本文選題：原發(fā)性凍結(jié)肩 + 關(guān)節(jié)鏡��； 參考：《中國(guó)修復(fù)重建外科雜志》2017年07期

【摘要】：目的探討經(jīng)岡上肌入路全關(guān)節(jié)鏡下松解治療重度原發(fā)性凍結(jié)肩的臨床效果。方法將2012年6月—2015年1月收治并符合標(biāo)準(zhǔn)的28例重度原發(fā)性凍結(jié)肩患者納入研究。男8例,女20例;年齡42~81歲,平均57歲。均為單肩發(fā)作,其中左側(cè)16例,右側(cè)12例。病程7~21個(gè)月,平均11個(gè)月。合并糖尿病6例。手術(shù)均經(jīng)岡上肌入路后,進(jìn)行關(guān)節(jié)鏡下松解。術(shù)前及術(shù)后6周、24個(gè)月檢查肩關(guān)節(jié)被動(dòng)外展、前屈、內(nèi)收位外旋活動(dòng)度以及被動(dòng)內(nèi)旋情況,采用疼痛視覺(jué)模擬評(píng)分(VAS)以及美國(guó)肩肘外科協(xié)會(huì)(ASES)評(píng)分評(píng)價(jià)肩關(guān)節(jié)疼痛及功能情況。結(jié)果術(shù)后切口均Ⅰ期愈合,無(wú)感染、肩關(guān)節(jié)不穩(wěn)、神經(jīng)損傷等并發(fā)癥發(fā)生;患者均獲隨訪24個(gè)月。術(shù)后患者肩關(guān)節(jié)疼痛顯著緩解,6周及24個(gè)月VAS評(píng)分均顯著低于術(shù)前(P0.05),術(shù)后24個(gè)月VAS評(píng)分較術(shù)后6周進(jìn)一步降低(P0.05)。術(shù)后6周及24個(gè)月,患者肩關(guān)節(jié)被動(dòng)外展、前屈、內(nèi)收位外旋活動(dòng)度以及ASES評(píng)分均較術(shù)前顯著提高(P0.05);術(shù)后6周及24個(gè)月間比較,ASES評(píng)分及被動(dòng)前屈、內(nèi)收位外旋活動(dòng)度差異有統(tǒng)計(jì)學(xué)意義(P0.05),被動(dòng)外展活動(dòng)度差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)前被動(dòng)內(nèi)旋達(dá)股骨大粗隆9例、臀區(qū)6例、骶骨7例、L4水平6例,術(shù)后6周及24周恢復(fù)至T12~T6水平,與健側(cè)相當(dāng)。結(jié)論對(duì)于重度原發(fā)性凍結(jié)肩患者,采用經(jīng)岡上肌入路能順利進(jìn)入盂肱關(guān)節(jié),精準(zhǔn)定位后方入路,有效保障了全關(guān)節(jié)鏡下松解的實(shí)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.
【作者單位】： 南京中醫(yī)藥大學(xué)附屬無(wú)錫中醫(yī)醫(yī)院關(guān)節(jié)骨科;上海交通大學(xué)附屬新華醫(yī)院骨科;
【分類號(hào)】：R687.4

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本文編號(hào)：1971105