肩关节镜治疗肩峰下撞击综合征及其合并症
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摘要
目的探讨肩关节镜治疗肩峰下撞击综合征及其合并症的方法和疗效。方法采用肩关节镜手术治疗28例肩峰下撞击综合征及其合并症患者。末次随访时,采用UCLA评分、ASES评分、Constant-Murley评分以及VAS评分对患侧肩关节功能和疼痛情况进行评价。结果 28例患者均获得随访,时间4～24个月。1例大型肩袖撕裂患者术后患肢残留疼痛及功能障碍,其他患者术后患肢疼痛症状缓解、关节功能基本恢复。末次随访时肩关节功能评分及疼痛评分均较术前明显改善,差异有统计学意义(P <0. 01)。结论肩峰下撞击综合征往往合并其他肩关节疾患,术前需要明确诊断,术中行关节镜下肩峰成形术同时治疗其合并症,才能够获得满意的疗效。
Objective To explore the method and effect of arthroscopy treatment of sub-acromial impingement syndrome and its complications. Methods The 28 patients with sub-acromial impingement combined with different levels of rotator cuff injury or adhesive capsulitis or bursitis or calcific tendinitis were treated. All patients were statistically analyzed by using UCLA,ASES,and Constant-Murley function score and VAS in the preoperative and last follow-up. Results All patients were followed up for 4 ～ 24 months. One case which had a large tear in the rotator cuff,had pain and dysfunction of the limb and reoperation for the latissimus dorsi transposition after operation. Pain was relieved and function was basically recovered in other patients at the postoperation. The functional score and pain score of all patients were significantly improved than the preoperation,and the differences were statistically significant( P < 0. 01). Conclusions Sub-acomial impingement syndrome is usually accompanied with other shoulder disorders. The accurate diagnosis is necessary. Acromioplasty should be done together with the management of the complications to achieve a satisfactory treatment.
Objective To explore the method and effect of arthroscopy treatment of sub-acromial impingement syndrome and its complications. Methods The 28 patients with sub-acromial impingement combined with different levels of rotator cuff injury or adhesive capsulitis or bursitis or calcific tendinitis were treated. All patients were statistically analyzed by using UCLA,ASES,and Constant-Murley function score and VAS in the preoperative and last follow-up. Results All patients were followed up for 4 ～ 24 months. One case which had a large tear in the rotator cuff,had pain and dysfunction of the limb and reoperation for the latissimus dorsi transposition after operation. Pain was relieved and function was basically recovered in other patients at the postoperation. The functional score and pain score of all patients were significantly improved than the preoperation,and the differences were statistically significant( P < 0. 01). Conclusions Sub-acomial impingement syndrome is usually accompanied with other shoulder disorders. The accurate diagnosis is necessary. Acromioplasty should be done together with the management of the complications to achieve a satisfactory treatment.
引文
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[7] Bidwai A S C,Birch A,Temperley D,et al. Medium-to long-term results of a randomized controlled trial to assess the efficacy of arthoscopic-subacromial decompression versus mini-open repair for the treatment of medium-sized rotator cuff tears[J]. Shoulder Elbow,2016,8(2):101-105.
[8] Mac Donald P,McRae S,Leiter J,et al. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears:a multicenter,randomized controlled trial[J]. J Bone Joint Surg A,2011,93(21):1953-1960.
[9] Matthewson G,Beach C J,Nelson A A,et al. Partial thickness rotator cuff tears:current concepts[J]. Adv Orthop,2015,2015(11):1-11.
[2] Li X,Xu W,Hu N,et al. Relationship between acromial morphological variation and subacromial impingement:A three-dimensional analysis[J]. PLo S One,2017,12(4):1-15.
[3] Dong W,Goost H,Lin X B,et al. Treatments for shoulder impingement syndrome:a PRISMA systematic review and network metaanalysis[J]. Medicine(Baltimore),2015,94(10):1-17.
[4]汪滋民,眭杰,年申生,等.关节镜下全面处理肩峰下撞击综合征及其合并症[J].第二军医大学学报,2011,32(3):302-305.
[5] Vitale M A,Arons R R,Hurwitz S,et al. The rising incidence of acromioplasty[J]. J Bone Joint Surg,2010,92(9):1842-1850.
[6] Yu E,Cil A,Harmsen W S,et al. Arthroscopy and the dramatic increase in frequency of anterior acromioplasty from 1980 to 2005:an epidemiologic study[J]. Arthroscopy,2010,26(9):S142-S147.
[7] Bidwai A S C,Birch A,Temperley D,et al. Medium-to long-term results of a randomized controlled trial to assess the efficacy of arthoscopic-subacromial decompression versus mini-open repair for the treatment of medium-sized rotator cuff tears[J]. Shoulder Elbow,2016,8(2):101-105.
[8] Mac Donald P,McRae S,Leiter J,et al. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears:a multicenter,randomized controlled trial[J]. J Bone Joint Surg A,2011,93(21):1953-1960.
[9] Matthewson G,Beach C J,Nelson A A,et al. Partial thickness rotator cuff tears:current concepts[J]. Adv Orthop,2015,2015(11):1-11.