关节镜下钙化性肩袖肌腱炎的手术治疗

Arthroscopic treatment of calcific rotator cuff tendinitis

[目的]探讨关节镜下手术治疗钙化性肩袖肌腱炎的手术要点与临床疗效。[方法]经保守治疗无效的钙化性肩袖肌腱炎患者32例,男8例,女24例;年龄38～62岁,平均49.5岁。采用肩关节后、前、外侧入口置入关节镜及器械,分别于盂肱关节内和肩峰下间隙进行操作,定位并清除钙化灶。采用VAS疼痛评分、Constant-Murley评分对患者进行手术前后的评估。[结果]32例术后早期均达到显著症状缓解,VAS疼痛评分由术前(7.5±0.9)分减少至术后3 d(3.0±0.6)分(P<0.001),所有患者均未发生严重并发症。平均随访18个月(8～30个月),VAS疼痛评分由术前(7.5±0.9)分,减少至末次随访时(0.1±0.3)分(P<0.001)。Constant-Murley评分由术前(45.9±9.9)分,增加至末次随访时(90.4±6.7)分(P<0.001)。术后X线显示仅2例患者钙化灶有少量残留,但症状消失,12个月后残留钙化物吸收。[结论]肩关节镜检下微创治疗钙化性肩袖肌腱炎是一种创伤小、恢复快、有效的治疗方法。手术要点在于迅速准确定位钙化灶,在保持肩袖原有连续性的前提下,尽量彻底清除钙沉积物。

[ Objective ] To explore the key issues in operation and outcome of arthroscopic treatment for calcific rotator cuff tendinitis. [ Methods] Thirty - two patients with calcific rotator cuff tendinitis resistant to conservative treatment were treated by arthroscopic removal of calcification, including 8 males and 24 females, aged 38 to 62 years with an average of 49. 5 years. Through posterior, anterior and lateral portals, glenohumeral arthroscopy and subacromial bursoscopy were conducted successive- ly. As the calcific deposit was located correctively, visible calcification was completely removed. VAS pain score and Constant - Murley score were adopted for evaluation before and after surgery. [ Results] In the early stage after operation, remarkable pain relief was obtained in all of the 32 patients. VAS scores decreased from （7.5 ±0. 9） preoperatively to （3.0 ±0. 6） at 3 days af- ter operation （P 〈 0. 001 ） . No severe complication occurred in any patients in this study. The patients were followed up for 18 months （ 8 - 30 months） . VAS pain scores decreased from （7.5 ± 0. 9） preoperatively to （0. 1 ± 0. 3 ） at the latest follow - up （P 〈 0. 001 ） . Additionally, Constant - Murley score increased from （45.9± 9. 9 ） preoperatively to 90.4 ＋ 6. 7 at the latest follow- up （P 〈0. 001 ） . Of the 32 patients, only 2 cases had residual calcification in X -ray film, however, got good pain relief after operation. The residual calcific deposits were regressed within 12 months. [ Conclusion ] Arthroscopic treatment of calcific rotator cuff tendinitis has advantages of minimal invasion, quick recovery, and reliable clinical outcome. The key points in operative technique include accurate location and complete removal of the calcific deposits, and protection of rotator cuff as much as possible.