Objective: To investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder.
Methods: Between April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S 1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up.
Results: All incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively ( P<0.05). The range of internal rotation restored to the level of T 6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation ( Z=-0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant ( P<0.05); and with time, the VAS scores and ASES scores improved further ( P<0.05).
Conclusion: Arthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.
目的: 探讨关节镜下 360° 关节囊松解治疗冻结肩的疗效。.
方法: 2018 年 4 月—2019 年 4 月，采用关节镜下 360° 关节囊松解治疗 42 例冻结肩患者。男 13 例，女 29 例；年龄 45～56 岁，平均 52.3 岁。左肩 14 例，右肩 28 例。病程 5～18 个月，平均 11.1 个月。主要临床症状为肩关节主、被动活动受限伴严重疼痛。所有患者均排除肩峰撞击综合征及肩关节骨关节炎。术前肩关节活动度为前屈（93.2±15.4）°、体侧外旋（15.9±6.0）°、外展 90° 外旋（18.4±9.9）°，以及内旋达股骨大转子 5 例、臀部 20 例、S 1 水平 17 例。疼痛视觉模拟评分（VAS）为（6.7±1.7）分，美国肩肘外科协会（ASES）评分为（41.6±9.3）分。术后定期随访，测量肩关节主动活动度以及疼痛、功能评分，评价肩关节恢复情况。.
结果: 术后切口均Ⅰ期愈合，无早期手术相关并发症发生。患者均获随访，随访时间 12～24 个月，平均 15.6 个月。术后各时间点肩关节前屈、体侧外旋、外展 90° 外旋活动度均较术前改善（ P<0.05）。术后 3 周内旋活动度均恢复至 T 6～12 水平，术后 12 个月与健侧相当（ Z=–0.943， P=0.346）。术后各时间点 VAS 评分均较术前下降、ASES 评分上升，差异有统计学意义（ P<0.05）；且随时间延长，VAS 评分及 ASES 评分均进一步改善（ P<0.05）。.
结论: 关节镜下 360° 关节囊松解可显著提高肩关节活动度、减轻疼痛、改善功能，是治疗冻结肩的一种有效方法。.
Keywords: Frozen shoulder; arthroscopy; capsular release; joint range of motion.