论文部分内容阅读
目的:比较关节镜下肩袖损伤伴肩关节粘连一期与二期手术临床疗效。方法:自2016年3月至2019年2月，我们对50例肩袖损伤合并肩关节粘连患者行关节镜下手术，其中25例行一期关节镜下肩袖修补＋关节囊松解术；25例先行患肩功能锻炼，二期行肩袖修补。患者术前及术后3、6、12个月及末次随访均行关节活动度检查，包括前屈上举、体侧外旋及内旋；并采用视觉模拟评分法(visual analogue scale，VAS)、美国肩肘外科协会(American shoulder and elbow surgeons，ASES)评分、洛杉矶加利福尼亚大学(university of California at Los Angeles score，UCLA)评分进行功能评分。结果:术后随访时间为11～28个月，平均22个月。两组术后随访的VAS、ASES评分、UCLA评分均显著改善，差异有统计学意义(n P<0.05)；患侧肩关节前屈上举、体侧外旋及内旋功能术后均明显提高，术后3个月前屈上举组间比较差异有统计学意义(n P0.05)，一期手术患者末次随访时满意度比二期手术患者高。n 结论:尽管一期手术患者术后3个月复查时患侧肩关节活动度较二期手术患者恢复慢，二期手术患者经保守治疗后患侧肩关节功能恢复不佳，全部行手术治疗，但二者术后临床疗效均满意，患侧肩关节功能及活动度恢复良好。“,”Objective:To compare the clinical efficacy of one-stage and two-stage arthroscopic repair of rotator cuff injury with shoulder joint adhesion.Methods:From March 2016 to February 2019, 50 patients with rotator cuff injury and shoulder joint adhesion were treated with arthroscopic surgery, including 25 cases with one-stage arthroscopic rotator cuff repair and joint capsule release and 25 cases with shoulder function exercise first and then rotator cuff repair in the second stage. The range of motion including forward flexion, lateral external rotation and internal rotation were examined before operation, at 3, 6, 12 months after operation and the last follow-up. Visual analogue scale (VAS), American shoulder and elbow surgeons (ASES) score and university of California at Los Angeles (UCLA) score were used to evaluate the functional recovery.Results:The follow-up time ranged from 11 to 28 months with an average of 22 months. The VAS, ASES and UCLA scores of the two groups were significantly improved after operation (n P<0.05); the function of forward flexion, lateral external rotation and internal rotation of the affected shoulder joint were significantly improved after operation. The difference of forward flexion was statistically significant between the two groups at 3 months after operation (n P0.05). The satisfaction of patients with one-stage surgery at the last follow-up was higher than that of patients with two-stage surgery.n Conclusion:Although the range of motion of the affected shoulder joint in the one-stage operation patients recovered more slowly than those in the two-stage operation patients at 3 months after the operation, and the function of the affected shoulder joint of the patients in the two-stage operation did not recover well after conservative treatment, the clinical efficacy of both groups were satisfactory and the function and range of motion of the affected shoulder joint recovered well.