前肩峰成形术治疗肩峰下撞击综合征

目的 探讨前肩峰成形术治疗肩峰下撞击综合征的方法和效果。方法 用前肩峰成形术治疗２３例经保守治疗无效的Ⅱ级肩峰下撞击综合征患者。结果 随访７－１８个月,２０例满意;３例不满意,其中２例因实际截骨厚度不足无改善,１例因合并肩锁关节炎失败,切除锁骨外侧端后治愈。ＵＣＬＡ平均分从术前１５．６分改善到３２．４分。结论前肩峰成形术治疗肩峰下撞击综合征方法简单,效果良好。     

关节镜肩峰下减压术与非手术治疗肩峰下撞击综合征的Meta分析

目的系统评价关节镜肩峰下减压术与非手术治疗肩峰下撞击综合征的临床疗效。方法计算机检索PubMed、EMbase、Cochrane、中国知网、维普、万方数据库,纳入关节镜肩峰下减压术(试验组)与非手术(对照组)治疗肩峰下撞击综合征疗效比较的随机对照试验。比较2组治疗后疼痛评分与随访6个月、1年、2年时肩关节功能评分,采用RevMan5.3软件进行Meta分析。结果纳入6篇文献进行Meta分析,共714例,其中试验组344例,对照组370例。Meta分析结果显示,试验组与对照组治疗后疼痛评分与随访6个月、1年、2年时肩关节功能评分比较差异无统计学意义(P0.05)。结论目前证据表明关节镜肩峰下减压术与非手术治疗肩峰下撞击综合征的临床疗效相当。     

肩峰撞击综合征的关节镜下治疗

目的评价肩关节镜下治疗肩峰撞击综合征的临床效果。方法2009年1月-2012年1月,对20例肩峰撞击综合征患者于肩关节镜下行肩峰成形术,术后采用Neer法进行评分。结果术后随访10-25个月,平均15个月,本组患者均未出现关节感染、血管神经损伤及关节腔积血等并发症。肩关节功能术前和术后依据Neer评分系统分别为（78．5±3．0）分及（92．0±2．6）分（P〈0．01）。结论肩关节镜下肩峰成形术能有效治疗肩峰撞击综合征。     

肩峰下撞击综合征的影像学检测方法研究进展

肩峰下撞击综合征(SIS)是造成肩关节疼痛中较常见的一种疾病。其临床症状与肩关节周围炎、肩关节不稳、骨性关节炎等引起的肩关节慢性疼痛较难鉴别。近年来,随着影像学技术的快速发展和对肩关节疾病的深入研究,有许多新方法可以用来检测肩峰下撞击综合征。本文将基于影像的肩峰下撞击综合征的临床诊断技术进展进行综述,为临床医生和相关研究工作者提供参考。     

关节镜下肩峰成形术治疗肩峰下撞击综合征

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。     

关节镜肱骨大结节成形术治疗非出口型肩峰下撞击综合征临床分析

目的探讨关节镜肱骨大结节成形术治疗非出口型肩峰下撞击综合征中的效果。方法将46例(46肩)非出口型肩峰下撞击综合征患者分为2组,A组(26例)采用单纯肩峰下减压成形手术,B组(20例)行肩峰成形的同时附加肱骨大结节成形术,术后采用UCLA评分(加利福尼亚大学洛杉矶评分)评价2组患者肩关节疼痛及功能恢复效果。结果 46例患者术后1 a复查,B组UCLA评分(36.24±2.53)分,显著优于A组(29.82±3.14)分,差异有统计学意义(P0.05)。结论对非出口部位撞击综合征患者,肩峰下减压成形附加肱骨大结节成形术,临床效果满意。     

肩峰下滑囊切除在肩峰下撞击综合征手术治疗中的应用价值

[目的]探讨肩峰下滑囊切除在肩峰下撞击综合征手术治疗中的应用价值.[方法]自2007年7月-2010年12月,对45例肩峰下撞击综合征患者实施了ASD,21例行肩峰成形术,24例肩峰成形同时行肩峰下滑囊切除术,术后采用美国肩肘外科学会肩关节评分标准ASES Scale和加利福尼亚大学洛杉矶评分标准UCLA Scale评价两组患者肩关节疼痛及功能.[结果] ASES评分结果术后最终随访肩峰成形+肩峰下滑囊切除组(88.08±3.22)分,高于肩峰成形组(84.57±3.91)分,差异有统计学意义(P＜0.05).UCLA评分结果术后最终随访肩峰成形+肩峰下滑囊切除组(32.42±2.06)分,高于肩峰成形组(30.81±2.51),差异有统计学意义(P＜0.05).肩峰成形组中优4例,良15例,可2例,优良率为90.5％.肩峰成形+肩峰下滑囊切除组结果中优9例,良13例,可2例,优良率为91.7％.[结论]肩峰撞击综合征导致的SAB慢性炎症反应是引起患者肩痛及功能障碍的重要原因;在肩峰下减压术中必须广泛、彻底地切除肩峰下滑囊.     

肩峰下空间研究进展

肩峰下空间在撞击综合征、肩关节炎等多种疾病的发病学中起重要作用.传统观点认为撞击综合征的潜在因素是肩峰下空间狭窄对冈上肌腱的刺激,最新研究发现这一解释并不全面.该文介绍了肩峰下空间的研究进展,如骨性距离测量、撞击综合征发病机制等.     

应用前肩峰成形术治疗肩峰撞击综合征

本文报道应用前肩峰成形术治疗肩峰撞击综合征12例,手术切除肩峰前下部,肩峰下滑囊,取得满意效果。文中讨论了病因、诊断及其手术治疗的临床意义等。     

肩峰成形术治疗肩峰下撞击综合征

1999—2005年,我科应用改良肩峰成形术治疗肩峰下撞击综合征14例,取得了满意的疗效。1．一般资料：本组共14例,男9例,女5例；年龄35～65岁,平均52岁。右侧9例,左侧5例,病程：10～30个月。全部患者均在门诊进行3～6个月的保守治疗(包括理疗、休息、局部封闭、玻璃质酸纳肩部注射等),因无效而行手术治疗。临床     

Arthroscopic subacromial decompression versus open acromioplasty

A random prospective comparison was conducted of 20 patients who underwent arthroscopic subacromial decompression or open acromioplasty as treatment for impingement syndrome. The Neer anterior acromioplasty served as comparison in the evaluation to arthroscopic technique. The comparison shows more rapid rehabilitation and better range of motion in the arthroscopic group. Time of surgery is also shorter for arthroscopy than for the open technique. Arthroscopic subacromial decompression appears to be superior to open acromioplasty as a treatment for impingement syndrome.     

Medium-term clinical results after operative and non-operative treatment of subacromial impingement

Summary Treatment of subacromial outlet impingement can be operative or non-operative. The purpose of this prospective study was to compare the results of these two types of treatment over a fairly long period. To this end, 72 patients suffering from grade II outlet impingement were prerandomized into two different groups. Group I was made up of 32 patients who were treated operatively; the 40 patients in group II underwent a non-operative treatment. Follow-up time was 4 years for both groups. Depending on the surgeon an arthroscopic subacromial decompression according to Ellman or an anterior acromioplasty according to Neer was performed in each patient in group I. During a 2-week hospital stay a non-operative treatment was administered to all patients in group II. Before the start of treatment patient evaluation was performed: clinical examination, transscapular, a. p. and oblique X-rays, ultrasonography and the LA test; in addition, the Subjective Shoulder Rating Scale (SSRS) was used. This is basically a modification of the Constant-Murley Scoring System. The patients were familiarized with the SSRS sheet before starting the treatment. The sheet was mailed to the patients for then to evaluate their shoulders at yearly intervals. The median total score in group I started from a lower level, with 54 points. The non-operativ median total score in group II started at 59 points. During the 4-year follow-up the improvement in the operatively treated shoulders was 30 points and that in the non-operatively treated shoulders, 15 points. Over the years there was a tendency for the operatively treated shoulders to improve. The pain score in group I improved from 10 points preoperatively to 25 points 1 year postoperatively and to 30 points in the 2nd, 3rd and 4th years after the operation. In group II the pain score declined. An increase of 5 points was found in the first 2 years after starting the treatment, and the same score, 20 points, as at the start was found in the 3rd and 4th years. The range of motion changed from 20 to 30 points only in group I. The activity score paralled the range of motion. Ability to work overhead was consistently reduced throughout the follow-up period and was not influenced by the treatment received. Instability was not a problem for these patients. There was no change in the scores in the two groups. In summary, both forms of treatment led to an improvement of the subacromial impingement. The improvement in pain was the most marked. The long-term results are required for the final evaluation, because results tend to change after both operative and non-operative treatment. In addition, clinical examination and diagnostic imaging techniques should be applied and are necessary to find the reasons for this change.      

In vivo anatomy of the Neer and Hawkins sign positions for shoulder impingement

The Neer and Hawkins impingement signs are commonly used to diagnose subacromial pathology, but the anatomy of these maneuvers has not been well elucidated in vivo. This 3-dimensional open magnetic resonance imaging study characterized shoulder anatomy and rotator cuff impingement in 8 normal volunteers placed in the Neer and Hawkins positions. Subacromial and intraarticular contact of the rotator cuff was graded, and minimum distances were computed between the tendon insertion sites and the glenoid, acromion, and coracoid. Both the Neer and Hawkins maneuvers significantly decreased the distance from the supraspinatus insertion to the acromion and posterior glenoid and from the subscapularis insertion to the anterior glenoid. However, the Hawkins position resulted in significantly greater subacromial space narrowing and subacromial rotator cuff contact than the Neer position. In the Hawkins position, subacromial contact of the supraspinatus and infraspinatus was observed in 7 of 8 and 5 of 8 subjects, respectively. In contrast, rotator cuff contact with the acromion did not occur in any subject in the Neer position. Intraarticular contact of the supraspinatus with the posterosuperior glenoid was observed in all subjects in both positions. Subscapularis contact with the anterior glenoid was also seen in 7 of 8 subjects in the Neer position and in all subjects in the Hawkins position. This extensive intraarticular contact suggests that internal impingement may play a role in the Neer and Hawkins signs.     

Evaluation of the effectiveness of dexamethasone iontophoresis in patients with subacromial impingement syndrome

BackgroundSubacromial impingement syndrome is the most common shoulder disease in individuals. There is no study evaluating the effectiveness of steroid iontophoresis in subacromial impingement syndrome. We aimed to assess the effectiveness of dexamethasone iontophoresis as treatment for impingement syndrome with respect to pain and function.MethodsForty-six patients with subacromial impingement syndrome were recruited to the study and divided randomly into two groups (21 patients in iontophoresis group and 25 patients in control group). Demographic, clinical features and MRI findings of patients were recorded. Detailed physical examination of all patients were performed and Numerical rating scale (NRS) during rest and exercise, The Disabilities of the Arm, Shoulder and Hand (DASH) scores were recorded at baseline, week 2 and week 6. Both group received physiotherapy program for ten days. Additionally the patients in iontophoresis group recieved dexamethasone iontophoresis (1 mg dexamethasone per 1 g administered under the active electrode) with an intensity of 0.1–0.2 mA/cm2 galvanic current for ten days.ResultsNo significant difference was observed between the groups in terms of gender, job status, MRI findings, painful shoulder and pain duration. Baseline range of motion, Neer, Hawkins, Yocum and painful arc tests, numerical rating scale (NRS) and DASH scores were similar between groups. A significant improvement was found in terms of the NRS (resting and exercise) and DASH scores at week 2 and week 6 in both group (p < 0.001). A significant difference was found in terms of improvement NRS (resting) and DASH scores between baseline and week 6 in iontophoresis group (p = 0.007, p = 0.011 respectively).ConclusionsAdding dexamethasone iontophoresis to physiotherapy for patients with subacromial impingement syndrome seems to provide a better clinical and functional improvement.     

Subacromial space in adult patients with thoracic hyperkyphosis and in healthy volunteers

The assumption that subacromial space decreases in patients with thoracic hyperkyphosis arises from sporadic and personal observations. The purpose of this study was to compare width of subacromial space calculated on radiographs and CT scans of a high number of patients with thoracic hyperkyphosis that registered on exams of healthy volunteers. We measured the subacromial space, using Petersson’s method, on radiographs of 47 patients with idiopathic or acquired thoracic hyperkyphosis and of 175 healthy shoulder volunteers. Both groups were further distinguished considering gender and age. Females with hyperkyphosis were also divided in two subgroups: those with a kyphotic curve of less (24 patients) or more (19 patients) than 50°, respectively. Subacromial space of all patients and of 21 volunteers was also evaluated using CT. Acromio-humeral space was less wide in patients with hyperkyphosis with respect to coeval volunteers of the same gender; in females and in subjects older than 60. Subacromial width of females with hyperkyphosis whose curve was more than 50° was significantly narrower (p<0.05) than that measured on radiograms or CT scans of females with a less severe spinal deformity. Decrease of subacromial space may be attributed to less posterior tilting of the scapula and to dyskinesis of the scapular movement. Scapular malposition causes an anomalous orientation of the acromion that may contribute to subacromial impingement. Patients with thoracic hyperkyphosis greater than 50° had a subacromial space narrower than that measured in patients with a less severe kyphosis. This suggests that subacromial width is directly related to severity of thoracic kyphosis. Because hyperkyphosis of patients with osteoporotic vertebral fractures may worsen over the time, subacromial decompression could give only temporary shoulder pain relief.     

Editorial Commentary: Arthroscopic Treatment Should No Longer Be Offered to People With Subacromial Impingement

Arthroscopic treatment should no longer be offered to people with subacromial impingement. In many people, subacromial impingement (or subacromial pain syndrome) is self-limiting and may not require any specific treatment. This is evident by the fact that almost 50% of people with new-onset shoulder pain consult their primary care doctor only once. The best-available evidence from randomized controlled trials indicates that glucocorticoid injection provides rapid, modest, short-term pain relief. Exercise therapy has also been found to provide no added benefit over glucocorticoid injection. Subacromial decompression (bursectomy and acromioplasty) for subacromial pain syndrome provides no important benefit on pain, function, or health-related quality of life. Acromioplasty does not improve the outcomes of rotator cuff repair.     

The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study

This prospective, randomized trial was performed to compare the results of treating subacromial impingement syndrome of the shoulder by a guided self-training program with the treatment by conventional physiotherapy or a functional brace. Sixty patients with the diagnosis of an outlet impingement syndrome of the shoulder (Neer I and II) were treated either by strengthening the depressors of the humeral head with a guided self-training program, by conventional physiotherapy, or by wearing a functional brace. The Constant-Murley score was assessed after 6 and 12 weeks. Shoulder pain was monitored with a visual analog scale. All three groups showed a significant improvement in shoulder function as well as a significant reduction in pain. There were no statistically significant differences among the groups. Guided self-training can lead to results similar to those of conventional physiotherapy. The comparable effect of the functional brace remains unclear and might be explained by an influence on proprioception.