经冈上肌入路全关节镜下松解治疗重度原发性冻结肩的疗效观察

发布时间：2018-06-03 02:27

本文选题：原发性冻结肩 + 关节镜　；参考：《中国修复重建外科杂志》2017年07期

【摘要】：目的探讨经冈上肌入路全关节镜下松解治疗重度原发性冻结肩的临床效果。方法将2012年6月—2015年1月收治并符合标准的28例重度原发性冻结肩患者纳入研究。男8例,女20例;年龄42~81岁,平均57岁。均为单肩发作,其中左侧16例,右侧12例。病程7~21个月,平均11个月。合并糖尿病6例。手术均经冈上肌入路后,进行关节镜下松解。术前及术后6周、24个月检查肩关节被动外展、前屈、内收位外旋活动度以及被动内旋情况,采用疼痛视觉模拟评分(VAS)以及美国肩肘外科协会(ASES)评分评价肩关节疼痛及功能情况。结果术后切口均Ⅰ期愈合,无感染、肩关节不稳、神经损伤等并发症发生;患者均获随访24个月。术后患者肩关节疼痛显著缓解,6周及24个月VAS评分均显著低于术前(P0.05),术后24个月VAS评分较术后6周进一步降低(P0.05)。术后6周及24个月,患者肩关节被动外展、前屈、内收位外旋活动度以及ASES评分均较术前显著提高(P0.05);术后6周及24个月间比较,ASES评分及被动前屈、内收位外旋活动度差异有统计学意义(P0.05),被动外展活动度差异无统计学意义(P0.05)。术前被动内旋达股骨大粗隆9例、臀区6例、骶骨7例、L4水平6例,术后6周及24周恢复至T12~T6水平,与健侧相当。结论对于重度原发性冻结肩患者,采用经冈上肌入路能顺利进入盂肱关节,精准定位后方入路,有效保障了全关节镜下松解的实施。
[Abstract]:Objective to investigate the clinical effect of total arthroscopic release through supraspinar muscle approach for severe primary frozen shoulder. Methods 28 patients with severe primary frozen shoulder who were admitted from June 2012 to January 2015 were included in the study. There were 8 males and 20 females, aged 42 to 81 years (mean 57 years). All cases were single shoulder attack, including 16 cases on left side and 12 cases on right side. The course of disease ranged from 7 to 21 months (mean 11 months). 6 cases were complicated with diabetes. Arthroscopic release was performed after operation through supraspinar muscle approach. Preoperative and postoperative 6 weeks, 24 months after the examination of shoulder passive abduction, forward flexion, adductive external rotation and passive internal rotation, the pain visual analogue score (VASS) and the American Society of shoulder and elbow surgery (ASESS) score to evaluate shoulder pain and function. Results all the postoperative incisions healed without infection, shoulder joint instability, nerve injury and other complications, and all the patients were followed up for 24 months. The VAS scores of patients with shoulder pain at 6 weeks and 24 months after operation were significantly lower than those before operation (P 0.05), and the VAS scores at 24 months after operation were significantly lower than those at 6 weeks after operation. At 6 weeks and 24 months after operation, the shoulder joint passive abduction, anterior flexion, adduction external rotation and ASES scores were significantly increased compared with those before operation, and the scores of ASES and passive flexion were compared between 6 weeks and 24 months after operation. There was significant difference in adductive external rotation activity (P0.05), but there was no significant difference in passive outreaching activity (P0.05). Preoperative passive internal rotation reached the great trochanter of femur in 9 cases, gluteal region in 6 cases, sacrum in 7 cases with L4 level in 6 cases, and recovered to T12~T6 level 6 and 24 weeks after operation, which was similar to that of healthy side. Conclusion for patients with severe primary frozen shoulder, the supracondylar muscle approach can successfully enter the glenohumeral joint and accurately locate the posterior approach, which effectively ensures the implementation of total arthroscopic release.
【作者单位】：南京中医药大学附属无锡中医医院关节骨科;上海交通大学附属新华医院骨科;
【分类号】：R687.4

【相似文献】