关节镜下全面处理肩峰下撞击综合征及其合并症  

Arthroscopic surgery for treatment of subacromial impingement syndrome and its complications

作　　者：汪滋民[1] 眭杰[1] 年申生[1] 王谦[1] 康一凡[1] 

机构地区：[1]第二军医大学长海医院骨科,上海200433

出　　处：《第二军医大学学报》2011年第3期302-305,共4页Academic Journal of Second Military Medical University

基　　金：上海市科委青年科技启明星项目(08QA1400400)~~

摘　　要：目的探讨通过关节镜微创治疗全面处理肩峰下撞击综合征及其合并症的方法及疗效。方法 2007年7月至2008年12月,对16例肩峰下撞击综合征患者行关节镜下微创手术,年龄34～65岁,平均(55.6±9.1)岁。术前均拍摄肩关节前后位和冈上肌出口位的X线片及行肩关节MRI检查,均行选择性封闭帮助确定诊断。13例患者除肩峰下撞击综合征外还合并其他疾患,合并冻结肩5例,合并肩袖撕裂5例,合并冈上肌钙化1例,合并肩锁关节炎2例。所有患者均行关节镜肩峰下间隙减压术,并对合并症进行全面处理:冻结肩行关节囊松解,肩袖损伤行肩袖修补或清创,钙化性腱炎行钙化灶清除和肩袖修补,肩锁关节炎行锁骨远端切除。结果随访时间12～31个月,平均(18±6.4)个月。ASES评分(美国肩肘外科学会肩关节评分):术前总分(42.7±13.4)分,随访(92.5±12.9)分,较术前提高(P=0.001);UCLA评分(加利福尼亚大学洛杉矶评分):术前(17.2±4.1)分,随访(31.1±3.4)分,也较术前提高(P=0.000),优良率为93.8%。结论肩峰下撞击综合征患者往往合并其他肩部疾患,需要结合病史、体检、影像学资料、选择性封闭试验和关节镜检查做出全面、准确的诊断。行关节镜肩峰下间隙减压术时对各类合并症进行全面处理,有利于取得良好的疗效。Objective To explore the method and clinical efficacy of arthroscopic surgery for treatment of subacromial impingement syndrome and its complications.Methods A total of 16 patients with subacromial impingement syndrome were operated using arthroscopy during Jul.2007 to Dec.2008.The patients aged from 34 to 65 years old,with a mean of（55.6±9.1） years old.Preoperative MRI of shoulder,X-ray of anterior-posterior view of shoulder joint and outlet view of supraspinatus muscle were carried out.Selective injection was used for diagnosis.Five of the 13 patients also had frozen shoulders,5 had rotator cuff tears,2 had acromioclavicular joint arthritis,and 1 had calcific tendinitis.All cases were treated by arthroscopic subacromial decompression（ASD） combined with treatments for complications,including arthroscopic capsular release for frozen shoulders,cuff repair or debridement for rotator cuff tears,distal clavicle resection for AC joint arthritis and calcium debridement and cuff repair for calcific tendinitis.Results The patients were followed up for a mean of（18±6.4） months（ranging 12 to 31 months）.The mean ASES score（American Solar Energy Society） of the 16 patients was significantly improved after operation（[42.7±13.4] vs [92.5±12.9],P=0.001）.The whole UCLA（University of California,Los Angeles） score was also significantly improved after operation（[17.2±4.1] vs [31.1±3.4],P=0.000）,with the overall excellent rate being 93.8%.Conclusion Subacomial impingement syndrome is usually complicated with other shoulder disorders;the accurate diagnosis should be based on patient history,physical examination,imaging findings,selective injection and arthroscopic examination.ASD should be done together with the management of the complications to achieve a better treatment outcome.

关 键 词：肩关节 肩撞击综合征 关节镜检查 

分 类 号：R684.73[医药卫生—骨科学]