肩袖撕裂合并冻结肩行手法松解后的关节镜下表现及影响因素分析  

Collateral injuries and risk factors of manual release for rotator cuff tear with frozen shoulder

作　　者：丁明 上官磊 廖炳辉 王迎春 张春礼 徐虎 DING Ming;SHANGGUAN Lei;LIAO Bing-hui;WANG Ying-chun;ZHANG Chun-li;XU Hu(Department of Sports Injury,Orthopaedics,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院(西京医院)骨科运动医学科,西安710032

出　　处：《骨科》2020年第6期480-484,共5页ORTHOPAEDICS

摘　　要：目的观察肩袖撕裂合并冻结肩行手法松解后的关节镜下表现,并分析其影响因素。方法回顾性分析2017年9月至2019年9月收治的68例肩袖撕裂合并冻结肩病人的病例资料,其中,男35例,女33例,年龄为(52.68±6.54)岁,均行一期麻醉后手法松解联合关节镜检查并肩袖修复术,观察手法松解后的关节镜下表现,比较松解损伤病人和未损伤病人之间的性别、患侧、肩袖撕裂程度差异,分析患肩关节疼痛时间、肩关节活动受限病程和实施手法松解时间与手法松解损伤的相关性。收集病人的数字分级法(numerical rating scale,NRS)疼痛评分、美国肩肘外科医师学会(American Shoulder and Elbow Surgeons,ASES)评分、Constant⁃Murley评分及丹麦健康与医疗管理局(Danish Health and Medicine Author⁃ity)满意度评分。结果共16例(23.53%)发生手法松解损伤,其中单一损伤者12例,两种及以上损伤者4例,损伤类型为前关节囊撕裂(3例,18.75%)、下关节囊撕裂(6例,37.50%)、盂肱中韧带撕裂(7例,43.75%)、盂肱下韧带肱骨端撕裂(humeral avulsion of the glenohumeral ligament,HAGL)(3例,18.75%)、前盂唇撕裂(2例,12.50%)。松解损伤病人和未损伤病人之间的年龄(P=0.431)、性别(P=0.893)、患侧(P=0.673)、肩袖撕裂程度(P=0.723)、患肩关节疼痛时间(P=0.813)、肩关节活动受限病程(P=0.250)、实施手法松解时间(P=0.125)均未见显著差异。松解损伤组和松解无损伤组术后NRS评分均较术前明显降低,肩关节功能评分较术前明显改善(P均<0.05);手术前后的NRS评分、肩关节功能ASES评分、Constant⁃Murley评分、病人满意度评分比较,差异均无统计学意义(P均>0.05)。结论肩袖撕裂合并冻结肩行麻醉后肩关节手法松解联合关节镜下肩袖修复术可能导致单一或合并的镜下损伤表现,年龄、性别、患侧、肩袖撕裂程度、患肩关节疼痛时间、肩关节活动受限病程、实施手法松解时间等因素Objective To summarize the collateral injuries and risk factors of manual release for rotator cuff tear with frozen shoulder to analyze the influencing and related factors.Methods The data of 68 cases of rotator cuff tears with frozen shoulder from September 2017 to September 2019 were retrospectively studied.There were 35 males and 33 females,aged(52.68±6.54)years old.All of them underwent manual release combined with arthroscopy for shoulder sleeve repair after one⁃stage anesthesia.The arthroscopic manifestations after manual injury were observed.The differences in gender,affected side and degree of rotator cuff tear between the patients with release injury and those without injury were compared.The correlation between the injury of manual release and the time of manual release,the duration of shoulder joint pain,duration of limited shoulder joint activity and implementation were analyzed.The numerical rating scale(NRS)scores,American Shoulder and Elbow Surgeons(ASES)scores,Constant⁃Murley scores,Danish Healthand Medicine Authority scores were collected.Results Total 16 cases(23.53%)of manual release injury were found under arthroscope surgery,including 12 cases single injury and 4 compond injury.The injury types were anterior joint capsule tear(3 cases,18.75%),inferior capsule tear(6 cases,37.50%),middle glenohumeral ligament tear(7 cases,43.75%),humeral avulsion of the glenohumeral ligament(HAGL)injury(3 cases,18.75%),anterior glenoid labrum tear(2 cases,12.50%).Age(P=0.431),gender(P=0.893),affected side(P=0.673),rotator cuff tear(P=0.723),duration of shoulder pain(P=0.813),duration of limited shoulder joint movement(P=0.250),and the time of mobilize injury(P=0.125)had no significant correlation with the injury.Post⁃operation NRS score was significantly lower in both groups,shoulder joint function was significantly improved,and patient satisfaction score was higher than pre⁃operation.There was no significant difference in NRS scores,ASES scores,Constant⁃Murley scores and patient satisfaction scores

关 键 词：肩袖撕裂 冻结肩 关节镜 手法松解 

分 类 号：R687.4[医药卫生—骨科学]