关节镜下喙肩韧带松解在微创治疗肩峰撞击征中的作用  

The role of minimally invasive release of coracoacromial ligament in treatment of subacromial impingment syndrome by arthroscopy

作　　者：江长青[1] 肖德明[1] 张文涛[1] 任士友 陈国飞[1] 李伟[1] 

机构地区：[1]北京大学深圳医院运动医学科,广东深圳510080

出　　处：《实用手外科杂志》2015年第4期347-350,365,共5页Journal of Practical Hand Surgery

摘　　要：目的通过前瞻性随机对照研究，分析关节镜下松解喙肩韧带（coraco acromial ligament，CAL）在微创治疗肩峰撞击征中的作用。方法2012年4月-2013年6月，对46例肩关节镜治疗的肩峰撞击征患者随机分组：实验组：肩峰成形＋肩峰下滑囊清理＋喙肩韧带松解组23例（完整随访17例）；对照组：肩峰成形十肩峰下滑囊清理＋喙肩韧带切除组23例（完整随访18例）。术后不同时间段评估VAS，Constant—Murley．HSS评分以及FE，ER和IR活动度，并进行组间及手术前后比较。结果术后8个月末次随访．实验组VAS评分为0．6±1．1，Constant—Murlcy评分为95．7±5．3，HSS评分为93．4±5．1，FE为146．8±13．30，ER为52．40±11．4，IR平均达T7水平。对照组VAS评分0．3±0．8，Constant—Murlcy评分为96．7±4．9，HSS评分为92．3±5．3，FE为143．5±14．70，ER为51．70±12．5，IR平均达T7水平。每组术前与术后相比各指标差异均有统计学意义（P〈0．05）。实验组与对照组FE，ER，平均IR在术后4个月时间段组间指标差异有统计学意义（P〈0．05），但在2，6，8个月时间段指标差异无统计学意义（P〉0．05）。其余各指标在术后2，4个月时间段组间指标差异有统计学意义（P〈0．05），但在6，8个月时间段指标差异无统计学意义（P〉0．05）。结论对需手术治疗的肩峰撞击征患者，应用肩峰成形术结合广泛的肩峰下滑囊清理术可获得较为满意的临床效果；术中松解喙肩韧带短期内的疗效较喙肩韧带切除差，但对临床远期效果无明显影响。Objective To explore the indications, surgical methods and results of the arthroscopic minimally invasive treatment with coracoacromial ligament reserved for subacromial impingement syndrome. Methods From April 2012 to June 2013, 46 cases were treated with shoulder arthroscopic operation, randomly derided into Group A（coracoacromial ligament reserved） and Group B（coracoacromial ligament not reserved）. Evaluated the VAS, Constant-Murlcy, HSS scoring and FE, ER, IR compared between groups and perioperation. Results Only 35 patients（17 in group A,18 in group B） were foUowed up for 8 months. The VAS score, Constant-Murley, HSS, FE, ER and IR were significantly improved after operation （P〈0.05） compared to that before operation. In 4 months after opetation there were significant differences between 2 groups （P〈0.05）intheoutcome of operation. Group B was better than Group A. But after 6 months there were no significant differences between 2 groups. Conclusion The short-term effect of arthroscopic minimally invasive treatment with coracoacromial ligament reserved was worse than coracoacromial ligament not reserved, but there were no significant differences between them in the long- term effect.

关 键 词：喙肩韧带 肩峰撞击征 肩关节 关节镜 

分 类 号：R654.4[医药卫生—外科学]