皮肤同种异体移植物
与常规修补术相比,使用人类皮肤同种异体移植对大型至巨型肩袖修补术进行增强已产生更好的功能性和结构性临床结果。在推荐该方法之前,需要进行进一步的研究。[66]Ferguson DP, Lewington MR, Smith TD, et al. Graft utilization in the augmentation of large-to-massive rotator cuff repairs: a systematic review. Am J Sports Med. 2016 Feb 4 [Epub ahead of print].http://www.ncbi.nlm.nih.gov/pubmed/26847487?tool=bestpractice.com
超声促渗
当结合适当的锻炼计划时,与离子电渗疗法相比,超声波促渗(结合双氯芬酸)已被证明可以改善关节活动度 (ROM),而且对于肩撞击综合征患者主诉的疼痛有所减轻。[67]García I, Lobo C, López E, et al. Comparative effectiveness of ultrasonophoresis and iontophoresis in impingement syndrome: a double-blind, randomized, placebo controlled trial. Clin Rehabil. 2016;30:347-358.http://www.ncbi.nlm.nih.gov/pubmed/25862770?tool=bestpractice.com
高能体外冲击波疗法和超声引导穿刺术
侵袭性最小的治疗方案,已研究用于一线保守治疗无法治愈的慢性钙化肩袖肌腱病变患者。这些疗法已显示出极好的临床结果,并且无长期并发症和严重不良反应。[68]Louwerens JK, Veltman ES, van Noort A, et al. The effectiveness of high-energy extracorporeal shockwave therapy versus ultrasound-guided needling versus arthroscopic surgery in the management of chronic calcific rotator cuff tendinopathy: a systematic review. Arthroscopy. 2016;32:165-175.http://www.arthroscopyjournal.org/article/S0749-8063(15)00580-0/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/26382637?tool=bestpractice.com
肉毒杆菌毒素
具有肩部疼痛的成人患者已报告说,与常规治疗(如皮质类固醇注射)相比,在接受肉毒杆菌毒素治疗时,疼痛评分和关节活动度均有所改善。[69]Wu T, Fu Y, Song HX, et al. Effectiveness of botulinum toxin for shoulder pain treatment: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96:2214-2220.http://www.ncbi.nlm.nih.gov/pubmed/26189200?tool=bestpractice.com
旋转中心偏侧化的反向肩关节成形术
反向肩关节成形术 (Reverse shoulder arthroplasty, RSA) 是一种成熟的手术选择,用于治疗肩袖撕裂关节病。一项研究发现,偏侧化 RSA 较非偏侧化 RSA 而言,可大幅度改善有着完好小圆肌的患者的外旋。[70]Greiner S, Schmidt C, Herrmann S, et al. Clinical performance of lateralized versus non-lateralized reverse shoulder arthroplasty: a prospective randomized study. J Shoulder Elbow Surg. 2015;24:1397-1404.http://www.ncbi.nlm.nih.gov/pubmed/26163281?tool=bestpractice.com