【摘要】 目的 评估关节镜下松解手术治疗特发性和继发性肩关节僵硬的疗效，分析影响肩关节松解手术疗效的因素。方法 纳入自2016-07—2022-09采用肩关节镜手术松解治疗的88例肩关节僵硬，特发性肩关节僵硬（ISS组）56例，创伤性肩关节僵硬（TSS组）22例，神经源性肩关节僵硬（NSS组）10例。比较3组间术后6个月、12个月肩关节主动活动度、肩关节功能评分、上肢功能DASH评分、疼痛VAS评分、前屈肌力。将肩关节功能分级和上肢功能分级作为因变量，性别、年龄、病因、体质量指数、损伤侧别、优势手侧、病程、合并糖尿病、合并甲状腺疾病、运动控制能力、肌力、术前疼痛VAS评分、术前物理治疗、既往手术史作为自变量，首先进行单因素分析，然后进行多因素Logistic回归分析。结果88例均获得随访，随访时间12～24个月，平均16个月。ISS组、TSS组、NSS组术后6个月肩关节主动活动度、肩关节功能评分、上肢功能DASH评分、疼痛VAS评分较术前明显改善，术后12个月持续改善，差异有统计学意义（P<0.05）。NSS组术后6个月肩关节主动外展活动度小于ISS组和TSS组（P<0.05）,NSS组术后12个月上肢功能DASH评分低于ISS组和TSS组（P<0.05），而且术后6个月、12个月前屈肌力低于ISS组和TSS组（P<0.05）。多因素Logistic回归分析结果显示，病程长、合并糖尿病、运动控制差是肩关节僵硬关节镜下松解术后肩关节功能较差的独立危险因素，患肢肌力差是肩关节僵硬关节镜下松解术后12个月上肢功能较差的独立危险因素。结论 关节镜下松解术治疗不同病因导致的肩关节僵硬的临床疗效满意，术后并发症少。需要注意的是合并糖尿病、病程长、运动控制能力差的患者肩关节功能恢复效果较差，肌力差的神经源性肩关节僵硬患者上肢功能恢复效果较差。更多还原

【Abstract】 ObjectiveTo evaluate the clinical efficacy of arthroscopic capsular release in the treatment of idiopathic and secondary shoulder stiffness and to analyze factors affecting the outcomes of the procedure.MethodsA total of 88 patients with shoulder stiffness who underwent arthroscopic capsular release from July 2016 to September 2022 were included. Patients were divided into three groups: idiopathic shoulder stiffness(ISS group, n=56), traumatic shoulder stiffness(TSS group, n=22), and neurogenic shoulder stiffness(NSS group, n=10). The active range of motion(AROM), shoulder function scores, DASH scores,VAS scores, and forward flexion muscle strength were assessed at 6 and 12 months postoperatively. Shoulder function and upper limb function grades were set as dependent variables, while gender, age, etiology, BMI, affected side, dominant hand, duration of symptoms, diabetes mellitus, thyroid disease, motor control, muscle strength, preoperative VAS pain score, prior physical therapy, and surgical history were analyzed as independent variables. Univariate analysis was performed followed by multivariate logistic regression analysis.ResultsAll 88 patients completed follow-up for 12 to 24 months(mean, 16 months). Significant improvements in AROM, shoulder function scores, DASH scores, and VAS scores were observed in the ISS, TSS, and NSS groups at 6 months postoperatively, with further improvements at 12 months postoperatively(P<0.05). The NSS group had significantly lower active abduction at 6 months postoperatively compared to the ISS and TSS groups(P<0.05). Additionally, the NSS group showed worse DASH scores at 12 months postoperatively and reduced forward flexion strength at both 6 and 12 months postoperatively compared to the ISS and TSS groups(P<0.05). Multivariate Logistic regression analysis identified that prolonged symptom duration, diabetes mellitus, and poor motor control were independent risk factors for poor shoulder function after arthroscopic capsular release. Additionally, poor muscle strength was an independent risk factor for poor upper limb function at 12 months postoperatively.ConclusionArthroscopic capsular release is an effective treatment for shoulder stiffness of various etiologies,with satisfactory clinical outcomes and low complication rates. However, patients with diabetes, prolonged symptom duration, or poor motor control tend to have less favorable shoulder function recovery. Furthermore, patients with neurogenic shoulder stiffness and poor muscle strength exhibit poorer upper limb functional recovery.更多还原