肩袖钙化性肌腱炎急性发作的关节镜治疗

Arthroscopic treatment for acute calcific tendinitis of rotator cuff

目的探讨关节镜下手术治疗肩袖钙化性肌腱炎急性发作的疗效。方法 2011年1月至2014年12月,南方医科大学第三附属医科骨外科共收治13例肩袖钙化性肌腱炎急性发作患者。手术采用全麻、侧卧位,常规入路,找到钙化灶,用探针作探查即可以看到牙膏样的乳白色稠状物流出即可确定。对于小于0.5 cm的病灶仅作清除即可,不影响肩袖的完整性;对于较大范围的病灶,即损伤滑囊面直径超过1.5 cm或厚度超过1/2的患者进行扩大清理及肩袖修复术,包括周围变性硬化的组织一并切除,于前侧作一辅助切口,将近端肩袖组织拉回其止点处,作单排或双排铆钉缝合固定。术后肩部冰敷24~48 h,前臂悬吊胸前固定3周。分别于术前、术后和末次随访测量美国加州大学肩关节评分(UCLA评分)和拍摄肩关节X线正侧位片,记录手术并发症。应用SPSS 13.0软件进行统计学分析,采用配对t检验对UCLA评分进行分析。结果所有病例术后疼痛即刻消失,经过3~12个月随访,UCLA评分由术前的(12.5±2.5)分提高至末次随访的(35.2±4.0)分,术前与末次随访比较,差异有统计学意义(t=5.317,P<0.05)。术后复查X线片,示患侧肩关节钙化灶被清除。无1例发生肩关节僵硬、肩袖撕裂或新的钙化灶。结论关节镜下手术治疗急性肩袖钙化性肌腱炎疗效肯定,术中彻底清除病灶的范围是取得疗效的关键,缺失的部分进行肩袖的重建。因创伤小、出血少、恢复快,关节镜下手术治疗是一种较为理想的治疗急性肩袖钙化性肌腱炎的手段,值得推广应用。

Objective To explore the clinical effects of arthroscopic treatment for acute calcific tendinitis of rotator cuff. Methods Thirteen patients with acute calcific tendinitis of rotator cuff were enrolled from January 2011 to December 2014 in orthopaedic department of the 3rd Affiliated Hospital of Southern Medical University. The surgery was performed under total anesthesia, with lateral position and routine portals. When the calcific focus and toothpaste-like white viscous substance was found with a probe, calcific tendonitis could be diagnosed. If the calcific focus was less than 0. 5 era, debridement was performed, which did not affect the integrity of the rotator cuff. As for larger focus, of which the diameter was more than 1.5 cm or the affected thickness was more than one half, an expansive focal cleaning was performed, including excision of peripheral degenerative hard tissues, and repair the rotator cuff by fixing the proximal dislocated rotator cuff at the insertion of greater tubercle with single row or double rows rivets through an anterior approach. The involved shoulder was iced for 24 to 48 h after the surgery, and was temporarily fixed with triangular bandage in a slightly anterior flexion and internal rotation position for three weeks. The rating scale of the University of California at Los Angeles （UCLA） was used to evaluate the shoulder before and after the surgery as well as the last follow-up, which was analyzed by t test; X-ray films of the shoulder joint were assessed and surgical complications were documented. Results Pain disappeared in all the patients after the surgery. In the follow-up of 3 -12 months, UCLA score increased to （35.2±4. 0） at the last follow-up; compared with the UCLA score before the surgery （12. 5 ±2. 5 ）, significant difference （ t = 5.317, P 〈 0. 05 ） was shown. X-ray films were taken ＇after surgery and the films showed that the calcific deposit in rotator cuff was cleared out. No patient developed stiffness of shoulder joint, rotator cuff tear or new calciflc focus. Conclusions Clinical results of arthroscopic treatment of acute calcific tendonitis of rotator cuff arc definitive. The key points of the surgery are thorough clearing of the pathological focus, and repair the rotator cuff at the same time if necessary. Because of less trauma, little bleeding and fast recovery, arthroscopic treatment for acute calcific tendinitis of rotator cuff is an ideal method, and is worthy of popularization.