标题：肩关节镜下松解联合几丁糖注射治疗黏连性肩关节囊炎疗效观察

      作者：曹世超 1，张耀 1，卢耀甲 2，费文勇 2，刘明生 1，王炫棋 1，谢斌 1    1.大连医科大学研究生院，辽宁 大连 116000；2.苏北人民医院运动医学科，江苏 扬州 225001

      卷次： 2020年31卷8期

      【摘要】 目的 研究肩关节镜下松解术联合几丁糖注射对黏连性肩关节囊炎术后疗效的影响。方法 回顾性分析苏北人民医院运动医学科2017年12月至2018年10月收治的42例确诊为黏连性肩关节囊炎患者的临床资料，所有患者均采用肩关节镜下松解术，根据术中是否注射医用几丁糖分为几丁糖组21例和对照组21例。比较两组患者术后1个月肩关节疼痛视觉模拟评分(VAS)、肩关节主动活动范围和末次随访时(术后平均12个月)美国肩与肘协会评分(ASES)、Constant评分。结果 术后两组患者切口均Ⅰ期愈合，无手术相关并发症，患者均获随访；几丁糖组和对照组患者术后 1个月的VAS评分分别为(2.43±0.68)分和(2.90±0.77)分，均较本组术前的(5.33±1.06)分和(5.24±0.10)分明显改善，且几丁糖组改善较对照组更明显，差异均有统计学意义(P<0.05)；几丁糖组和对照组患者术后1个月患肩主动活动范围较术前明显改善，且几丁糖组患肩术后主动活动范围优于对照组，差异均有统计学意义(P<0.05)；末次随访时，几丁糖组和对照组患者术后ASES评分分别为(86.46±3.73)分、(84.74±4.88)分，Constant评分分别为(85.79±3.42)分、(87.02±4.46)分，均较其术前的ASES评分[(45.74±11.77)分、(44.39±10.32)分]和Constant评分[(44.57±7.83)分、(45.14±10.52)分]明显改善，差异均有统计学意义(P<0.05)，但术后两组间的ASES评分和Constant评分比较差异均无统计学意义(P>0.05)。结论 肩关节镜下松解术能显著提高黏连性肩关节囊炎患者术后肩关节功能，术后联合应用几丁糖可在早期一定程度改善患肩的疼痛及活动范围，但在长期肩关节功能恢复上未见明显优势。
      【关键词】 肩关节镜；几丁糖；黏连性肩关节囊炎；关节腔内注射；关节囊松解
      【中图分类号】 R684.3 【文献标识码】 A 【文章编号】 1003—6350（2020）08—0989—05

Curative effects of chitansa combined with arthroscopic release in treatment of adhesive capsulitis of shoulder.CAO Shi-chao 1, ZHANG Yao 1, LU Yao-Jia 2, FEI Wen-yong 2, LIU Ming-sheng 1, WANG Xuan-qi 1, XIE Bin 1.
1. GraduateSchool, Dalian Medical University, Dalian 116000, Liaoning, CHINA; 2. Department of Sports Medicine, Northern JiangsuPeople's Hospital, Yangzhou 225001, Jiangsu, CHINA
【Abstract】 Objective To study of curative effects of chitansa combined with arthroscopic release in the treat-ment of adhesive capsulitis of shoulder. Methods Forty-two cases of adhesive capsulitis of shoulder from Departmentof Sports Medicine, Northern Jiangsu People’s Hospital, from December 2017 to October 2018 were collected. All pa-tients were treated with arthroscopic release. According to whether to inject medical chitosan during operation, the pa-tients were divided into chitosan group (21 patients, treated with chitosan injection) and control group (21 patients, nottreated with chitosan injection). Visual analogue scale (VAS) of shoulder joint pain and active range of shoulder jointwere compared 1 month after operation between the chitansal group and control group. At the last follow-up (the meanpostoperative period was 12 months), American shoulder and elbow association scores (ASES) and Constant scores werecompared between the two groups. Results The incisions of the two groups healed in the first stage, and there was nooperation related complications. All the patients were followed up. One month after operation, the VAS scores were 2.43±0.68 in the chitansal group and 2.90±0.77 in the control group, which were significantly higher than 5.33±1.06 and 5.24±0.10 before operation (P<0.05). The improvement in the chitinose group were better than that in the control group (P<0.05). The active range of postoperative movement of affected shoulder were significantly improved after operation inthe two groups, and the range in the chitinose group after operation were significantly better than that in the controlgroup (P<0.05). At the last follow-up, the postoperative ASES scores of the chitansal group and control group were86.46±3.73 and 84.74±4.88, and the Constant scores were 85.79±3.42 and 87.02±4.46, which were significantly im-proved compared with the preoperative ASES scores 45.74±11.77 and 44.39±10.32, and the Constant scores 44.57±7.83and 45.14±10.52 (P<0.05), but there was no statistically significant difference between the two groups in ASES scoreand Constant score (P>0.05). Conclusion Arthroscopic release of the shoulder can significantly improve the postopera-tive shoulder joint function of patients with adhesive capsulitis of the shoulder. Intraoperative application of chitinosecan improve the pain and range of motion of the affected shoulder to some extent in the early stage, but there is no obvi-ous advantage in the long-term recovery of shoulder joint function.
      【Key words】 Shoulder arthroscopy; Chitansa; Adhesive capsulitis of shoulder; Ntra-articular injection; Joint cap-sule release