关节镜微创治疗钙化性冈上肌腱炎

Minimally invasive therapy for calcific supraspinatus tendinitis under arthroscope

背景：对于经保守治疗无效的钙化性冈上肌腱炎，可以考虑关节镜手术，但手术细节和疗效尚需讨论。 目的：探讨关节镜下手术治疗钙化性冈上肌腱炎的方法与效果。 方法：2008年1月至2012年7月，30例钙化性冈上肌腱炎患者行关节镜下手术。男7例，女23例；年龄42-73岁，平均52.3岁；右侧13例，左侧17例。采用VAS疼痛评分、Constant-Murley评分、UCLA评分及X线检查对患者进行手术前后的评估。 结果：经过平均28.7个月（21-42个月）的随访，所有患者症状均得到明显改善。患者术前平均VAS评分为（7.7±1.3）分、Constant-Murley评分为（46.5±8.2）分、UCLA评分为（13.5±3.4）分，某次随访时分别为（1.9±1.2）分、（94.4±3.8）分、（33.2±1.7）分，术前和末次随访时比较差异均有统计学意义（P＜0.05）。6例患者术后X线片仍残留部分钙化灶，但症状消失、功能良好。 结论：对于保守治疗无效的钙化性冈上肌腱炎，行关节镜下钙化病灶清理具有良好的治疗效果，是一种创伤小且安全有效的治疗途径。

Background：Arthroscopic surgical procedure is a considerable method for patients who suffered from calcific supraspinatus tendinitis and failed to conservative treatment. However, the details and effectiveness of the procedure need to be discussed. Objective：To investigate the surgical techniques and results of arthroscopic treatment for calcifying supraspinatus tendinitis. Methods：From January 2008 to July 2012, arthroscopic operation was performed in 30 patients with calcifying supraspina-tus tendinitis. There were 7 males and 23 females with a mean age of 52.3 years old （range, 42-73 years）. 17 left and 13 right shoulders were involved. X-Ray examination on the AP was obtained before and after surgery. The shoulder function was evaluated by VAS pain score, Constant-Murley score and UCLA scoring system before surgical treatment and at the last follow up. Results：The mean follow-up period was 28.7 months （range, 21 to 42 months）. The shoulder function was evidently im-proved in all patients. The average VAS pain score was 7.7±1.3 preoperatively and 1.9±1.2 at the last follow-up. The aver-age Constant-Murley score was 46.5 ± 8.2 preoperatively and 94.4 ± 3.8 at the last follow-up. The average UCLA score was 13.5 ± 3.4 preoperatively and 33.2 ± 1.7 at the last follow-up. Significant difference was found between preoperative scores and the ones at the last follow-up （P〈0.05）. The radiographs showed reservation of partially calcified deposit in 6 patients, but no preoperative symptoms recurred. Conclusions：Arthroscopic excision is a minimally invasive, safe and effective treatment for patients with calcific supraspi-natus tendinitis who failed to conservative treatment.