关节镜下全面处理肩峰下撞击综合征及其合并症

目的探讨通过关节镜微创治疗全面处理肩峰下撞击综合征及其合并症的方法及疗效。方法 2007年7月至2008年12月,对16例肩峰下撞击综合征患者行关节镜下微创手术,年龄34～65岁,平均(55.6±9.1)岁。术前均拍摄肩关节前后位和冈上肌出口位的X线片及行肩关节MRI检查,均行选择性封闭帮助确定诊断。13例患者除肩峰下撞击综合征外还合并其他疾患,合并冻结肩5例,合并肩袖撕裂5例,合并冈上肌钙化1例,合并肩锁关节炎2例。所有患者均行关节镜肩峰下间隙减压术,并对合并症进行全面处理:冻结肩行关节囊松解,肩袖损伤行肩袖修补或清创,钙化性腱炎行钙化灶清除和肩袖修补,肩锁关节炎行锁骨远端切除。结果随访时间12～31个月,平均(18±6.4)个月。ASES评分(美国肩肘外科学会肩关节评分):术前总分(42.7±13.4)分,随访(92.5±12.9)分,较术前提高(P=0.001);UCLA评分(加利福尼亚大学洛杉矶评分):术前(17.2±4.1)分,随访(31.1±3.4)分,也较术前提高(P=0.000),优良率为93.8%。结论肩峰下撞击综合征患者往往合并其他肩部疾患,需要结合病史、体检、影像学资料、选择性封闭试验和关节镜检查做出全面、准确的诊断。行关节镜肩峰下间隙减压术时对各类合并症进行全面处理,有利于取得良好的疗效。

Arthroscopic surgery for treatment of subacromial impingement syndrome and its complications

Objective To explore diagnosis, method and clinical results of arthroscopic surgery for the treatment of subacromial impingement syndrome and its complications. Methods 16 patients with subacromial impingement syndrome and complications were operated with arthroscopy. The average age was 55.6 years, ranging from 34 to 65 years. Preoperative MRI of shoulder and X-ray of obverse shoulder joint and outlet supraspinatus muscle was made. Selective injection was used on every case for diagnosis. During to the history, physical exam, radiology, selective injection and arthroscopic examination, there were 13 cases with concurrent diseases, including 5 frozen shoulders, 5 rotator cuff tears, 2 acromioclavicular joint arthritis and 1 calcific tendinitis. All cases were treated with arthroscopic subacromial decompression (ASD), combined with the arthroscopic capsular release for frozen shoulders, cuff repair or debridement for rotator cuff tears, distal clavicle resection for AC joint arthritis and calcium debridement and cuff repair for calcific tendinitis. Results Average follow up was 16 months (range, 12 to 31 months). The whole ASES score was improved from 42.7±13.4 preoperatively to 92.5±12.9 (P=0.001) postoperatively. The whole UCLA score was improved from 17.2±4.1preoperatively to 31.1±3.4 postoperatively. Over all, 93.8% of patients had good or excellent result. Conclusions Subacomial impingement syndrome was commonly accompanied with other complications. The accurate diagnosis depended on history, physical exam, radiology, selective injection and arthroscopic examination. Selective injection was an effective test for diagnosis of both the impingement and its complications. ASD combining procedures for other complications was showed to be ideal method for subacomial impingement and its complications.