关节内类固醇注射治疗关节镜下肩袖修复术后肩关节僵硬的随机对照研究
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摘要
目的比较关节内类固醇注射在关节镜下肩袖修复后肩关节僵硬的临床效果。方法选取2012-2016年在海军陆战队医院就诊行关节镜下肩袖修复的患者98例,根据患者术后情况分为无僵硬对照组(空白对照组)、观察组、有僵硬对照组(对照组)。评估3组患者术前术后肩关节活动度(ROM)、美国加州大学肩关节功能评分(UCLA)、美国肩肘协会评分(ASES)。结果98例患者中有26例发生了术后僵硬。在术后6周时,3组患者的UCLA评分、ASES评分、术前活动度差异具有统计学意义,空白对照组优于观察组和对照组;在术后12周和术后半年,观察组和空白对照组较对照组的UCLA评分和ASES评分以及活动度明显改善,差异有统计学意义(P <0.05);但在术后1年时,3组患者的UCLA评分、ASES评分、术前活动度差异无统计学意义(P>0.05)。3组患者发生肩袖撕裂或者不愈合情况差异无统计学意义(P>0.05)。结论对关节镜下肩袖修复术后肩关节僵硬进行关节内类固醇注射,可以改善短期内患者症状,提升术后疗效。
Objective To compare the clinical effect of intra-articular steroid injection on shoulder stiffness after arthroscopic rotator cuff repair.Methods 98 cases with arthroscopic rotator cuff repairment were enrolled from 2012 to 2016.Patients divided into no rigid control group(blank control group),observation group,rigid control group(control group)according to the postoperative situation.Before and after surgery,the shoulder joint activity(ROM),the shoulder joint function score(UCLA)of the university of California in United States and shoulder elbow association score(ASES)were assessed among three groups.Results Postoperative stiffness occurred in 26 of the 98 patients.At 6weeks after surgery,there were no statistically significant differences in UCLA score,ASES score and preoperative activity degree among the 3groups,and the blank control group was superior to the observation group and the control group.12 weeks after surgery and half a year after surgery,the UCLA score,ASES score and activity level of the observation group and the blank control group were significantly improved compared with the control group(P <0.05).However,one year after the surgery,there was no statistical difference on UCLA points,ASES points and preoperative activity levels among three groups(P >0.05).There was no statistical difference on rotator cuff tears or nonunion among three groups(P >0.05).Conclusion Intra-articular steroid injection can improve patients' symptoms in a short period of time and improve postoperative efficacy.
Objective To compare the clinical effect of intra-articular steroid injection on shoulder stiffness after arthroscopic rotator cuff repair.Methods 98 cases with arthroscopic rotator cuff repairment were enrolled from 2012 to 2016.Patients divided into no rigid control group(blank control group),observation group,rigid control group(control group)according to the postoperative situation.Before and after surgery,the shoulder joint activity(ROM),the shoulder joint function score(UCLA)of the university of California in United States and shoulder elbow association score(ASES)were assessed among three groups.Results Postoperative stiffness occurred in 26 of the 98 patients.At 6weeks after surgery,there were no statistically significant differences in UCLA score,ASES score and preoperative activity degree among the 3groups,and the blank control group was superior to the observation group and the control group.12 weeks after surgery and half a year after surgery,the UCLA score,ASES score and activity level of the observation group and the blank control group were significantly improved compared with the control group(P <0.05).However,one year after the surgery,there was no statistical difference on UCLA points,ASES points and preoperative activity levels among three groups(P >0.05).There was no statistical difference on rotator cuff tears or nonunion among three groups(P >0.05).Conclusion Intra-articular steroid injection can improve patients' symptoms in a short period of time and improve postoperative efficacy.
引文
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[8]谢杰,孙亚英,殷浩,等.关节镜下肩袖修补联合粘连松解术治疗肩袖撕裂合并肩关节僵硬疗效分析[J].中国运动医学杂志,2015,34(7):633-637.
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[11]SHIN S,DO N,LEE J,et al.Efficacy of a subacromial corticosteroid injection for persistent pain after arthroscopic rotator cuff repair[J].Am J Sports Med,2016,44(9):2231-2236.
[12]闵红巍,刘克敏.继发性肩关节僵硬的诊断与治疗进展[J].中华关节外科杂志(电子版),2014(3):388-390.
[13]PARSONS B,GRUSON K,CHEN D,et al.Does slower rehabilitation after arthroscopic rotator cuff repair lead to longterm stiffness[J].J Shoulder Elbow Surg,2010,19(7):1034-1039.
[14]COOK T,MINNS LOWE C,MAYBURY M,et al.Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain?A systematic review[J].Br J Sports Med,2018,52(8):497-504.
[15]MAMAN E,YEHUDA C,PRITSCH T,et al.Detrimental effect of repeated and single subacromial corticosteroid injections on the intact and injured rotator cuff:a biomechanical and imaging study in rats[J].Am J Sports Med,2016,44(1):177-182.
[16]LEE S,KIM Y,KYUNG H.Pseudohypopyon after management of posterior capsule rupture using intracameral triamcinolone injection in cataract surgery[J].Korean J Ophthalmol,2014,28(4):356-357.
[17]DEAN B,FRANKLIN S,MURPHY R,et al.Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon:a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy[J].Br JSports Med,2014,48(22):1620-1626.
[18]MUTO T,KOKUBU T,MIFUNE Y,et al.Temporary inductions of matrix metalloprotease-3(MMP-3)expression and cell apoptosis are associated with tendon degeneration or rupture after corticosteroid injection[J].J Orthop Res,2014,32(10):1297-1304.
[19]LEE H,KIM Y,OK J,et al.Effect of a single subacromial prednisolone injection in acute rotator cuff tears in a rat model[J].Knee Surg Sports Traumatol Arthrosc,2015,23(2):555-561.
[20]IANNOTTI J,DEUTSCH A,GREEN A,et al.Time to failure after rotator cuff repair:aprospective imaging study[J].J Bone Joint Surg Am,2013,95(11):965-971.
[21]MILLER B,DOWNIE B,KOHEN R,et al.When do rotator cuff repairs fail?Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears[J].Am JSports Med,2011,39(10):2064-2070.
[22]EASON D,TUCKER J,LEE C,et al.Rat rotator cuff tendon-to-bone healing properties are adversely affected by hypercholesterolemia[J].J Shoulder Elbow Surg,2014,23(6):867-872.
[23]MALL N,TANAKA M,CHOI L,et al.Factors affecting rotator cuff healing[J].J Bone Joint Surg Am,2014,96(9):778-788.
[24]KOH K,LIM T,SHON M,et al.Effect of immobilization without passive exercise after rotator cuff repair:randomized clinical trial comparing four and eight weeks of immobilization[J].J Bone Joint Surg Am,2014,96(6):e44.
[25]KIM I,JUNG D.An intra-articular steroid injection at 6weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity[J].Am JSports Med,732-733.
[2]UHL T,MUIR T,LAWSON L.Electromyographical assessment of passive,active assistive,and active shoulder rehabilitation exercises[J].PMR,2010,2(2):132-141.
[3]LAMBERT S.STIFFNESS,MCNAMARA et al.The relationship between shoulder stiffness and rotator cuff healing.a study of 1,533consecutive arthroscopic rotator cuff repairs[J].J Bone Joint Surg Am,2016,98(22):e102.
[4]SKEDROS J,ADONDAKIS M,KNIGHT A,et al.Frequency of shoulder corticosteroid injections for pain and stiffness after shoulder surgery and their potential to enhance outcomes with physiotherapy:A retrospective study[J].Pain Ther,2017,6(1):45-60.
[5]JEONG J Y,CHUNG P K,YOO J C.Effect of sodium hyaluronate/carboxymethyl cellulose(Guardix-sol)on retear rate and postoperative stiffness in arthroscopic rotator cuff repair patients:A prospective cohort study[J].J Orthop Surg(Hong Kong),2017,25(2):2309499017718908.
[6]HIGPEN C,SHAFFER M,GAUNT B,et al.The American Society of Shoulder and Elbow Therapists consensus statement on rehabilitation following arthroscopic rotator cuff repair[J].J Shoulder Elbow Surg,2016,25(4):521-535.
[7]AUDIGL,BLUM R,MLLER A,et al.Complications following arthroscopic rotator cuff tear repair:A systematic seview of terms and definitions with focus on shoulder stiffness[J].Orthop J Sports Med,2015,3(6):631-632.
[8]谢杰,孙亚英,殷浩,等.关节镜下肩袖修补联合粘连松解术治疗肩袖撕裂合并肩关节僵硬疗效分析[J].中国运动医学杂志,2015,34(7):633-637.
[9]钱立群,包英华.肱骨近端骨折术后肩关节康复训练[J].中医正骨,2007,19(11):42-42.
[10]YAMAGUCHI T,OCHIAI N,SASAKI Y,et al.Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury[J].J Orthop Res,2015,33(12):1861-1867.
[11]SHIN S,DO N,LEE J,et al.Efficacy of a subacromial corticosteroid injection for persistent pain after arthroscopic rotator cuff repair[J].Am J Sports Med,2016,44(9):2231-2236.
[12]闵红巍,刘克敏.继发性肩关节僵硬的诊断与治疗进展[J].中华关节外科杂志(电子版),2014(3):388-390.
[13]PARSONS B,GRUSON K,CHEN D,et al.Does slower rehabilitation after arthroscopic rotator cuff repair lead to longterm stiffness[J].J Shoulder Elbow Surg,2010,19(7):1034-1039.
[14]COOK T,MINNS LOWE C,MAYBURY M,et al.Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain?A systematic review[J].Br J Sports Med,2018,52(8):497-504.
[15]MAMAN E,YEHUDA C,PRITSCH T,et al.Detrimental effect of repeated and single subacromial corticosteroid injections on the intact and injured rotator cuff:a biomechanical and imaging study in rats[J].Am J Sports Med,2016,44(1):177-182.
[16]LEE S,KIM Y,KYUNG H.Pseudohypopyon after management of posterior capsule rupture using intracameral triamcinolone injection in cataract surgery[J].Korean J Ophthalmol,2014,28(4):356-357.
[17]DEAN B,FRANKLIN S,MURPHY R,et al.Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon:a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy[J].Br JSports Med,2014,48(22):1620-1626.
[18]MUTO T,KOKUBU T,MIFUNE Y,et al.Temporary inductions of matrix metalloprotease-3(MMP-3)expression and cell apoptosis are associated with tendon degeneration or rupture after corticosteroid injection[J].J Orthop Res,2014,32(10):1297-1304.
[19]LEE H,KIM Y,OK J,et al.Effect of a single subacromial prednisolone injection in acute rotator cuff tears in a rat model[J].Knee Surg Sports Traumatol Arthrosc,2015,23(2):555-561.
[20]IANNOTTI J,DEUTSCH A,GREEN A,et al.Time to failure after rotator cuff repair:aprospective imaging study[J].J Bone Joint Surg Am,2013,95(11):965-971.
[21]MILLER B,DOWNIE B,KOHEN R,et al.When do rotator cuff repairs fail?Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears[J].Am JSports Med,2011,39(10):2064-2070.
[22]EASON D,TUCKER J,LEE C,et al.Rat rotator cuff tendon-to-bone healing properties are adversely affected by hypercholesterolemia[J].J Shoulder Elbow Surg,2014,23(6):867-872.
[23]MALL N,TANAKA M,CHOI L,et al.Factors affecting rotator cuff healing[J].J Bone Joint Surg Am,2014,96(9):778-788.
[24]KOH K,LIM T,SHON M,et al.Effect of immobilization without passive exercise after rotator cuff repair:randomized clinical trial comparing four and eight weeks of immobilization[J].J Bone Joint Surg Am,2014,96(6):e44.
[25]KIM I,JUNG D.An intra-articular steroid injection at 6weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity[J].Am JSports Med,732-733.