[1]钱平康,熊晓扬,孙斌峰,等.肩胛下肌腱前方间隙滑膜清理和粘连松解对合并肩关节僵硬的肩袖损伤患者肩关节疼痛和旋转功能影响的临床研究[J].中医正骨,2025,37(10):30-37.
　QIAN Pingkang,XIONG Xiaoyang,SUN Binfeng,et al.Effects of synovectomy and adhesiolysis in the anterior interval of subscapularis tendon on shoulder pain and rotational function in patients with rotator cuff injuries and shoulder stiffness:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(10):30-37.
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肩胛下肌腱前方间隙滑膜清理和粘连松解对合并肩关节僵硬的肩袖损伤患者肩关节疼痛和旋转功能影响的临床研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年10期
页码:
30-37
栏目:
临床研究
出版日期:
2025-10-20

文章信息/Info

Title:
Effects of synovectomy and adhesiolysis in the anterior interval of subscapularis tendon on shoulder pain and rotational function in patients with rotator cuff injuries and shoulder stiffness:a clinical study
作者:
钱平康; 熊晓扬; 孙斌峰; 杨荃; 王毅焘; 汪青; 董燚; 钱胤华; 徐锋
昆山市中医医院,江苏 昆山 215300
Author(s):
QIAN Pingkang; XIONG Xiaoyang; SUN Binfeng; YANG Quan; WANG Yitao; WANG Qing; DONG Yi; QIAN Yinhua; XU Feng
Kunshan Hospital of Chinese Medicine,Kunshan 215300,Jiangsu,China
关键词:
肩袖损伤;  关节镜检查;  组织粘连;  活动范围; 关节;  粘连松解术;  临床研究专题
Keywords:
rotator cuff injuries;  arthroscopy;  tissue adhesions;  range of motion; articular;  adhesiolysis;  clinical studies as topic
摘要:
目的:探讨肩胛下肌腱前方间隙滑膜清理和粘连松解对合并肩关节僵硬的肩袖损伤患者肩关节疼痛和旋转功能的影响。方法:回顾性分析2021年1月至2022年6月采用肩关节镜手术治疗的53例合并肩关节僵硬的肩袖损伤患者的病例资料,其中24例采用常规肩关节镜下肩袖修补术联合肩关节粘连松解术治疗(常规组)、29例在上述常规手术基础上进行肩胛下肌腱前方间隙滑膜清理和粘连松解治疗(联合组)。比较2组患者的肩关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、肩关节活动度(内旋、外旋、前屈)、美国肩肘外科医师协会(American shoulder and elbow surgeons,ASES)评分、Constant-Murley肩关节评分及并发症的发生情况。结果:①肩关节疼痛VAS评分。2组肩关节疼痛VAS评分均随时间呈逐渐减小的趋势(F=110.488,P=0.000; F=135.333,P=0.000); 术前、术后3个月、术后6个月、术后12个月及末次随访时,2组肩关节疼痛VAS评分的组间差异均无统计学意义; 术后1个月、2个月,联合组肩关节疼痛VAS评分均小于常规组(t=-5.370,P=0.000; t=-4.944,P=0.000)。②肩关节内旋活动度。2组肩关节内旋活动度均随时间呈逐渐增大的趋势(F=2 047.377,P=0.000; F=699.551,P=0.000); 术前2组肩关节内旋活动度的差异无统计学意义; 术后1个月、2个月、3个月、6个月、12个月及末次随访时,联合组肩关节内旋活动度均大于常规组(t=16.614,P=0.000; t=17.939,P=0.000; t=16.976,P=0.000; t=16.538,P=0.000; t=15.764,P=0.000; t=15.574,P=0.000)。③肩关节外旋活动度。2组肩关节外旋活动度均随时间呈逐渐增大的趋势(F=1 580.797,P=0.000; F=1 048.052,P=0.000); 术前、术后6个月、术后12个月及末次随访时,2组肩关节外旋活动度的组间差异均无统计学意义; 术后1个月、2个月、3个月,联合组肩关节外旋活动度均大于常规组(t=9.792,P=0.000; t=3.133,P=0.003; t=2.433,P=0.018)。④肩关节前屈活动度。肩关节前屈活动度随时间变化总体呈逐渐增大的趋势(F=1 011.979,P=0.000)。2组肩关节前屈活动度总体比较,差异无统计学意义。⑤ASES评分。2组ASES评分均随时间呈逐渐增大的趋势(F=12 418.619,P=0.000; F=6 315.915,P=0.000); 术前、术后12个月及末次随访时,2组ASES评分的组间差异均无统计学意义; 术后1个月、2个月、3个月、6个月,联合组ASES评分均大于常规组(t=2.453,P=0.018; t=2.886,P=0.005; t=2.897,P=0.005; t=2.093,P=0.041)。⑥Constant-Murley评分。2组Constant-Murley评分均随时间呈逐渐增大的趋势(F=1 140.558,P=0.000; F=573.188,P=0.000); 术前、术后6个月、术后12个月及末次随访时,2组Constant-Murley评分的组间差异均无统计学意义; 术后1个月、2个月、3个月,联合组Constant-Murley评分均大于常规组(t=3.047,P=0.000; t=3.264,P=0.006; t=2.360,P=0.039)。⑦并发症。2组均未发生感染、血管神经损伤; 2组患者在术后外展固定的6周内,患侧均存在不同程度的三角肌“酸软”症状,经功能锻炼后症状均缓解,均未出现三角肌萎缩; 至随访结束时,2组均未出现修补的冈上肌腱再次撕裂的情况。结论:对于合并肩关节僵硬的肩袖损伤患者,在肩关节镜下肩袖修补术和肩关节粘连松解术的基础上进行肩胛下肌腱前方间隙滑膜清理和粘连松解,可促进肩部疼痛症状缓解和肩关节旋转功能恢复,而且具有较高的安全性。
Abstract:
Objective:To investigate the effects of synovectomy and adhesiolysis in the anterior interval of subscapularis tendon on shoulder pain and rotational function in patients undergoing arthroscopic surgery for rotator cuff injuries and shoulder stiffness.Methods:The clinical data of 53 patients who underwent shoulder arthroscopic surgery for rotator cuff injuries and shoulder stiffness from January 2021 to June 2022 were analyzed retrospectively.Twenty-four patients were treated with conventional arthroscopic rotator cuff repair and shoulder adhesiolysis(conventional group),while the other 29 ones with the aforementioned conventional procedures combined with synovectomy and adhesiolysis in the anterior interval of subscapularis tendon(combined group).The shoulder pain visual analogue scale(VAS)score,shoulder range of motions(ROMs)including inward rotation,outward rotation,and forward flexion,American shoulder and elbow surgeons(ASES)score,Constant-Murley shoulder score,and complications were compared between the 2 groups.Results:①The shoulder pain VAS score.The shoulder pain VAS score presented a gradual decreasing trajectory over time in the 2 groups(F=110.488,P=0.000; F=135.333,P=0.000).In addition,the shoulder pain VAS score was not significantly different between the 2 groups before the procedure,at 3,6 and 12-month post-procedure,as well as at the last follow-up,respectively,while,at 1 and 2-month post-procedure,it was lower in combined group compared to conventional group(t=-5.370,P=0.000; t=-4.944,P=0.000).②The shoulder inward rotation ROM.The shoulder inward rotation ROM presented a gradual increasing trajectory over time in the 2 groups(F=2 047.377,P=0.000; F=699.551,P=0.000).In addition,the shoulder inward rotation ROM was not significantly different between the 2 groups before the procedure,while,at 1,2,3,6,and 12-month post-procedure,as well as at the last follow-up,it was greater in combined group compared to conventional group(t=16.614,P=0.000; t=17.939,P=0.000; t=16.976,P=0.000; t=16.538,P=0.000; t=15.764,P=0.000; t=15.574,P=0.000).③The shoulder outward rotation ROM.The shoulder outward rotation ROM presented a gradual increasing trajectory over time in the 2 groups(F=1 580.797,P=0.000; F=1 048.052,P=0.000).In addition,the shoulder outward rotation ROM was not significantly different between the 2 groups before the procedure,at 6 and 12-month post-procedure,as well as at the last follow-up,respectively,while,at 1,2,and 3-month post-procedure,it was greater in combined group compared to conventional group(t=9.792,P=0.000; t=3.133,P=0.003; t=2.433,P=0.018).④The shoulder forward flexion ROM.The shoulder forward flexion ROM presented a gradual increasing tra-jectory over time in the 2 groups(F=1 011.979,P=0.000),and no statistical difference was observed in the shoulder forward flexion ROM between the 2 groups in general.⑤The ASES score.The ASES score presented a gradual increasing trajectory over time in the 2 groups(F=12 418.619,P=0.000; F=6 315.915,P=0.000).In addition,the ASES score was not significantly different between the 2 groups before the procedure,at 12-month post-procedure,and at the last follow-up,respectively,while,at 1,2,3,and 6-month post-procedure,it was higher in combined group compared to conventional group(t=2.453,P=0.018; t=2.886,P=0.005; t=2.897,P=0.005; t=2.093,P=0.041).⑥The Constant-Murley score.The Constant-Murley score presented a gradual increasing trajectory over time in the 2 groups(F=1 140.558,P=0.000; F=573.188,P=0.000).In addition,the Constant-Murley score was not significantly different between the 2 groups before the procedure,at 6 and 12-month post-procedure,as well as at the last follow-up,respectively,while,at 1,2,and 3-month post-procedure,it was higher in combined group compared to conventional group(t=3.047,P=0.000; t=3.264,P=0.006; t=2.360,P=0.039).⑦Complications.No complications such as infections or neurovascular injuries were found in the 2 groups.During the initial 6-week period following the abduction immobilization,all patients in the 2 groups experienced varying degrees of deltoid muscle soreness on the affected side,which all resolved with functional exercises,and no deltoid muscle atrophy occurred.Furthermore,no re-tears of the repaired supraspinatus tendon were observed in the 2 group by the final follow-up.Conclusion:Combination of conventional arthroscopic rotator cuff repair and shoulder adhesiolysis with synovectomy and adhesiolysis in the anterior interval of subscapularis tendon can accelerate the shoulder pain relief and promote the shoulder rotational function recovery,with a favorable safety profile,in patients with rotator cuff injuries and shoulder stiffness.

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备注/Memo

备注/Memo:
基金项目:苏州市临床重点病种诊疗技术专项项目(LCZX202127); 昆山市中医药科技发展基金项目(KZYY2219)
通讯作者:徐锋 E-mail:xf701228@163.com
更新日期/Last Update: 1900-01-01