Clinical study of arthroscopic surgery combined with articular perfusion of conventional drug and tranexamic acid in treating shoulder periarthritis
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目的 探究关节镜手术联合关节灌注常规药物及氨甲环酸治疗肩周炎的临床价值.方法 回顾性选择2021年2月至2023年2月遵义市第一人民医院收治的需要行关节镜手术的肩周炎患者105例,按治疗方法不同分为A组(34例)、B组(31例)、C组(40例)3组,3组均行关节镜手术,A组灌注氨甲环酸,B组灌注常规药物,C组灌注氨甲环酸+常规药物.比较3组术后24 h引流量及术后住院时间,并记录3组术前、术后1 d、3 d、1周、1个月、3个月疼痛视觉模拟评分(VAS)、尼尔肩关节功能评分、美国肩肘外科协会评分(ASES)、肩关节疼痛与功能障碍指数(SPADI)评分和关节活动度(ROM).3组计量资料对比用单因素方差检验,进一步对比用q检验,组间计数资料比较用x2检验.结果 A、C组术后24h引流量少于B组[(10.82±2.79)、(9.49±2.57)ml比(17.91±3.45)ml,F=79.862,P＜0.05],B、C 组术后住院时间短于 A 组[(5.27±0.89)、(5.03±0.91)d 比(7.15±1.48)d,F=37.501,P＜0.05];B 组、C 组术后 VAS 评分低于 A 组[1 d:(3.60±0.68)、(3.51±0.63)分比(5.78±0.77)分,F=119.421,P＜0.01;3 d:(3.29±0.61)、(3.17±0.75)分比(4.46±0.73)分,F=35.685,P＜0.01;1 周:(2.74±0.50)、(2.22±0.78)分比(3.70±0.69)分,F=44.347,P＜0.01;1 个月:(1.18±0.65)、(0.96±0.64)分比(1.94±0.91)分,F=17.137,P＜0.01],SPADI 评分低于 A 组[1 d:(56.07±6.81)、(54.99±7.06)分比(60.16±6.43)分,F=5.729,P＜0.01;3 d:(51.20±5.73)、(48.46±6.35)分 比(56.49±5.89)分,F=16.595,P＜0.01;1 周:(44.27±4.01)、(39.14±4.88)分比(51.03±5.66)分,F=53.733,P＜0.01;1 个月:(35.11±4.59)、(33.37±4.25)分比(45.85±5.13)分,F=74.269,P＜0.01],尼尔肩关节功能评分高于 A 组[1 d:(65.95±5.77)、(67.68±5.06)分比(55.31±6.49)分,F=47.483,P＜0.01;3 d:(68.07±5.24)、(70.22±6.41)分比(58.96±5.71)分,F=36.842,P＜0.01;1 周:(77.18±4.96)、(84.75±5.82)分比(70.84±5.23)分,F=61.756,P＜0.01;1 个月:(87.74±3.29)、(89.01±3.63)分比(81.45±4.47)分,F=39.373,P＜0.01],ASES评分高于 A 组[1 d:(61.04±4.55)、(63.22±4.87)分比(55.06±3.14)分,F=34.816,P＜0.01;3 d:(67.52±4.07)、(68.78±4.23)分比(57.66±3.85)分,F=78.632,P＜0.01;1 周:(73.15±3.68)、(79.92±4.06)分比(61.47±4.42)分,F=190.281,P＜0.01;1 个月:(86.30±3.82)、(87.94±4.41)分比(74.62±4.96)分,F=93.950,P＜0.01],且 C 组术后 1 周 VAS 评分、SPADI 评分低于B组(q=4.530、6.163,P均＜0.05),尼尔肩关节功能评分、ASES评分高于B组(q=8.303、9.819,P均＜0.05).B 组、C 组术后前屈 ROM 高于 A 组[1 个月:(152.96±7.22)°、(155.07±8.33)° 比(141.15±10.88)°,F=24.715,P＜0.01;3 个月:(159.72±7.44)°、(161.22±8.59)°比(155.07±9.14)°,F=5.140,P＜0.05],外展 ROM 高于 A 组[1 个月:(148.03±9.15)°、(151.72±8.84)° 比(137.46±8.21)°,F=25.659,P＜0.01;3 个月:(151.36±6.62)°、(154.04±7.19)° 比(145.09±8.46)°,F=13.590,P＜0.01],内旋 ROM 高于 A 组[1 个月:(66.84±5.66)°、(69.02±6.37)° 比(60.41±7.23)°,F=17.101,P＜0.01;3 个月:(71.02±5.58)°、(73.66±5.94)° 比(65.26±7.41)°,F=16.446,P＜0.01],外旋 ROM 高于 A 组[1 个月:(65.04±5.71)°、(67.39±6.22)° 比(58.72±6.60)°,F=18.711,P＜0.01;3 个月:(70.55±5.24)°、(73.17±4.59)° 比(67.04±4.76)°,F=14.736,P＜0.01],且 C 组术后 1 周前屈、内旋 ROM 高于 B 组(q=5.379、5.320,P＜0.05).结论 关节镜手术联合关节灌注常规药物及氨甲环酸治疗肩周炎疗效显著,可有效控制出血,减轻患者疼痛,缩短术后住院时间,并促进患者术后早期肩关节功能恢复,安全可靠.
Objective To explore the clinical value of arthroscopic surgery combined with articular perfusion of conventional drug and tranexamic acid in the treatment of shoulder periarthritis.Methods 105 patients with shoulder periarthritis who needed arthroscopic surgery in the First People's Hospital of Zunyi were retrospectively selected from February 2021 to February 2023,and were divided into group A(34 cases),group B(31 cases)and group C(40 cases)according to different treatment methods.All the three groups received arthroscopic surgery,group A was infused with trantranic acid,and group B was in-fused with conventional drug and group C was infused with tranexamic acid+conventional drug.The drainage volume at 24 hours after surgery and postoperative hospital stay were compared among the three groups,and Visual Analog Scale(VAS),Neer shoulder function score,American Society of Shoulder and Elbow Surgery Shoulder Joint Score(ASES)and Shoulder Pain and Disability Index(SPADI)and joint range of motion(ROM).were recorded before surgery and at 1 day,3 days,1 week,1 month and 3 months after surgery.One-way ANOVA test was used to compare the measurement data of the three groups,q test was performed for further comparison,and chi-square test was applied to compare the enu-meration data between groups.Results The drainage volume in group A and group C at 24 hours after surgery was less than that in group B[(10.82±2.79),(9.49±2.57)ml vs.(17.91±3.45)ml,F=79.862,P＜0.05],and the postoperative hospital stay in group B and group C was shorter than that in group A[(5.27±0.89),(5.03±0.91)d vs.(7.15±1.48)d,F=37.501,P＜0.05].VAS scores at 1 day,3 days,1 week and 1 month after surgery in groups B and C were lower than those in group A[(3.60±0.68),(3.51±0.63)points vs.(5.78±0.77)points,F=119.421,P＜0.01;(3.29±0.61),(3.17±0.75)points vs.(4.46±0.73)points,F=35.685,P＜0.01;(2.74±0.50),(2.22±0.78)points vs.(3.70±0.69)points,F=44.347,P＜0.01;(1.18±0.65),(0.96±0.64)points vs.(1.94±0.91)points,F=17.137,P＜0.01],and SPADI scores at 1 day,3 days,1 week and 1 month after surgery were lower than those in group A[(56.07±6.81),(54.99±7.06)points vs.(60.16±6.43)points,F=5.729,P＜0.01;(51.20±5.73),(48.46±6.35)points vs.(56.49±5.89)points,F=16.595,P＜0.01;(44.27±4.01),(39.14±4.88)points vs.(51.03±5.66)points,F=53.733,P＜0.01;(35.11±4.59),(33.37±4.25)points vs.(45.85±5.13)points,F=74.269,P＜0.01],and the Neer shoulder function scores were higher than those in group A[(65.95±5.77),(67.68±5.06)points vs.(55.31±6.49)points,F=47.483,P＜0.01;(68.07±5.24),(70.22±6.41)points vs.(58.96±5.71)points,F=36.842,P＜0.01;(77.18±4.96),(84.75±5.82)points vs.(70.84±5.23)points,F=61.756,P＜0.01;(87.74±3.29),(89.01±3.63)points vs.(81.45±4.47)points,F=39.373,P＜0.01],and ASES scores were higher comapred with those in group A[(61.04±4.55),(63.22±4.87)points vs.(55.06±3.14)points,F=34.816,P＜0.01;(67.52±4.07),(68.78±4.23)points vs.(57.66±3.85)min,F=78.632,P＜0.01;(73.15±3.68),(79.92±4.06)points vs.(61.47±4.42)points,F=190.281,P＜0.01;(86.30±3.82),(87.94±4.41)points vs.(74.62±4.96)points,F=93.950,P＜0.01],and the VAS score and SPA-DI score in group C were lower than those in group B at 1 week after surgery(q=4.530,6.163,all P＜0.05)while the Neer shoulder function score and ASES score were higher than those in group B(q=8.303,9.819,all P＜0.05).The ROM of flexion in groups B and C at 1 month and 3 months after sur-gery were higher than those in group A[(152.96±7.22)°,(155.07±8.33)° vs.(141.15±10.88)°,F=24.715,P＜0.01;(159.72±7.44)°,(161.22±8.59)° vs.(155.07±9.14)°,F=5.140,P＜0.05],and the ROM of abduction were higher than those in group A[(148.03±9.15)°,(151.72±8.84)° vs.(137.46±8.21)°,F=25.659,P＜0.01;(151.36±6.62)°,(154.04±7.19)° vs.(145.09±8.46)°,F=13.590,P＜0.01],and the ROM of internal rotation were higher than those in group[(66.84±5.66)°,(69.02±6.37)° vs.(60.41±7.23)°,F=17.101,P＜0.01;(71.02±5.58)°,(73.66±5.94)°vs.(65.26±7.41)°,F=16.446,P＜0.01],ad the ROM of external rotation were higher than those in group A[(65.04±5.71)°,(67.39±6.22)° vs.(58.72±6.60)°,F=18.711,P＜0.01;(70.55±5.24)°,(73.17±4.59)° vs.(67.04±4.76)°,F=14.736,P＜0.01].The ROM of flexion and internal rotation in group C at 1 week after surgery were higher than those in group B(q=5.379,5.320,P＜0.05).Conclusion Arthroscopic surgery combined with articular perfu-sion of conventional drug and tranateic acid has significant efficacy in the treatment of shoulder periarthri-tis,and it can effectively control bleeding,relieve pain,shorten postoperative hospital stay,and promote early postoperative shoulder function recovery,which is safe and reliable.
Arthroscopic surgeryArticular perfusionTranexamic acidShoulder periarthritisClinical value
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