不同类型肩峰下骨赘对肩袖肌腱病关节镜治疗的影响

Effects of different types of acromial spur on arthroscopic treatment of rotator cuff tendinopathy

目的观察肩峰外侧骨赘对关节镜下肩峰成形术治疗肩袖肌腱病临床疗效的影响。方法对2016年1月至2016年12月在中山大学孙逸仙纪念医院行肩峰成形术的68例肩袖肌腱病患者进行回顾性研究。依据患者肩关节X线检查将其肩峰下骨赘分为外侧型骨赘和前侧型骨赘两大类。采用视觉模拟评分法(visual analogue scale/score,VAS)、Constant肩关节评分、12条生存质量量表(12-items the short form health survey questionnaire,SF-12)评分进行术前及术后3个月评分。结果68例患者中26例为外侧型,42例为前侧型。术前外侧型患者的VAS、Constant、SF-12评分明显劣于前侧型患者(P<0.05)。术后3个月,外侧型患者VAS评分降低(3.64±0.54)分,前侧型患者VAS评分降低(2.61±0.09)分,外侧型患者VAS评分改善显著(P<0.05)。其Constant、SF-12评分改善也更为明显(P<0.05)。结论肩峰下骨赘的形态短期内影响肩袖肌腱病的临床效果。外侧型骨赘的患者临床症状更严重,但手术效果改善也较为明显。

Background Shoulder joint pain is a very common clinical symptom.Approximately 1%-2%of patients visit a doctor for shoulder pain each year,and symptoms usually last for many years.Acromial osteophyte is an important external cause of rotator cuff tendinopathy.Tucker,et al.proposed a special type of acromial osteophyte-Keeled Acromion which had the characteristics of being located in the center of the inferior margin of acromion,longitudinally,and downward sloping.They believed that this type of osteophyte was an important risk factor for partial rotator cuff injury on the bursal side and fullthickness rotator cuff tear.Joo Han Oh,et al.divided the acromial osteophytes into heel type,lateral traction type,anterior traction type,lateral bird beak type,anterior bird beak type and medial type.The heel type of acromial osteophytes is the most common(56%),and the author speculates that it may be a risk factor for rotator cuff tendinopathy.However,the influences of different types of acromial osteophytes on the symptoms of patients with rotator cuff tendinopathy and the therapeutic effect of arthroscopic treatment have not been reported.As the classification of acromial osteophytes in previous studies is complicated,and some types of osteophytes are rare,it is not conducive to clinical application.Considering that the acromion extension will affect the muscle force vector direction of the middle portion of deltoid muscle(the further outside the acromion extends,the greater the upward component of the deltoid muscle,and the more prone to subacromial impingement and supraspinatus tendon degeneration).Therefore,the lateral acromial osteophyte may promote rotator cuff tendinopathy by affecting the acromion extension.Objective To observe the effect oflateral acromial osteophytes on the clinical effect of arthroscopic acromioplasty in the treatment of rotator cuff tendinopathy.Methods From January 2016 to December 2016,68 patients with rotator cuff tendinopathy underwent acromioplasty in our hospital,and the data was retrospectively analyzed.According to the patient’s shoulder X-ray examination,the acromial osteophytes were divided into two types:lateral osteophytes and anterior osteophytes.The VAS score,SF 12 score and Constant-Murley score were used before and 3 months after surgery.Results Of the 68 patients,26 were lateral type and 42 were anterior type.The VAS score,Constant-Murley score and SF 12 score of the patients with acromial osteophytes of the lateral type before surgery were significantly inferior to those of the anterior type(P<0.05).Three months after surgery,the VAS score of the lateral type group decreased by(-3.64±0.54),and the VAS score of the anterior type group decreased by(-2.61±0.09).In the lateral type group,the VAS score improved more significantly(P<0.05),and the improvements of Constant-Murley score and SF 12 score were also more obvious(P<0.05).Conclusions The morphology of acromial osteophytes affects the clinical effect of rotator cuff tendinopathy in the short term.The clinical symptoms of patients with lateral osteophytes are more severe,but the results of the surgery also improved significantly.