粘连性肩关节囊炎的治疗（六）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Redler LH, Dennis ER. Treatment of Adhesive Capsulitis of the Shoulder. J Am Acad Orthop Surg. 2019;27(12):e544-e554. 本次学习由阎芳副研究员主讲。

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Calcitonin

A double-blinded randomized controlledtrial of 64 patients with AC compared intranasal calcitonin versus placebo for 6weeks along with PT and NSAIDs. At 6 weeks, shoulder pain, ROM, and functionalscores were markedly improved in the calcitonin group.

降钙素

一项双盲随机对照试验对64例AC患者进行了为期6周的研究，比较鼻内降钙素或安慰剂对肩痛的疗效，两组均联合使用理疗和NSAIDs。6周时，降钙素组的肩痛、关节活动度和功能评分明显改善。

Calcitonin is a polypeptide hormonesecreted from parafollicular cells of the thyroid. It has been used for themanagement of complex regional pain syndrome, rheumatoid arthritis, and bonetumors for its analgesic properties. Although its pathophysiology is notcompletely understood, it is thought to decrease the systemic inflammatoryresponse and stimulate the release of endorphins. Calcitonin primarily acts to inhibitosteoclast function and has been shown to stabilize and sometimes increase bonedensity. The aforementioned study used calcitonin in the form of an intranasal spray,but both this form and intramuscular injections have been shown to have low adverseeffect profiles (facial flushing, nasal irritation/sneezing, rhinitis) and long-termtherapy with calcitonin has been shown to be safe, without serious adverseeffects.

降钙素是甲状腺滤泡旁细胞分泌的一种多肽激素。由于其镇痛特性，它已被用于治疗复杂区域疼痛综合征、类风湿性关节炎和骨肿瘤。虽然其病理生理机制尚未完全了解，但它被认为可以降低全身炎症反应，刺激内啡肽的释放。降钙素主要起抑制破骨细胞功能的作用，并已被证明能够保持甚至增加骨密度。上述研究以鼻内喷雾剂的形式使用降钙素，鼻内使用和肌肉注射都显示出较低的不良反应（面部潮红、鼻刺激/喷嚏、鼻炎）发生率，并且降钙素的长期治疗被证明是安全的，没有严重的不良反应。

In the setting of AC, calcitonin therapy isthought to be an effective augment for pain control. The current doserecommendation is 200 U (1 puff) daily. At our institution, one inhaler (a30-day supply) costs $115 to $120. This form of the therapy is derived fromsalmon, so it is contraindicated in patients with salmon allergies.

在AC的治疗中，降钙素治疗被认为能有效控制疼痛。目前的推荐剂量是每天200 U（1揿）。在我们的机构，一个吸入器（30天使用量）的价格是115到120美元。这种药物是从鲑鱼中提取的，所以对鲑鱼过敏的患者是禁忌症。

Ultrasonography–guided Hydrodistention

Ultrasonography-guided hydrodistention has beenshown to be effective in patients with AC in the short term, but no differencehas been found in long-term relief between hydrodistention and intra-articularsteroid injection. In a prospective randomized controlled study of 121 patientswith AC, patients were randomized between hydrodistention with joint manipulationunder an interscalene block and treatment with an intraarticular corticosteroidinjection. Hydrodistention combined with joint manipulation under aninterscalene block provided earlier pain relief and restoration of shoulder ROMand function compared with single intraarticular corticosteroid injection in patientswith AC; however, at 12 months no difference existed between the two groups. Arandomized controlled study of 64 patients with refractory AC who receivedcapsulepreserving hydrodistention with corticosteroid versus a standard intraarticularcorticosteroid showed notable improvement in both the groups in shoulder painand disabilities index score and visual analogue scale (VAS) for pain but nodifference between the two groups.

超声引导下水扩张

超声引导下关节腔水扩张在短期内对AC患者有效，但在长期缓解方面与关节腔内注射类固醇没有差异。在一项对121例AC患者进行的前瞻性随机对照研究中，患者被随机分为两组，一组是在肌间沟阻滞下进行关节水扩张并手法松解，另一组是关节内注射皮质类固醇。与单纯关节内注射皮质类固醇相比，肌间沟阻滞下的关节水扩张并手法松解能更快地缓解疼痛，恢复肩关节活动度和功能；然而，在术后12个月时，两组之间没有差异。对64例难治性AC患者进行的随机对照研究显示，关节内皮质类固醇液体扩张组与标准的关节腔内皮质类固醇注射组相比，两组患者在肩痛和残疾指数评分以及疼痛视觉模拟评分（VAS）方面均有显著改善，但两组之间差异无统计学意义。