关节镜下肩袖修补术同时行肩峰成形术手术前后肩峰形态学参数的差异

Differences in morphological parameters of acromion before and after arthroscopic rotator cuff repair with acromioplasty

目的比较100例行关节镜下肩袖修补术患者同时行肩峰成形术的术前、术后肩峰形态学参数的差异。方法选取本院2017年1月至2018年5月间进行的肩关节镜肩袖损伤修补手术连续性病例100例,所有患者在关节镜下均同时行肩峰成形术,术前、术后常规拍摄标准肩关节前后位X线片及标准冈上肌出口位片。术前、术后测量肩重角(critical shoulder angle,CSA)、肩峰倾斜角(acromial tilt,AT)、外侧肩峰角(lateral acromial angle,LAA)、肩峰指数(acromion index,AI)、肩峰肱骨头中心边角(acromiohumeral centre edge angle,ACEA)。结果 CSA:术前为(41.48±4.84)°,术后为(41.23±5.01)°,差异无统计学意义(P=0.2566);AT:术前为(34.79±5.61)°,术后为(38.87±6.27)°,术后AT较术前增大,差异有统计学意义(P=0.0006);LAA:术前为(68.65±9.18)°,术后为(67.83±9.29)°,差异无统计学意义(P=0.1446);AI:术前为(0.699±0.062),术后为(0.692±0.060),差异无统计学意义(P=0.2101);ACEA:术前为(19.33±5.17)°,术后为(17.65±5.61)°,术后ACEA较术前减小,差异有统计学意义(P=0.0331)。Constant肩关节评分:术后为(91.42±3.29)分;UCLA (美国加州大学)肩关节评分:术后为(31.83±2.01)分,与术后肩峰形态学各参数间差异无统计学意义(P>0.05)。结论镜下肩袖修补术同时行肩峰成形术可使术后AT增大及肩峰肱骨头中心边角ACEA减小,对减少术后肩袖再损伤风险有一定的作用。尚无充分证据表明常规行肩峰成形术能有效减少肩袖再损伤发生率及提高肩关节功能。

Objective To compare differences in acromial morphological parameters before and after operation in 100 patients after rotator cuff repair combined with acromioplasty in arthroscopy.Methods One hundred consecutive cases of arthroscopic rotator cuff repair were included from January 2017 to May 2018.All patients underwent acromioplasty simultaneously.Anteroposterior radiograph and the outlet-view radiograph were taken before and after the operation routinely.Preoperative and postoperative acromial morphological parameters including critical shoulder angle(CSA),acromial tilt(AT),lateral acromial angle(LAA),acromion index(AI),acromiohumeral centre edge angle(ACEA)were measured.Results CSA:(41.48±4.84)°preoperatively;(41.23±5.01)°postoperatively;with no statistical significance(P=0.2566).AT:(34.79±5.61)°preoperatively;(38.87±6.27)°postoperatively;with statistical significance(P=0.0006).LAA:(68.65±9.18)°preoperatively;(67.83±9.29)°postoperatively;with no statistical significance(P=0.1446).AI:(0.699±0.062)preoperatively;(0.692±0.060)postoperatively;with no statistical significance(P=0.2101).ACEA:(19.33±5.17)°preoperatively;(17.65±5.61)°postoperatively;with statistical significance(P=0.0331).Constant shoulder function score:(91.42±3.29)postoperatively;UCLA shoulder function score:(31.83±2.01)postoperatively;there were no significant correlations with postoperative acromial morphological parameters.Conclusions Arthroscopic rotator cuff repair combined with acromioplasty can increase the AT and reduce the ACEA.It has some effects on reducing the risk of postoperative rotator cuff re-injury.However,there is no sufficient evidence suggesting that conventional acromioplasty can effectively reduce the incidence of rotator cuff re-injury and improve shoulder function postoperatively.