肩峰撞击征诊断与治疗的研究进展

Advances in the diagnosis and treatment of acromial impingement syndrome

肩峰撞击征(subcromicai impingement syndrome,SIS)是成人肩部疼痛最常见原因,常被误诊为肩周炎。以肩关节功能受限并伴疼痛为主要特征。1972年,Neer第一次提出SIS的概念,并进行了详细的解释[1]。其机制包含肩峰前突骨赘的形成、关节盂唇的增生、肩峰下滑囊的增生及冈上肌肌腱的钙化等造成肩关节活动时和肱骨大结节产生碰撞,从而出现肩关节疼痛及活动受限[2]。按照肩峰角及其外形(Bigliani分型),将肩峰可分为平坦型(I型)、弧型(II型)及钩型(III型)[3]。术中评估SIS的Neer分期,可将SIS分为:I期:肩峰下水肿和出血;II期:纤维化和肌腱炎;III期:骨赘形成和肌腱损伤[4]。

Acromial impingement syndrome is one of the causes of shoulder pain and limited functcous.It is often misdiagnosed as'shoulder periarthritis'before.With the development of technology,the diagnosis of acromial impingement is gradually clear,including physical examinations and some imaging examinations.Arthroscopy and fluoroscopy are relatively new diagnostic techniques,while arthroscopy is not only a diagnostic method,but also surgical treatment.Arthroscopic surgery requires highskills and long learning curve,so that it has not completely replaced traditional surgery at present.Treatment of acromial impingement includes conservative treatment and surgical treatment.Many related literatures have proved that arthroscopy has advantages of less trauma,early healing and early exercise compared with open surgery,but its long-term efficacy of the shoulder joint movement still needs to be confirmed.This article reviews the progress in the diagnosis and treatment of acromial impingement.