Abstract：
Arthroscopic capsular release (ACR) and Manipulation under anaesthesia(MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures.
From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n = 44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis.
Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24 weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD.
Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.
From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n = 44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis.
Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24 weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD.
Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.
摘要：
关节镜下关节囊松解术（ACR）和麻醉下手法（MUA）已广泛用于治疗冻结肩（FS）。然而,只有有限的I级证据表明更喜欢ACR而不是MUA。我们研究的目的是进行一项比较ACR和MUA的随机试验，以评估结果的差异。两种手术的并发症和成本效益。
从2020年5月至2021年6月，将出现FS的患者随机分为ACR（n=44）和MUA（n=41）两组。关节炎患者,全厚度袖口撕裂，创伤史/既往手术史被排除在研究之外.运动范围（ROM），使用视觉模拟评分法(VAS)进行疼痛分级，功能评分-加州大学洛杉矶分校，在术前和术后测量CONSTANT和EuroQol-5D评分。MRI在术后三周进行，以筛查任一程序的并发症。质量调整寿命年(QALY)用于成本分析。
术后，患者疼痛有显著改善，随访24周时两组ROM和功能评分差异无统计学意义(P<0.001)。与非糖尿病患者相比，接受ACR的糖尿病患者在外展和外旋转方面的改善较小。MUA组的唇膜撕裂和ACR组的骨挫伤是术后MRI上最常见的并发症。对于ACR，每QALY的成本为896美元，而MUA的成本为424美元。
ACR和MUA均导致疼痛和肩关节功能的良好改善。好的结果,简单的技术和更好的成本效益仍然使MUA成为治疗FS比ACR有吸引力的选择。
从2020年5月至2021年6月，将出现FS的患者随机分为ACR（n=44）和MUA（n=41）两组。关节炎患者,全厚度袖口撕裂，创伤史/既往手术史被排除在研究之外.运动范围（ROM），使用视觉模拟评分法(VAS)进行疼痛分级，功能评分-加州大学洛杉矶分校，在术前和术后测量CONSTANT和EuroQol-5D评分。MRI在术后三周进行，以筛查任一程序的并发症。质量调整寿命年(QALY)用于成本分析。
术后，患者疼痛有显著改善，随访24周时两组ROM和功能评分差异无统计学意义(P<0.001)。与非糖尿病患者相比，接受ACR的糖尿病患者在外展和外旋转方面的改善较小。MUA组的唇膜撕裂和ACR组的骨挫伤是术后MRI上最常见的并发症。对于ACR，每QALY的成本为896美元，而MUA的成本为424美元。
ACR和MUA均导致疼痛和肩关节功能的良好改善。好的结果,简单的技术和更好的成本效益仍然使MUA成为治疗FS比ACR有吸引力的选择。
