant-Murley score at 3 months postoperatively(P<0.05),but no significant difference was found in passive flexion,abduction and VAS scores(P>0.05).At 6 months after operation,there was no significant difference in any above-mentioned parameters between the two groups(P>0.05).Conclusions:The therapy of preoperative six-week shoulder function training and nonsteroidal drug plus surgical treatment can achieve better short-term(<3 months)clinical outcome than one-stage arthroscopic operation in patients with rotator cuff injury in combination of frozen shoulder.However,they have similar long-term(>6 months)efficacy.