麻醉下单纯肩关节松解与联合肩关节镜囊内松解治疗骨质疏松合并冻结肩患者的早期疗效比较

戴寿旺 骆国钢 张鸿振 郑润杰 王萧枫

[摘要] 目的 比較麻醉下单纯肩关节松解与联合关节镜下囊内松解治疗骨质疏松合并冻结肩患者的早期疗效。方法 2015年10月～2019年10月期间在温州市中西医结合医院关节外科及温州市运动医学中心，将诊断为原发性骨质疏松合并有冻结肩的36例患者进行随机分组，A组行麻醉下单纯肩关节松解，B组行麻醉下肩关节松解联合肩关节镜囊内松解。对比术前、术后1 d、术后1个月的疼痛程度（VAS）、肩关节的主、被动活动度及Constant-Murley肩关节评分（CMS），并作统计学分析。 结果 A组术后VAS[（1.16±0.83）分vs.（6.63±1.21）分]，肩关节的主、被动活动度[主动：（156.58±16.16）° vs.（82.11±13.98）°;被动：（168.16±7.30）° vs.（105.79±14.27）°]，CMS评分均有显著好转[（82.21±6.19）分vs.（43.79±5.86）分]，差异有统计学意义（P<0.05）;B组术后VAS[（1.65±0.79）分vs.（6.76±1.25）分]，肩关节主、被动活动度[主动：（151.64±9.41）° vs.（86.47±13.67）°;被动：（169.12±6.67）° vs.（108.53±17.48）°]，CMS评分均有显著好转[（84.47±4.72）分vs.（43.06±3.5）分]，差异有统计学意义（P<0.05）;但组间比较无统计学差异（P>0.05）。 结论 麻醉下单纯肩关节松解与麻醉下肩关节松解联合肩关节镜囊内松解两种治疗方式对原发性骨质疏松合并有冻结肩患者均有显著疗效，最终选用何种治疗方式应根据术者自身的经验与条件合理选择。

[关键词] 冻结肩;麻醉;关节镜;关节松解

[中图分类号] R686          [文献标识码] B          [文章编号] 1673-9701（2020）18-0089-04

Comparison of early curative effect between shoulder arthrolysis alone and its combination with shoulder arthroscopic intracapsular arthrolysis under anesthesia for frozen shoulder in osteoporosis patients

DAI Shouwang1   LUO Guogang1   ZHANG Hongzhen1   ZHENG Runjie2   WANG Xiaofeng1

1.Department of Orthopedics， Wenzhou Integrated Traditional Chinese and Western Medicine Hospital in Zhejiang Province， Wenzhou   325000， China; 2.Department of Orthopedics， Rui'an Hospital of Traditional Chinese Medicine in Zhejiang Province， Rui'an   325200， China

[Abstract] Objective To compare early curative effect between shoulder arthrolysis alone and its combination with shoulder arthroscopic intracapsular arthrolysis under anesthesia for frozen shoulder in osteoporosis patients. Methods From October 2015 to October 2019， 36 patients diagnosed with primary osteoporosis（PO） complicated with frozen shoulder in Department of Joint Surgery of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital and Wenzhou Sports Medicine Center were randomly divided into two groups， with group A treated with shoulder arthrolysis alone under anesthesia and group B treated with shoulder arthrolysis under anesthesia combined with shoulder arthroscopic intracapsular arthrolysis under anesthesia. The VAS scores of pain degree， active and passive activity of shoulder joint and Constant-Murley scores（CMS） were compared before operation， 1 d after operation and 1 m after operation， and the statistical analysis was made. Results After operation， group A had significant ameliorations in VAS scores[（1.16±0.83） vs.（6.63±1.21）]， active and passive activity of shoulder joint[active：（156.58±16.16）° vs.（82.11±13.98）°; passive：（168.16±7.30）° vs.（105.79±14.27）°]， and CMS scores[（82.21±6.19） vs.（43.79±5.86）]， and the differences were statistically significant（P<0.05）. After operation， group B had significant ameliorations in VAS scores[（1.65±0.79） vs.（6.76±1.25）]， active and passive activity of shoulder joint [active： （151.64±9.41）° vs. （86.47±13.67）°; passive：（169.12±6.67）° vs.（108.53±17.48）°]， and CMS scores[（84.47±4.72） vs. （43.06±3.5）]， and the differences were statistically significant（P<0.05）. However， there was no statistical difference between those of the two groups（P>0.05）. Conclusion Both shoulder arthrolysis alone under anesthesia and its combination with shoulder arthroscopic intracapsular arthrolysis under anesthesia have significant curative effect on the patients with PO complicated with frozen shoulder. The final choice of therapy should be made reasonably in light of the operator's experience and objective conditions.

[Key words] Frozen shoulder; Anesthesia; Arthroscope; Arthrolysis

凍结肩又称为肩凝症、肩周炎、粘连性关节囊炎，是骨伤科临床中常见的一种疾病，其所引发的肩关节疼痛和功能障碍会严重影响患者的日常生活与工作[1]。冻结肩的治疗方法很多，主要为针灸推拿、小针刀疗法、运动疗法、物理疗法、药物治疗、闭合手法松解及肩关节镜手术治疗等[2-4]。不管采用何种治疗方法，其目的都是为了尽快减轻患者疼痛及改善肩关节的活动度，从而提高患者生活质量。……