摘要
目的探讨关节镜下肩袖肌间隙入路在治疗重度粘连性肩关节囊炎中的应用。方法前瞻性纳入2018年7月至2021年12月无锡市中医医院收治的35例重度粘连性肩关节囊炎患者,其中男16例,女19例;年龄51~81岁,平均(61.1±7.9)岁;病程8~23个月,平均(12.5±3.8)个月;术前保守治疗6~12个月,平均(8.2±2.1)个月。手术均采用经肩袖肌间隙入路由外而内技术进行关节囊松解。手术前后采用肩关节主/被动活动度、美国肩肘协会(American shoulder and elbow surgeons evaluation form,ASES)评分和疼痛视觉模拟评分(visual analogue scale,VAS)评价患者肩关节功能及疼痛。结果患者均术后随访2年。均无感染及血肿血栓,伤口一期愈合,无血管及腋神经损伤,无肩关节僵硬复发等并发症发生,术后6周复查MRI无肩袖损伤表现。术后6周肩关节主/被动前屈、外展、内收位外旋活动度较术前显著改善(P<0.01),术后2年进一步改善(P<0.05)。术后6周VAS显著低于术前(P<0.01),术后2年进一步降低(P<0.01)。术后6周ASES评分显著高于术前(P<0.01),术后2年进一步提高(P<0.05)。结论采用经肩袖肌间隙入路由外而内技术治疗重度原发性粘连性肩关节囊炎,能够保障关节镜顺利进入盂肱关节,帮助精准定位前后方入路,利于关节镜下松解,效果优良、安全、可操作性强。
Objective To explore the application of the arthroscopic trans-intermuscular septum approach in the treatment of severe adhesive capsulitis of the shoulder.Methods A prospective study was conducted on 35 patients with severe adhesive capsulitis of the shoulder treated at Wuxi Hospital of Traditional Chinese Medicine from July 2018 to December 2021.The cohort included 16 males and 19 females,with a mean age of(61.1±7.9)years(range,51 to 81 years).The mean duration of symptoms was(12.5±3.8)months(range,8 to 23 months),and the mean duration of conservative treatment before surgery was(8.2±2.1)months(range,6 to 12 months).All patients underwent arthroscopic capsular release via the trans-intermuscular septum approach.Shoulder function and pain were evaluated using the visual analogue scale(VAS),the American shoulder and elbow surgeons(ASES)score,and active/passive range of motion(ROM)before and after surgery.Results All patients were followed up for 2 years.No complications such as infection,hematoma,thrombosis,vascular injury,axillary nerve injury,or recurrent stiffness occurred.Postoperative MRI at 6 weeks showed no rotator cuff injury.At 6 weeks postoperatively,the active ROM in flexion,abduction,and external rotation significantly improved compared with preoperative values(P<0.01),and further improvement was observed at 2 years(P<0.05).The VAS scores significantly decreased at 6 weeks(P<0.01)and further decreased at 2 years(P<0.01).The ASES scores significantly increased at 6 weeks(P<0.01)and further increased at 2 years(P<0.05).Conclusion The arthroscopic trans-intermuscular septum approach for treating severe adhesive capsulitis of the shoulder ensures smooth access to the glenohumeral joint,facilitates precise anterior and posterior portal placement,and simplifies capsular release under arthroscopy.It achieves excellent clinical outcomes,is safe,and has strong operability.
作者
陆振飞
王庆
周虹霞
刘雷
Lu Zhenfei;Wang Qin;Zhou Hongxia;Liu Lei(Department of Sports Medicine,Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214000,China)
出处
《实用骨科杂志》
2025年第5期389-393,共5页
Journal of Practical Orthopaedics
基金
无锡市中医药管理局科技项目(ZYYB20)。
关键词
原发性粘连性肩关节囊炎
关节镜
肩袖肌间隙入路
adhesive capsulitis of the shoulder
arthroscopy
trans-intermuscular septum approach
