无牵引装置的侧卧位肩关节镜下肩袖缝合术

Arthroscopic rotator cuff surgery without traction system in the lateral position

目的:评价侧卧位无牵引装置的肩关节镜下肩袖修复术的优点。对象及方法:选19例确诊为肩袖撕裂病例在侧卧位无牵引装置下施行肩袖修复术。手术方法为在侧卧位无牵引装置下用关节镜确认肩袖撕裂病变后行关节镜下施行肩袖损伤边缘刨削术、关节镜下肩袖缝合术及小切口肩袖缝合术,并确认肩峰下关节囊病变后施行肩峰下减压术。结果:随上肢外展45°～70°、内旋下肩胛下肌松弛,使其持续牵引状态下对难以确认的肩胛下肌损伤较易确认。无牵引装置比牵引装置平均缩短14分钟手术时间,并可预防持续牵引所致上肢神经损伤。结论:在无牵引装置下的肩袖撕裂缝合术可得到以下优点而是可施行的有效术式;①可得到更宽广的手术视野;②可较易确认肩胛下肌的病变:③可缩短手术时间;④可避免牵引所致的神经血管损伤;⑤可较易评价术前术后功能范围。

Object:To evaluate the efficiencies of the arthroscopic rotator cuff surgery without traction in the lateral decubitus position.Methods:From February 2002 to January 2003,twenty-nine cases of arthroscopic rotator cuff surgery without tration system in the lateral decubitus position were studied. The arthroscopic rotator cuff surgery without traction system in the lateral decubitus position consisted of the arthroscopic debridement and the arthroscopic rotator cuff repair or the mini-open technique after the identification of rotator cuff tear,followed by the arthroscopic subacromial decompression after the identification of subacromial lesions.Results:The subscapularis tear that often was overlooked during arthroscoic rotator cuff surgery with traction system could easily be identified by the relaxation of subscapularis as arm position was internal rotation in 45 to 70 degrees of abduction.We could reduce the operation time of 14 minutes compaired with the using group of the traction system.Also,we could prevent the neurologic complications of the upper extremity that were developed by using the traction system.Conclusions:We considered the arthroscopic rotator cuff surgery without traction system in the lateral decubitus position as one of satisfactory procedure because of following efficiencies;①Better visual field;②Easily evaluated subscapularis condition;③Short operation time;④Easily evaluate pre- and post-operative ROM and postoperative manipulation;⑤Easily swetch to the mini-open incision technique.