| Background and purpose: Frozen shoulder(FS)is characterized by spontaneous shoulder pain and progressive limitation of the range of motion(ROM).Although published literature showed that the incidence of FS in the population is 2 to 5%,the actual incidence of FS is still increasing with the change of lifestyle.In the past,FS was considered to be a self-limiting disease,and patients could recover within 2 to 3 years after the onset of symptoms.However,some patients did not relief their symptoms in the years following onset,which affected normal work and life.Clinically,there are disputes over the treatment of FS,and early non-surgical treatment is mainly adopted.However,it is reported that the efficacy of non-surgical treatment is controversial.The condition often persists,and even the symptoms were worsen.With the advancement of arthroscopic minimally invasive technology,the efficacy of arthroscopic joint capsule release for FS is recognized,but the scope of release under the arthroscope has not yet reached consensus.Some scholars suggest that release the anterior and maintain the inferior joint capsule can improve the function of FS.They believe that the inferior joint capsule release is a higher risk of injury to the axillary nerve,but the contracture of the inferior joint capsule has a limited effect on abduction,internal and external rotation.Other scholars have suggested that although 360° capsules release can improve the ROM of shoulder joint after surgery,the ROM recovery is still not enough when compared to the healthy side.There is no consensus on the reasons for ROM limitation after arthroscopy,but residual contracture ligaments and soft tissues should be considered.Some researchers have also released the inferior glenohumeral ligament based on the release of the joint capsule,but there is less systematic analysis about the effect after surgery and whether it affects shoulder stability.The purpose of this study is to determine whether arthroscopy can be used to further improve the function of patients with FS,and to explore whether it affects the stability of the shoulder joint.Methods: From January 2018 to June 2019,50 patients with FS who met the research criteria were admitted to the Northern Jiangsu People's Hospital Hospital.They were divided into experimental group and control group according to the random number table method,with 25 cases each.The experimental group was arthroscopic inferior glenohumeral ligament combined with capsule release,and the control group was arthroscopic capsular release(ACR).Both group patients were guided rehabilitation training after surgery.Pre-and post-operative assessment items include: Visual analogue scale(VAS),American shoulder and elbow surgeons score(ASES),Constant shoulder score,ROM(including forward flexion,abduction and internal or external rotation)and Apprehension test.Results: There was no significant difference in baseline data between the two groups of patients(P>0.05).VAS score: The(0.87±0.55)after operation were significant lower than before operation(7.00±0.85)in the experimental group(P<0.05);The(1.27±0.63)after operation were significant lower than before operation(6.91±0.81)in the control group(P<0.05).ASES score: The(95.87±3.56)after operation were significant higher than before operation(31.17±5.32)in the experimental group(P<0.05);The(93.32±2.85)after operation were significant higher than before operation(32.73±7.13)in the control group(P<0.05).Constant score: The(94.30±4.28)after operation were significant higher than before operation(33.98±6.93)in the experimental group(P<0.05);The(91.57±2.79)after operation were significant higher than before operation(34.73±5.74)in the control group(P<0.05).Shoulder flexion: The(171.65±6.44)° after operation were significant higher than before operation(64.70±12.24)° in the experimental group(P<0.05);The(168.86±5.82)° after operation were significant higher than before operation(63.18±12.68)° in the control group(P<0.001).Shoulder abduction: The(171.22±5.78)° after operation were significant higher than before operation(61.61±6.07)° in the experimental group(P<0.05);The(167.23±4.01)° after operation were significant higher than before operation(59.18±12.33)° in the control group(P<0.05).External rotation of the shoulder: The(55.91±2.41)° after operation were significant higher than before operation(17.87±3.39)° in the experimental group(P<0.05);The(51.86±3.08)° after operation were significant higher than before operation(18.36±5.36)° in the control group(P<0.05).Internal rotation of the shoulder: The(9.65±0.78)after operation were significant higher than before operation(1.48±1.08)in the experimental group(P<0.05);The(8.64±1.14)after operation were significant higher than before operation(1.45±1.10)in the control group(P<0.05).There was no significant difference in the scores before operation(P>0.05).There was no significant difference in the postoperative scores except for forward flexion(P>0.05),and the other scores were significant difference in the experimental group and control group(P<0.05).Apprehension test found no positive signs.There were no infections or axillary nerve injuries after operation,no recurrence of shoulder stiffness or the need for re-operation.Conclusions: Arthroscopic inferior glenohumeral ligament combined with capsule release is a safer surgical method,which can effectively alleviate shoulder pain in FS patients,increase ROM,and restore function.It is a reliable and safe surgical method. |
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