粘连性肩关节囊炎的治疗（一）

 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。

Abstract

Adhesive capsulitis presents clinically as limited, active and passive range of motion caused by the formation of adhesions of the glenohumeral joint capsule. Radiographically, it is thickening of the capsule and rotator interval. The pathology of the disease, and its classification, relates to inflammation and formation of extensive scar tissue. Risk factors include diabetes, hyperthyroidism, and previous cervical spine surgery. Nonsurgical management includes physical therapy, corticosteroid injections, extracorporeal shock wave therapy, calcitonin, ultrasonography-guided hydrodissection, and hyaluronic acid injections. Most patients will see complete resolution of symptoms with nonsurgical management, and there appears to be a roleof early corticosteroidinjection in shortening theoverall duration of symptoms. Surgical intervention, including manipulation under anesthesia, arthroscopic capsular release both limited and circumferential, and the authors’ technique are described in this article. Complications include fracture, glenoid and labral injuries, neurapraxia, and rotator cuff pathology. Postoperative care should always include early physical therapy.

摘要

粘连性肩关节囊炎临床表现为由盂肱关节囊粘连引起的肩关节主动和被动活动范围受限。从影像学上看，是关节囊增厚和肩袖间隙增厚。本病的病理学及分类与炎症和广泛瘢痕组织的形成有关。危险因素包括糖尿病、甲状腺功能亢进和既往颈椎手术。非手术治疗方法包括理疗、皮质类固醇注射、体外冲击波治疗、降钙素、超声引导下的水扩张和透明质酸注射。大多数患者通过非手术治疗症状可完全缓解，早期注射皮质类固醇可在一定程度上缩短病程。本文介绍了手术治疗方法，包括麻醉下的手法操作、关节镜下的局部松解和环周松解，以及作者的手术技巧。并发症包括骨折、盂唇损伤、神经失用症和肩袖病变。术后护理应始终包括早期物理治疗。

Adhesive capsulitis (AC), or frozen shoulder, clinically presents as equal active and passive range of motion (ROM), both of which are limited secondary to the formation of adhesions of the glenohumeral joint capsule. An expanding body of literature exists which explores the various treatment options. This article reviews the current consensus on the pathology of the disease, its classification system, risk factors for the development of AC, treatment modalities for nonsurgical management, and techniques for optimal surgical intervention.

粘连性关节囊炎（AC）或肩周炎，临床表现为由盂肱关节囊粘连引起的肩关节主动和被动活动范围均受限。大量文献探讨了各种治疗方法。本文综述了目前对该病的病理学、分类系统、发生的危险因素、非手术治疗方式和最佳手术治疗技术的共识。

AC primarily involves contracture of the joint capsule and the rotator interval, which is composed of the superior glenohumeral interval and the coracohumeral ligament (CHL).1  In an elegant study, Lee et al 2 used intra-articular hydraulic distention to quantify capsular stiffness by examining the slope of the elastic phase of pressure-volume curves. They determined that the degree of stiffness of the capsule did not correlate to patient pain. However, as expected, the amount of decreased ROM did correlate with capsular stiffness, especially in abduction and external rotation.

AC主要表现为关节囊挛缩和肩袖间隙挛缩，肩袖间隙由肩肱上间隙和喙肱韧带组成。在一项简洁的研究中，Lee等人通过检查压力-容积曲线弹性相的斜率，使用关节内液压扩张来量化关节囊僵硬度。他们确定关节囊的僵硬程度与患者疼痛无关。然而，正如预期的那样，关节活动度的减少程度确实与关节囊僵硬度相关，尤其是外展和外旋。