肩关节镜手术治疗钙化性冈上肌肌腱炎

Arthroscopic treatment of calcifying tendinifis of the supraspinatus

目的探讨钙化性冈上肌肌腱炎的病理特点和肩关节镜手术的疗效。方法2009年3月至2010年10月采用关节镜下手术治疗钙化性冈上肌肌腱炎34例。根据法国关节镜协会分类方法将钙化灶分成三组：小（〈10mm）、中（10～20mm）和大（〉20mm）。所有病例均行关节镜下钙化灶清除术和肩峰下滑囊切除术，同时行肩峰成形术（8例），肩袖修补术（10例）。所有研究病例均在术前及术后随访时采用Constant评分、疼痛视觉模拟评分（visual analog scale，VAS）评估其疗效，手术前后均摄肩关节X线片和MR检查，其中9例行组织学和透射电镜检查。结果34例患者获得平均11．5个月的随访。术前1个月、术前2天和末次随访时Constant评分分别为（36．1±6．9）分、（55．6±12．4）分和（89．7±2．7）分，VAS评分分别为（8．2±0．8）分、（7．03±O．7）分和（1．7±0．3）分，治疗前后评分的差异均有统计学意义，而三组间（小、中和大钙化灶）疗效的差异无统计学意义。患者在术后随访期间均未复发。病理检查发现钙化灶周围组织未见胶原纤维退变，周围可见新生胶原，细胞未见坏死溶解。结论正确认识钙化性肌腱炎的临床特点并准确把握手术时机是取得良好疗效的关键。肩关节镜手术是治疗钙化性肌腱炎安全、有效且微创的方法。对不同大小的钙化灶，术后均可取得满意的效果。

Objective To investigate the pathological features and clinical outcomes of the arthro- scopic treatment for calcifying tendinitis of the supraspinatus. Methods From March 2009 to October 2010, 34 patients with calcifying tendinitis of the supraspinatus were treated with shoulder arthroscopy. Based on size of calcifying deposits, they were divided into three groups： small （〈10 mm）, middle （≥10 mm, ≤20 mm）, and large （〉20 ram）. All patients underwent arthroscopic calcium excision and subacromial decompres- sion, and acromioplasty of shoulder was performed in 8 cases, rotator cuff neoplasty in 10. The preoperative and postoperative clinical data such as ConstantSs score, Visual Analog Scale （VAS） pain score and radio- graphs were adopted for evaluation. Besides, histological and scanning electronic microscopic examinations of calcium deposits were also carried out. Results All patients were follwed up for average 11.5 months. The patients were regularly examined at a time point of 1 month preoperatively, 2 days preoperatively and of the latest follow-up. The average Constant score was 36.1±6.9, 55.6±12.4 and 89.7±2.7 respectively; the av- erage VAS pain score was 8.2±0.8,7.03±0.7,1.7±0.3 respectively. Both scoring systems revealed a signifi- cant difference before and after surgery. However, the clinical outcomes of the calcified deposit （small, mid- dle, and large） showed on significant difference among the 3 groups. Collagen fibers were not degenerated around the calcified deposit, and no apoptotic or dead cells could be found, therefore, it is not a pathological calcification. Conclusion Recognition of calcifying tendinitis and good timing of surgery are keys to good clinical results. Shoulder arthroscopy is a safe, effective and minimally invasive method for the treatment of calcifying tendinitis of the supraspinatus. The patients with various size of the calcium deposit treated with shoulder arthroscopy can lead to an excellent clinical outcome postoperatively.