等速肌力锻炼对麻醉下手法松解冻结肩的影响

Effect of isokinetic exercise on manual release of frozen shoulder under anesthesia

摘要:

[目的] 评价麻醉下手法松解术 （manipulation under anesthesia, MUA） 结合等速肌力锻炼治疗冻结肩的临床疗效。 [方法]回顾性分析 2017 年 10 月—2019 年 2 月在本院采用 MUA 治疗的冻结肩 60 例患者的临床资料。依据医患沟通结果，30 例的 MUA 治疗后行等速肌力锻炼 （等速组），30 例在 MUA 治疗后常规康复锻炼 （常规组）。比较两组治疗期、随访和 ISOMED2000 检查资料。[结果]所有患者均顺利完成治疗，无严重并发症发生。等速组治疗周期显著短于常规组 [(84.6±8.3) d vs (103.9±28.3) d, P＜0.05]，但等速组治疗费用显著高于常规组 [(2 760.7±134.2) 元 vs (2 355.2±401.9) 元, P＜0.05]。随时间推移，两组疼痛 VAS 评分均显著下降（P＜0.05）；治疗后 2、4 周等速组 VAS 评分显著优于常规组（P＜0.05）。治疗期间等速组止痛药物的使用强度显著低于常规组（P＜0.05）。所有患者随访平均（34.5±5.9）个月，随时间推移，两组 Constant-Murley 评分，以及肩关节外展、前屈、后伸活动度 （range of motion, ROM） 均显著增加 （P＜0.05）。末次随访时等速组的 Constant-Murley 评分，以及外展、前屈、后伸 ROM 均显著优于常规组 [(91.4±4.2) 分 vs (88.3±4.6) 分; (165.8±9.6)° vs (149.7±14.8)°; (171.1±8.3)° vs (159.2± 12.6)°; (49.7±5.6)° vs (40.0±4.7)°, P＜0.05]。ISOMED2000 检测方面，与治疗前相比，末次随访时两组 60°/s 外展、60°/s 前屈、60°/ s 后伸、120°/s 外展、120°/s 前屈、120°/s 后伸、180°/s 外展、180°/s 前屈和 180°/s 后伸峰值扭矩 （peak torque, PT） 均显著增加 （P＜0.05），治疗前两组间上述测量指标的差异无统计学意义，但末次随访时等速组均显著优于常规组 （P＜0.05）。[结论] MUA 结合等速肌力锻炼治疗冻结肩可显著改善治疗效果，有效缓解肩关节疼痛、增加关节活动度和增强肩关节力量。

Abstract:

[Objective] To evaluate the clinical outcomes of manipulation under anesthesia (MUA) combined with isokinetic muscle strength exercise for frozen shoulder. [Methods] A retrospective study was performed on 60 patients who received MUA therapy for frozen shoulder in our hospitals from October 2017 to February 2019. According to doctor-patient communication prior to treatment, 30 patients received isokinetic exercises after treatment of MUA (isokinetic group), while the other 30 patients received routine rehabilitation exercises after treatment of MUA (routine group). The documents regarding to treatment period, follow-up and ISOMED2000 examination were com- pared between the two groups. [Results] All the patients in both groups had treatment finished successfully without serious complications. The isokinetic group had significantly shorter treatment period than the routine group [(84.6±8.3) days vs (103.9±28.3) days, P＜0.05], de- spite the fact that former had significantly higher treatment cost than the latter [(2 760.7±134.2) yuan vs (2 355.2±401.9) yuan, P＜0.05]. The VAS scores for pain decreased significantly over time in both groups (P＜0.05), which in the the isokinetic group was significantly better than that of the routine group 2 and 4 weeks after treatment (P＜0.05). In addition, the intensity of analgesic used in the isokinetic group was significantly lower than that in the routine group (P＜0.05). All patients were followed up for a mean of (34.5±5.9) months. The ConstantMurley scores, as well as shoulder abduction, flexion, and posterior extension range of motion (ROM) increased significantly over time in both groups (P＜0.05). At the last follow-up, the isokinetic group proved significantly superior to the routine group in terms of constant-Mur- ley scores, abductor, flexion, and extension ROMs [(91.4±4.2) vs (88.3±4.6); (165.8±9.6)° vs (149.7±14.8)°; (171.1± 8.3)° vs (159.2±12.6)°; and (49.7±5.6)° vs (40.0±4.7)°, P＜0.05]. In terms of the ISOMED2000 test, the peak torque (PT) of 60°/s abduction, 60°/s flexion, 60°/s ex- tension, 120°/s abduction, 120°/s flexion, 120°/s extension, 180°/s abduction, 180°/s flexion, and 180°/s extension significantly increased in both groups at the latest follow-up compared with those before treatment (P＜0.05). Although there were no significant differences in the above measures between the two groups before treatment, the isokinetic group was significantly better than the routine group at the latest fol- low-up (P＜0.05). [Conclusion] MUA combined with isokinetic exercises does significantly improve the therapeutic effect for frozen shoul- der, which more effectively relieve shoulder pain, increase joint motion and enhance shoulder strength.