【原】粘连性肩关节囊炎的治疗（八）

 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Redler LH, Dennis ER. Treatment of Adhesive Capsulitis of the Shoulder. J Am Acad Orthop Surg. 2019;27(12):e544-e554. 本次学习由阎芳副研究员主讲。

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Likewise, a systematic review of 22 studiescompared outcomes between patients treated with MUA, capsular release, or acombination of both. Of the study participants, 60% were women and the median age was 52years (24 to 91years). Minimal differences existed in the median changes in abduction,flexion, and external rotation ROM, and final constant score between the MUAand capsular release groups. These authors therefore concluded that littlebenefit may be there for a capsular release instead of, or in addition to, an MUA. 

同样，一项对22项研究的系统回顾比较了接受麻醉下手法松解、关节囊松解或两者联合治疗的患者的结果。研究参与者中，60%是女性，中位年龄为52岁（24至91岁）。手法松解与关节镜组患者在外展、屈曲和外旋活动度的中位数值以及最终恒定分数间的差异非常小。因此，这些作者得出结论，使用关节镜下肩关节囊松解代替手法松解或作为手法松解的补充并没有什么必要。

Alternatively, many studies have shownnotable effectiveness of arthroscopic release for the management of AC. LeLievre and Murrell showed maintained improvement in ROM, pain, and function at7 years for a group of 43 patients treated with arthroscopic capsular release.

另外，也有许多研究表明关节镜下松解术对AC的治疗效果显著。lelievre和Murrell观察了43例关节镜下关节囊松解术治疗的患者，治疗7年后活动度、疼痛和功能持续改善。

With respect to the technique of arthroscopicrelease, limited anterior capsular release with controlled MUA has been shownto yield statistically significant improvement in both pain and function modulesof the Oxford Shoulder Score and ROM at 6-month follow-up. Some feel that theaddition of a posterior capsule release is essential to regain internalrotation, but this has not been shown to make a notable difference in outcomes.

关于关节镜下松解技术，局限前部关节囊松解配合手法松解在疼痛控制和功能改善的Oxford肩关节评分和活动度方面在术后6个月的随访中都有显著的改善。有些人认为增加后部关节囊松解对恢复内旋至关重要，但这并没有显示出显著的疗效差异。

These findings support the concept thatarthroscopy provides a minimally invasive technique to directly visualize theanatomy and pathologic tissue in patients with AC under the same anestheticburden as MUA with optimal and better controlled outcomes.

这些发现表明，关节镜是一种微创技术，可以直接观察肩周炎患者的解剖结构和病变组织，其麻醉负荷与手法松解相同，可提供最佳且更加可控的治疗效果。