ASD联合三维重建技术治疗肩峰下撞击综合征疗效分析  

Therapeutic effect analysis of ASD combined 3D reconstruction technique in the treatment of subacromial impingement syndrome

作　　者：刘海鹏[1] 郝宗文[1] 徐雅强[1] 刘振刚[1] 张培训[2] Liu Haipeng;Hao Zongwen;Xu Yaqiang;Liu Zhengang;Zhang Peixun(Department of Orthopaedics,Changyi People's Hospital,Changyi 261300,China;Department of Trauma and Orthopedics,Peking Univers ity People's Hospital,Beijing 100044,China)

机构地区：[1]昌邑市人民医院骨关节外科,261300 [2]北京大学人民医院创伤骨科,100044

出　　处：《中华肩肘外科电子杂志》2017年第2期102-107,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：国家自然科学基金(31571235);国家自然科学基金(31171150);国家自然科学基金(31271284);国家自然科学基金(81171146);教育部新世纪优秀人才(BMU20110270);国家科技部863计划(SS2015AA020501);教育部创新团队(IRT1201)

摘　　要：目的评价关节镜肩峰下间隙减压术(arthroscopic subacromial decompression,ASD)联合三维重建技术治疗肩峰下撞击综合征的疗效。方法回顾性分析自2014年1月至2015年6月在昌邑市人民医院采取ASD联合三维重建技术治疗的肩峰下撞击综合征患者共58例,术前应用三维重建技术对肩关节进行模拟成像,在其三维图像上测量同一患者患侧及健侧头顶肩峰距(head to acromion distance,HAD)、肱骨头的相对高度(the relative height of the humerus head,HH)、肩峰喙突距(acromion to coracoid distance,ACD)、结节肩峰距(tuberosity to acromion distance,TAD)。根据每个患者的测量结果,明确引起撞击的原因,在ASD中行个性化操作,精确磨除相应骨赘治疗肩峰下撞击综合征。采用美国加州大学(University of California,Los Angeles,UCLA)肩关节功能标准评价手术疗效。结果患侧HH的平均值为(0.87±0.19)cm,健侧HH的平均值为(1.08±0.21)cm,患侧较健侧距离低,差异有统计学意义(P<0.05);患侧HAD的平均值为(0.54±0.11)cm,健侧HAD的平均值为(0.66±0.15)cm,患侧较健侧的距离低,差异有统计学意义(P<0.05);患侧ACD的平均值为(2.90±0.39)cm,健侧ACD的平均值为(2.91±0.40)cm,患侧较健侧的距离差异无统计学意义(P>0.05);患侧TAD的平均值为(1.96±0.48)cm,健侧TAD的平均值为(1.95±0.45)cm,患侧较健侧的距离差异无统计学意义(P>0.05)。随访时间12~24个月,平均16.4个月。UCLA评分术前为(16.8±4.1)分,术后(32.4±1.5)分,两者差异有统计学意义(P<0.05),优良率为91.4%。结论术前采用三维重建技术测量肩关节HAD、HH、ACD、TAD可明确引起撞击的原因,为ASD提供精确的量化指标,术中可精确磨除相应骨赘,具有创伤小、精确度高、恢复快、并发症少等优点。Background Acromial impingement syndrome was first proposed by Neer and is a common cause of shoulder pain and dysfunction.Currently,arthroscopic subacromial decompression(ASD)has become a preferred method for the treatment of subacromial impingement,which achieved satisfactory results and got a great promotion.In this study,58 patients with acromial impingement syndrome were treated with ASD combined with threedimensional reconstruction technique in Changyi people's hospital from January 2014 to June 2015 to evaluate the corresponding therapeutic effect.Methods(1)General information.Fifty-eight patients were involved in the group,including 26 males and 32 females;the age ranged from 27-81 years with an average of 56 years.All patients were treated conservatively for 3-6 months with poor outcomes,including rest,physical therapy,oral medication of NSAIDs and muscle strengthening exercise.(2)Preoperative measurement.The three-dimensional reconstruction technique was adopted to measure the relative height of the humerus head(HH),the head to acromion distance(HAD),the acromion to coracoid distance(ACD),the tuberosity to acromion distance(TAD).①HAD:the vertical distance between the highest point of the humeral head and the anterolateral acromial angle measured on the 3D reconstruction image of shoulder,marked as A1A2.②HH:the distance between the greater tuberosity of humeral and the vertex of humeral head on the 3D reconstruction image of shoulder,marked as B1B2.③ACD:the distance between the anterolateral acromial angle and the tip of coracoid process measured on the 3D reconstruction image of the shoulder with rotation of scapula,marked as C1C2.④TAD:the horizontal distance between the lateral margin of great tubercle of humerus and the outermost margin of acromion measured on the 3D reconstruction image of shoulder,marked as D1D2.(3)Surgical methods.①Individualized o p e r a t i o n d e s i g n.T h r o u g h p r e o p e r a t i v e m e a s u r e m e n t s o f H A D,H H,A C D,T A D a n d o t h e r anatomical

关 键 词：关节镜肩峰下间隙减压术 三维重建技术 个性化操作 肩峰下撞击综合征 

分 类 号：R687.4[医药卫生—骨科学]