Suenaga Naoki, Minami Akio, Fukuda Kimitaka, Kaneda Kiyoshi
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Arthroscopy. 2002 Jan;18(1):16-20. doi: 10.1053/jars.2002.25963.
Ideally, decompression of the coracoacromial arch in patients with shoulder impingement syndrome should be done only at the site of impingement. However, it is very difficult to determine the exact site of impingement before acromioplasty. The objectives of this study were to investigate the relationship between findings and the histopathologic changes of the undersurface of the acromion in subacromial impingement syndrome and to evaluate the usefulness of bursoscopy in identifying the site of the impingement.
Case series.
We investigated the correlation between subacromial bursoscopic findings and histopathologic changes of the coracoacromial arch in 50 patients with subacromial impingement syndrome. The acromion and the coracoacromial ligaments removed during acromioplasty were fixed in 10% formalin, decalcified, embedded in paraffin, and cut into sections along the direction of the coracoacromial ligament. After staining with toluidine blue, the specimens were evaluated for pathology using an optical microscope.
The pathologic changes were classified into 3 types according to the direction of proliferative fibrocartilaginous changes at the enthesis of the acromial insertion of the coracoacromial ligament. The bursoscopic findings were classified into 4 types. Subacromial abnormalities in the bursoscopy findings correlated with histopathologic changes at the undersurface of the acromion. On the other hand, cases with normal findings on the undersurface of the acromion on bursoscopy had hypertrophic changes of fibrocartilage at the insertion of the coracoacromial ligament to the acromion. These results suggest that, with normal findings on the undersurface of the acromion in patients with subacromial impingement syndrome, there is impingement at the coracoacromial ligament.
Bursoscopy is a useful procedure to determine the impingement site in patients with subacromial impingement.
理想情况下，肩峰撞击综合征患者的喙肩弓减压应仅在撞击部位进行。然而，在肩峰成形术前很难确定确切的撞击部位。本研究的目的是探讨肩峰下撞击综合征中肩峰下表面的检查结果与组织病理学变化之间的关系，并评估关节镜检查在确定撞击部位方面的实用性。
病例系列。
我们调查了50例肩峰下撞击综合征患者的肩峰下关节镜检查结果与喙肩弓组织病理学变化之间的相关性。肩峰成形术中切除的肩峰和喙肩韧带固定在10%福尔马林中，脱钙，石蜡包埋，并沿喙肩韧带方向切片。用甲苯胺蓝染色后，使用光学显微镜对标本进行病理学评估。
根据喙肩韧带肩峰附着处增殖性纤维软骨变化的方向，病理变化分为3种类型。关节镜检查结果分为4种类型。关节镜检查发现的肩峰下异常与肩峰下表面的组织病理学变化相关。另一方面，关节镜检查显示肩峰下表面正常的病例，在喙肩韧带与肩峰的附着处有纤维软骨肥大改变。这些结果表明，肩峰下撞击综合征患者肩峰下表面检查结果正常时，喙肩韧带存在撞击。
关节镜检查是确定肩峰下撞击患者撞击部位的有用方法。
