摘要目的 分析糖尿病及黏连性肩关节囊炎症状持续时间对关节镜下肩关节松解术患者预后的影响。方法 本研究共纳入安徽医科大学第三附属医院2019年6月至2022年4月45例黏连性肩关节囊炎患者，其中男18例，女27例；年龄47～66岁，平均(53.4±6.1)岁。所有纳入患者完善术前检查及围手术期准备后行关节镜手术治疗。根据术前肩关节症状持续总时间将患者分为A组(3个月以内)、B组(3~6个月)、C组(6个月以上)。通过分析对比患者患侧肩关节各方向活动度，术后臂、肩、手功能障碍(disabilities of the arm，shoulder and hand，DASH) 评分，美国肩肘外科协会(American shoulder and elbow surgeons，ASES) 评分，疼痛视觉模拟评分(visual analogue score，VAS)，疼痛缓解时间(手术后至患肩疼痛感消失用时)，总病程时间(首发症状至手术后患肩疼痛消失及活动度恢复如常时)的组间不同，探究糖尿病及黏连性肩关节囊炎症状持续时间对肩关节镜下手术治疗黏连性肩关节囊炎患者的预后影响。结果 患者均获随访，随访时间1～19个月，平均随访(17.3±5.1)个月。无糖尿病组及糖尿病组患者术后患肩前屈、外展、内旋度数分别为：(164.4±20.2)°、(169.9±18.7)°、(38.5±8.0)°，(161.3±19.8)°、(170.6±14.2)°、(34.6±9.4)°。无糖尿病组及糖尿病组患者术后DASH评分、ASES评分、VAS评分分别为：(9.4±10.1)分、(86.2±13.2)分、(7.9±1.4)分，(12.5±12.9)分、(82.6±17.1)分、(7.8±1.9)分。无糖尿病组及糖尿病组患者患侧肩术后疼痛完全缓解时间、黏连性肩关节囊炎总病程分别为：(3.6±3.5)周、(31.4±7.3)个月，(3.7±2.5)周、(38.7±12.5)个月。术前A、B、C三组发病时长对内旋影响差异有统计学意义(P＝0.02)；A、B、C三组总发病时间及术后症状持续时间组间比较，差异有统计学意义(P＜0.001)，术后B、C组患者的ASES评分显著高于A组(P＝0.02)，同时糖尿病组患者DASH评分显著高于非糖尿病患者组(P＝0.03)。结论 肩关节镜下松解手术是治疗黏连性肩关节囊炎的一种有效手段且其疗效与患者发病时间无明显相关，然而糖尿病对于患者的术后康复有着较为明显的影响。
Abstract：Objective To analyze and evaluate the influence of diabetes mellitus and symptom duration on the prognosis of frozen shoulder patients undergoing arthroscopic shoulder joint release.Methods A total of 45 frozen shoulder patients from June 2019 to April 2022 from the third affiliated hospital of Anhui Medical University were collected in this study，including 18 males and 27 females，aged 47~66 years，with an average of (53.4±6.1) years.All patients underwent arthroscopic surgeries after complete preoperative examination and perioperative preparation.The patients were divided into group A (within 3 months)，group B (3~6 months)，and group C (more than 6 months) according to the total duration of shoulder symptoms before surgery.This study analyzed the range of motion(ROM)，disabilities of the arm，shoulder，and hand score(DASH)，American shoulder and elbow surgeons(ASES)，visual analogue score(VAS)，pain duration，and total disease duration to explore the effect of diabetes mellitus and duration of frozen shoulder on the prognosis of patients with frozen shoulder treated by arthroscopic surgery.Results All patients were followed up for 1~19 months，with an average follow-up of(17.3±5.1) months.The degrees of shoulder flexion，abduction，and internal rotation of patients without or with diabetes after surgery were：(164.4±20.2)°、(169.9±18.7)°、(38.5±8.0)°，(161.3±19.8)°、(170.6±14.2)°、(34.6±9.4)°.The postoperative DASH score，ASES score，and VAS score of patients without or with diabetes were：(9.4±10.1)、(86.2±13.2)、(7.9±1.4)，(12.5±12.9)、(82.6±17.1)、(7.8±1.9).Time to complete pain relief after the operation and the total duration of frozen shoulder in the patients without or with diabetes were (3.6±3.5) weeks、(31.4±7.3) months，(3.7±2.5) weeks、(38.7±12.5)months.The duration of shoulder symptoms of A、B、C group had a statistically significant effect on internal rotation (P＝0.02)，A、B、C group had significant differences in the total symptom duration and postoperative symptom duration (P＜0.001)，the ASES score of patients in group B and group C after surgery was significantly higher than that in group A (P＝0.02)，and the DASH score of patients in diabetic group was significantly higher than that in non-diabetic group (P＝0.03).Conclusion Arthroscopic release surgery is an effective method for the treatment of frozen shoulder，and its efficacy is not significantly related to the time of onset of the patient.However，diabetes has a significant impact on the postoperative recovery of patients.
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