关节镜下肩峰成形术治疗肩峰下撞击综合征  

Arthroscopic acromioplasty for the treatment of impingement syndrome of shoulder

作　　者：施培华[1] 虞和君[1] 黄悦[1] 方向前[1] 张剑[1] 赵凯[1] 范顺武[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016

出　　处：《中华骨科杂志》2004年第3期170-173,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨关节镜下肩峰成形术治疗肩峰下撞击综合征的方法和临床疗效.方法肩峰下撞击综合征患者15例,男9例,女6例;年龄32～54岁,平均47岁.右肩10例,左肩5例.Ⅰ度3例,Ⅱ度4例,Ⅲ度8例.术前UCLA评分平均为(18.5±8.2)分.所有患者均有外伤史或慢性劳损,均有不同程度的肩周疼痛和夜间痛.疼痛弧试验阳性12例,撞击征阳性13例.术前13例行MR检查,5例行肩关节造影.术前常规拍摄肩关节正位和冈上肌出口位X线片.平坦肩峰4例,弧形肩峰5例,钩状肩峰6例.关节镜下肩峰成形术手术步骤:采用常规后入路做盂肱关节腔检查,排除或治疗肩关节内病变;用刨削打磨器清理切除肩峰下滑囊壁;用钩刀或钬激光切断或部分切除喙肩韧带;用打磨钻切除(或磨平)肩峰前外侧部分;最后探查肩锁关节,磨去骨赘.4例做肩袖修补术.术后早期行肩关节功能锻炼.结果 15例患者均获得随访,平均15个月.终末随访时的UCLA评分平均为(31.7±6.5)分,其中优8例,良4例,可2例,差1例;和术前评分比较,差异有显著性(t=3.35,P＜0.05).结论肩峰下撞击综合征是肩关节疼痛和功能障碍的常见原因.关节镜下肩峰成形术是治疗肩峰下撞击综合征的有效方法,创伤小,术后恢复快,术后早期即可进行功能锻炼.Objective To explore the methods and clinical results of the arthroscopic acromioplasty for the treatment of impingement syndrome of shoulder. Methods 15 cases with impingement syndrome of shoulder were studied. There were 9 males and 6 females. 10 right shoulders and 5 left ones were involved. The average age of patients was 47 years ranging from 32 to 54 years. 3 injuries were classified as degree I, 4 as Ⅱ, and 8 as Ⅲ according to Neer classification. All the patients had a chronic injury and painful history around shoulder. The positive arch pain test was presented in 12 cases and impingement test in 13 cases. 13 patients had been received MR examinations, and 5 arthrographies of the shoulder. The AP and the supraspinatus outlet projection of the X-rays were obtained before surgery. The procedure of arthroscopic acromioplasty consisted of 5 following steps: the first was arthroscopic subacromial inspection with posterior portal; the second was subacromial bursectomy with electro-shaver or burr; the third was release or resection of the coracoacromial ligament with electrocautery; the fourth was subacromial decompression with full-radius resector or burr; and the last was debridement of the soft tissue around the acromio-clavicular joint and resection of the the spurs. 4 patients underwent reparation of the rotator cuff simultaneously. Results All cases were available for follow-up. The average time was 15 months. According to the UCLA scoring system, the average score was 18.5±8.2 and 31.7±6.5 pre- and post-operation respectively; the difference was of statistical significance(t=3.35, P<0.05). The results were 8 excellent, 4 good, 2 fair and 1 poor. Conclusion Impingement is the common cause for the pain and dysfunction of the shoulder, the arthroscopic acromioplasty is a reliable solution. This surgery has many advantages, such as mini-invasion, rapid recovery and early rehabilitation.

关 键 词：关节镜 肩峰成形术 治疗 肩峰下撞击综合征 

分 类 号：R687[医药卫生—骨科学]