关节镜松解序贯关节灌注治疗疼痛期冻结肩

doi:10.3877/cma.j.issn.2095-5790.2021.02.005

目的

研究关节镜松解序贯关节灌注治疗疼痛期冻结肩的临床疗效。

方法

收集2018年1月至2019年10月在南华大学附属第一医院行关节镜松解序贯关节灌注治疗的原发性疼痛期冻结肩患者18例，分别于术前、术后1周、术后4周、术后3个月、术后6个月收集肩关节被动活动度（前屈、外展、外旋、内旋），视觉模拟评分（visual analogue scale,VAS），美国加州大学洛杉矶分校（the university of California at Los Angeles shoulder rathing scale,UCLA）肩关节评分，上肢功能（disabilities of the arm, shoulder, and hand，DASH）评分。

结果

以上各项指标组内比较差异均有统计学意义（P<0.05）。各时间点之间比较，术后1周时，除内旋外，其他各项指标与术前比较均有明显改善（P<0.05）；术后4周，各项指标与术前及术后1周比较均有明显改善（P<0.05）；术后3个月，各项指标与术前及术后1周、4周比较均有明显改善（P<0.05）；术后6个月各项指标与术前及术后1周、4周、3个月比较均有明显改善（P<0.05）；所有患者均对手术及治疗效果表示满意。

结论

关节镜松解序贯关节灌注治疗疼痛期冻结肩能够有效缓解疼痛，快速改善肩关节的活动度，恢复肩关节功能，临床疗效良好。

关键词: 疼痛期冻结肩, 关节镜, 关节灌注, 松解

Background

The main manifestations of frozen shoulder are shoulder pain and limitation of movement, which can be divided into three stages: pain stage, stiffness stage and remission stage. Currently, conservative treatment is the main treatment method for frozen shoulder in pain stage, including oral non-steroidal anti-inflammatory drugs, physiotherapy, traditional Chinese medicine treatment, shoulder perfusion, etc. Shoulder perfusion can quickly and effectively relieve pain, but the improvement of range of motion is slow with long duration of treatment. Arthroscopic release can rapidly improve the range of motion of the shoulder joint. However, due to the limited effect of anti-inflammation, it is mainly applicable to frozen shoulder in the stiffness stage, and it is still controversial to treat frozen shoulder in the pain stage, which is prone to recurrence.

Objective

To investigate the clinical efficacy of arthrolysis and sequential arthroperfusion in the treatment of frozen shoulder in the pain stage.

Methods

From January 2018 to October 2019, 18 patients of frozen shoulder in the pain stage were treated with arthrolysis and sequential arthroperfusion in our hospital. The data of active and passive range of motion, VAS score, UCLA score, DASH score of before operation and 1st week, 4th week, 3rd month, and 6th month after operation were collected.

Results

There were significant differences in the above indexes among the groups (P<0.05) . At each time point 1 week after the operation, all other indicators except internal rotation were significantly improved compared with those before operation (P<0.05) . In the 4th week after operation, all the indicators were significantly improved compared with those before operation and 1 week after operation (P<0.05) .In the 3rd month after operation, all the indexes were significantly improved compared with those before operation and 1 week and 4 weeks after operation (P<0.05) . In the 6th month after operation, all the indexes were significantly improved compared with those before operation and 1 week, 4 weeks and 3 months after operation (P<0.05) . All patients were satisfied with the curative effect.

Conclusion

Arthrolysis and sequential arthroperfusion in the treatment of frozen shoulder during pain stage can quickly relieve pain, improve the range of motion of shoulder joint and restore the shoulder function.

Key words: Frozen shoulder of pain stage, Arthroscopy, Arthroperfusion, Arthrolysis

图1 患者女性，45岁，右侧冻结肩　图A-D：术前活动受限；图E-H：术后3个月活动基本正常；图I-L：术后6个月活动完全正常

表1 患者术前及术后随访肩关节功能评分表（分，±s）

时间	UCLA评分	DASH评分	VAS评分
术前	9.5±4.2	31.9±2.3	8.6±1.0
术后1周	16.4±3.6^a	27.3±2.2^a	4.5±0.3^a
术后4周	20.1±3.5^a	22.4±2.1^a	2.9±0.5^a
术后3个月	23.9±5.4^a	19.0±2.3^a	2.2±0.6^a
术后6个月	31.6±4.8^a	9.3±1.9^a	1.3±0.9^a
P值	<0.05	<0.05	<0.05

表1 患者术前及术后随访肩关节功能评分表（分，±s）

时间	UCLA评分	DASH评分	VAS评分
术前	9.5±4.2	31.9±2.3	8.6±1.0
术后1周	16.4±3.6^a	27.3±2.2^a	4.5±0.3^a
术后4周	20.1±3.5^a	22.4±2.1^a	2.9±0.5^a
术后3个月	23.9±5.4^a	19.0±2.3^a	2.2±0.6^a
术后6个月	31.6±4.8^a	9.3±1.9^a	1.3±0.9^a
P值	<0.05	<0.05	<0.05

表2 患者术前及术后肩关节活动度比较（°，±s）

时间	前屈	外展	外旋	内旋
术前	83.5±12.5	90.7±8.9	10.2±5.6	16.3±0.4
术后1周	129.8±13.4^a	121.8±12.6^a	25.6±8.2^a	15.2±0.8
术后4周	145.3±10.2^a	134.2±11.3^a	31.5±9.3^a	13.4±0.4^a
术后3个月	168.6±8.6^a	161.8±9.2^a	40.3±7.4^a	12.1±0.6^a
术后6个月	175.8±9.3^a	171.7±12.9^a	49.3±5.6^a	10.5±0.7^a
P值	<0.05	<0.05	<0.05	<0.05

表2 患者术前及术后肩关节活动度比较（°，±s）

时间	前屈	外展	外旋	内旋
术前	83.5±12.5	90.7±8.9	10.2±5.6	16.3±0.4
术后1周	129.8±13.4^a	121.8±12.6^a	25.6±8.2^a	15.2±0.8
术后4周	145.3±10.2^a	134.2±11.3^a	31.5±9.3^a	13.4±0.4^a
术后3个月	168.6±8.6^a	161.8±9.2^a	40.3±7.4^a	12.1±0.6^a
术后6个月	175.8±9.3^a	171.7±12.9^a	49.3±5.6^a	10.5±0.7^a
P值	<0.05	<0.05	<0.05	<0.05

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