小切口喙突成形术治疗喙突下撞击综合征  

CORACOPLASTY WITH MINI-INCISION FOR TREATMENT OF SUBCORACOID IMPINGEMENT SYNDROME

作　　者：谢美明[1] 唐康来[2] 邓银栓[2] 李辉[2] 陶旭[2] 许建中[2] 

机构地区：[1]成都军区总医院骨科,成都610083 [2]第三军医大学西南医院骨科

出　　处：《中国修复重建外科杂志》2012年第11期1296-1299,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨小切口喙突成形术治疗喙突下撞击综合征的方法和临床疗效。方法 2006年5月-2011年9月,收治喙突下撞击综合征患者4例。男3例,女1例;年龄20～56岁,平均36岁。病程6～22个月,平均11.2个月。先天性喙突发育异常3例,盂肱关节前方不稳1例。患者均有肩关节前方慢性疼痛和弹响史,内收、内旋和前屈时加重。Neer撞击征试验和Hawkins-Kennedy改良试验呈阳性。内收轴位CT示喙肱间距变小,喙突指数增大。术中截除喙突颈0.5～1.5 cm,游离肱二头肌短头及喙肱肌联合肌腱止点,重叠缝合于截骨面近端。术后支具固定肩关节6周。结果术后切口均Ⅰ期愈合,无并发症发生。4例均获随访,随访时间8个月～5年。患者肩关节疼痛和弹响均消失。末次随访时,疼痛视觉模拟评分(VAS)、美国加州大学洛杉矶分校(UCLA)肩关节评定标准评分、Constant评分表评分及简单肩关节测试(SST)评分平均分别为0.25、34.25、91.25、0.25分,均较术前7.75、10.25、65.50、9.75分明显改善。内收轴位CT及三维重建和MRI显示,过长喙突已切除,喙肱间距从术前平均4.16 mm增至13.38 mm,喙突指数从术前平均13.08 mm降至0.28 mm。结论小切口喙突成形术是治疗喙突下撞击综合征的有效方法,具有创伤小、术后恢复良好等优点。Objective To investigate the method and effectiveness of coracoplasty with mini-incision for subcoracoid impingement syndrome.Methods Between May 2006 and September 2011,4 patients with subcoracoid impingement syndrome were treated,including 3 cases of congenital dysplasia of the coracoid process and 1 case of anterior glenohumeral instability.There were 3 males and 1 female with an average age of 36 years（range,20-56 years）.The disease duration was 6-22 months（mean,11.2 months）.The patients had a history of chronic pain and click of the anterior should,which was aggravated in adduction,internal rotation,and flexion.The results of the coracoid impingement test were positive by Neer and Hawkins-Kennedy impingement sign.The axial CT in adduction position showed that the coracohumeral interval decreased and coracoid index increased.The 2 cm lateral coracoid incision was made and the 0.5-1.5 cm coracoid neck was revealed and cut by osteotomy.The coracoplasty was performed by amputating the conjoined tendon insertion of the short head of the biceps and the coracobrachialis muscle and suturing to proximal coracoid osteotomy surface.Shoulder was fixed with the external braces for 6 weeks.Results Healing of incision by first intention was observed in all cases without any complication.All the 4 patients were followed up from 8 months to 5 years.At last follow-up,pain and click disappeared.The mean visual analogue scale（VAS）,University of California at Los Angeles（UCLA）,Constant,and simple shoulder test（SST） scores were significantly improved from 7.75,10.25,65.50,and 9.75 at preoperation to 0.25,34.25,91.25,and 0.25 at last follow-up respectively.The axial CT in adduction position and MRI showed that long coracoid process was removed;the coracohumeral interval was increased to 13.38 mm from 4.16 mm at preoperation;and the coracoid index was decreased to 0.28 mm from 13.08 mm at preoperation.Conclusion Coracoplasty with mini-incision is an effective method to relieve clinical symptoms of subcoracoid im

关 键 词：喙突下撞击综合征 小切口喙突成形术 肩关节功能 

分 类 号：R687.3[医药卫生—骨科学]