顽固性肩袖钙化性肌腱炎的关节镜治疗效果评价

Arthroscopic treatment of refractory calcifying rotator cuff tendinitis

目的观察关节镜治疗顽固性肩袖钙化性肌腱炎的临床效果。方法 21例顽固性肩袖钙化性肌腱炎患者采用关节镜下钙化灶清除术,缝合清理后肩袖缺损较深的部分（〉50%）,其中2例加行肩峰成形术。术前及术后随访采用加州大学肩关节评分系统（University of California at Los Angeles,UCLA）、Constant-Murley评分（Constant-Murley score,CMS）、视觉模拟评分法（Visual Analogue Scale,VAS）、美国肩与肘协会评分系统（American Shoulder and Elbow Surgeons＇Form,ASES）、患者满意度评估其疗效评估。结果所有患者均获随访,随访时间5-7年。VAS由术前（6.971±1.016）分减至术后（1.524±0.981）分;UCLA由术前（11.571±2.521）分提高到术后（30.190±1.991）分;CMS由术前（50.476±7.567）分提高到术后（89.571±3.627）分;ASES由术前（52.048±6.614）分提高到术后（91.667±4.139）分。术前术后VAS、UCLA、CMS、ASES评分比较差异均有统计学意义（P〈0.01）。1例（4.76%）于术后3-7d出现切口炎性反应,经对症处理后愈合;其余切口均Ⅰ期愈合。结论关节镜下钙化灶清理是治疗顽固性肩袖钙化性肌腱炎的有效方法。手术创伤小,术后恢复快,具有良好的临床效果和安全性。

Objective To evaluate the clinical results of arthroscopic treatment of refractory calcifying tendonitis.Methods Twenty-one patients with calcifying tendinitis of rotator cuff of the shoulder underwent arthroscopic resection of calcific deposits after failing to respond to conservative treatment.Two cases got extra treated by arthroscopic arcromialplasty.Visual Analogue Scale（VAS）,University of California at Los Angeles（UCLA）,Constant-Murley Score（CMS）,American Shoulder and Elbow Surgeons＇ Form（ASES）and the ratio of satisfaction for operation were adopted for evaluation before surgery and at follow up.Results All patients were followed up for 5-7 years.The average VAS score was（6.971±1.016）scores and（1.524±0.981）scores pre-and post-operation,respectively.The average UCLA score was（11.571±2.521）scores and（30.190±1.991）scores pre-and post-operation respectively.The average CMS was（50.476±7.567）scores and（89.571±3.627）scores pre-and post-operation respectively.The average ASES score were（52.048± 6.614）scores and（91.667± 4.139）scores preoperatively and postoperatively,respectively.There were significant differences between preoperative and postoperative assessments in UCLA score,CMS,VAS score and ASES score.The ratio of satisfaction for operation was 90.48%（P0.01）.The inflammatory reaction occurred at wound in 1case（4.76%）at 3-7 days after operation and was cured after symptomatic management;other incision healed by first intention.Conclusion Arthroscopic debridement was shown to be an effective method for the treatment of calcifying tendinitis of rotator cuff and has advantages of minimal trauma and rapid postoperative recovery.The clinical effect and safety are excellent.