肩撞击综合征的手术治疗

Surgical treatment for shoulder impingement syndrome

目的 评价单纯切开或关节镜下前肩峰成形术以及结合肩袖修补术分别治疗伴或不伴肩袖撕裂的肩撞击综合征的疗效。方法 2 0 0 1年 11月～ 2 0 0 3年 7月 ,选择 2 5例 (2 6肩 )肩撞击综合征患者 ,平均年龄5 1.32岁 ,平均随访时间 11.34个月。所有患者均接受肩关节镜检查 ,镜下发现Ⅱ期肩撞击综合征 14肩 ,其中 9肩行切开前肩峰成形术 ,5肩于镜下行此手术。Ⅲ期 (伴肩袖撕裂 ) 12肩 ,其中完全撕裂 9肩 ,不全撕裂 3肩 ;所有肩袖完全撕裂和 1个肩袖大部撕裂肩关节在切开前肩峰成形同时修补撕裂肩袖 ,另 2个伴肩袖不全撕裂肩关节仅行撕裂缘清创 ,未予缝合。采用视觉模拟法 (VAS)评价疼痛程度 ,采用美国肩肘外科医师协会评价系统(ASES)和加州大学洛杉矶分校 (UCLA)进行肩关节评分 ,以完成 10个日常活动的能力评价手术疗效。结果 患肩的术前平均VAS为 6 .4 7分 ,术后显著下降至 1.5 3分 (P <0 .0 1)。术前患肩关节平均活动度为 :上举12 6 .6 7°、内收 2 3.33°、后伸 2 6 .6 7°、外展 90 .6 7°、外旋 15 .6 7°、内旋T10 ,术后分别提高到上举 15 7.33°、内收37.0 0°、后伸 37.33°、外展 119.33°、外旋 2 7.0 0°、内旋T7。术前患肩完成 10项日常活动能力平均 8.4 5分 ,术后提高至 2 4 .6 0分。

Objective To evaluate the results of anterior acromioplasty for shoulder impingement syndrome without rotator cuff tears and those accompanied by torn cuff repair for patients with cuff tears. Methods From November of 2001 to July of 2003, 26 shoulders of 25 patients were accepted for surgical treatment. There were 9 males and 14 females. The mean age of the patients was 51.32 years, and mean follow up duration was 11.34 months. Diagnostic shoulder arthroscopy was performed in all cases. Stage Ⅱ shoulder impingement syndrome expressing with subacromial bursitis and rotator cuff tendonitis and fibrosis, were found in 14 shoulders and stage Ⅲ characterized by cuff tears in 12 shoulders. For stage Ⅱ group, anterior acromial arthroplasty was performed in 9 shoulders via mini-open incisions and the other 5 under arthroscopy. There were 9 full thickness cuff tear shoulders and 3 partial tears in stage Ⅲ group. For this group, all full thickness and 1 more than 1/2 partial thickness rotator cuff tear shoulders accepted anterior acromial arthroplasty with cuff repair, and the other 2 less than 1/2 partial thickness cuff tear shoulders were treated with debridement for torn cuffs only. The severity of pain was assessed with visual analog scale (VAS). The outcomes of surgical treatment were evaluated using the American Shoulder and Elbow Surgeon Assessment (ASES), Los Angeles score of University of California (UCLA)and the ability of performing 10 daily activities. Results The mean VAS score of all effected shoulders was 6.47 preoperatively and reduced to 1.53 postoperatively.(P< 0.01). The average range of preoperative motion of the shoulders were forward elevation 126.67°, adduction 23.33°, extension 26.67°, abduction 90.67°, external rotation 15.67° and internal rotation T10. Postoperatively, they were increased respectively to forward elevation 157.33°, adduction 37.00°, extension 37.33°, abduction 119.33°, external rotation 27.00° and internal rotation T7. The mean score of ability of performing 10 daily activities, the ASES and UCLA score improved from 8.45, 25.24 and 9.00 preoperatively to 24.60, 69.50 and 22.40 postoperatively, respectively. Comparing the pre- and post-operative results of ASES and UCLA score in stage Ⅱ and Ⅲ groups, significant improvements were found in both. Conclusions Anterior acromioplasty has been verified as effective and safe surgical procedure for shoulder impingement syndrome. This procedure combined with torn cuff repair can precisely provide pain relief and functional improvementy the affected shoulders in cuff tear patients.