 英语晨读 · 山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。 本次文献选自Rangan A, Brealey SD , Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial[J]. The Lancet, 2020, 396(10256):977-989.本次学习由魏广福主治医师主讲。 Introduction Frozen shoulder, also known as adhesive capsulitis, is a painful condition that most commonly affects people in the sixth decade of life. The capsule of the shoulder joint becomes inflamed, then scarred and contracted, causing pain, stiffness, and loss of function. People with frozen shoulder can struggle with basic daily activities and have sleep disturbance due to shoulder pain. The cumulative incidence of frozen shoulder has been estimated at 2.4 per 1000 population per year in the Netherlands, affecting 8.2% of men and 10.1% of women of working age. The exact cause remains unknown, which is why it is often labelled as idiopathic or primary frozen shoulder. Recognised associations include diabetes, cardiovascular disease, trauma, stroke, neurosurgery, and thyroid disease. Association with diabetes is considered to make frozen shoulder more resistant to treatment. 引言 冻结肩，又称粘连性肩周炎，是一种非常痛苦的疾病，最常见的是60岁左右的人。肩关节囊发炎，结疤和收缩，引起疼痛、僵硬和功能丧失。冻结肩的人会因为肩关节疼痛而难以进行基本的日常活动，也会出现睡眠障碍。据估计，荷兰每年每1000人中有2.4人患肩周炎，其中8.2%的工作年龄男性和10.1%的工作年龄女性患肩周炎。确切的原因尚不清楚，这就是为什么它经常被贴上特发性或原发性肩周炎的标签。公认的相关因素包括糖尿病、心血管病疾病、创伤、中风、神经外科手术、甲状腺疾病。伴发糖尿病被认为是导致冻结肩更难以治疗的原因。 Diagnosis of frozen shoulder is based on clinicalfeatures of an insidious onset of deep-seated pain in the shoulder and upper arm with increasing stiffness, and clinical findings of limited active and passive external rotation in the absence of crepitus. X-rays are not routinely required, but can be done to exclude shoulder arthritis or posterior dislocation, which could present with similar clinical signs. 冻结肩的诊断是基于临床表现为肩关节和上臂深层疼痛，隐匿开始并逐渐僵硬，临床表现为主动和被动外旋受限且无捻鸣。X光不是常规要求，但可以排除肩关节或后脱位，这可能出现类似的临床症状。 Frozen shoulder can spontaneously resolve, butrecovery might be slow or incomplete. Around 40% of patients report persistent symptoms even 4 years after onset. Primarily, the severity of pain and disability arising from the restriction of movement drives patients to seek treatment. A range of treatment options with increasing degrees of invasiveness are available, but there is uncertainty about when these should be offered and their clinical effectiveness or cost-effectiveness. A survey of specialist health professionals that we conducted in the UK identified three interventions as most commonly used: physiotherapy, manipulation under anaesthesia, and arthroscopic capsular release. The UK national physiotherapy guidelines for frozen shoulder, based on a systematic review, recommend exercise and manual therapy either in isolation or to supplement intra-articular injection of glucocorticoid (steroid), manipu lation, or capsular release. We further developed and standardised the non-surgical care pathway for this trial to include intra-articular steroid injection followed by structured physiotherapy, using the best available evidence and consensus from expert shoulder physio therapists. We called this early structured physiotherapy because it is more quickly accessible within secondary care than are the surgical interventions. It is not known whether early structured physiotherapy or either of the surgical interventions followed by physiotherapy is more effective. Systematic reviews have identified large gaps in evidence and a need for high quality primary research. With the intention of facilitating quicker recovery, manipulation and capsular release are increas ingly used despite the dearth of good evidence. 肩周炎可自行消退，但恢复可能缓慢或不完全。大约40%的患者在发病4年后仍有持续症状。主要是由于运动受限造成的疼痛和残疾的严重程度驱使患者寻求治疗。有一系列的治疗选择，随着侵入程度的增加，但何时应该提供，其临床效果或成本效益尚不确定。我们在英国进行了一项针对专业卫生专业人员的调查，确定了三种干预措施最常用的:物理治疗，麻醉下手法松解，关节镜下关节囊松解。英国国家冷冻肩关节理疗指南在系统回顾的基础上，推荐单独运动和手动治疗，或辅以关节内注射糖皮质激素(类固醇)、手法或关节囊手术松解。我们进一步开发和标准化了这项试验的非手术治疗途径，包括关节内类固醇注射，然后进行结构化物理治疗，使用了最佳的可用证据和来自肩部物理治疗师的共识。我们称其为早期结构理疗，因为它在次级治疗中比外科干预更容易获得。目前尚不清楚早期结构物理治疗或这两种关节囊松解续以早期结构物理治疗更有效。系统研究已经发现了证据上的巨大差距和对高质量的初步研究的需要。为了促进更快的恢复，尽管缺乏良好的证据，手法松解和关节囊手术松解被越来越多地使用。 We designed the UK Frozen Shoulder Trial (UKFROST) to assess the effectiveness and cost-effectiveness of three care pathways to treat adults with a frozen shoulder: two commonly used surgical interventions within the UK National Health Service (NHS) hospitals (manipulation and capsular release), and our specifically designed non-surgical physiotherapy pathway. 我们设计英国冻结肩试验(英国FROST)评估有效性和成本效益三种治疗方案来治疗成人冻结肩:两个常用的外科干预措施在英国国民健康服务(NHS)医院(手术松解和关节囊松解)，和我们专门设计的非手术物理治疗途径。 |
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