Lim Justin T K, Acornley Alexander, Dodenhoff Ronald M
Department of Orthopaedics, Princess Royal Hospital, Telford, Shropshire, England.
Arthroscopy. 2005 Jun;21(6):680-3. doi: 10.1016/j.arthro.2005.03.015.
To evaluate the use of a steroid/local anesthetic subacromial injection as a prognostic tool for patient recovery following arthroscopic subacromial decompression (ASD).
Prospective cohort study.
A local anesthetic/steroid subacromial injection was administered to all patients with a clinical diagnosis of subacromial impingement syndrome. In the event of a negative result to the injection test, the diagnosis was confirmed by computed tomographic arthrography or magnetic resonance imaging. All patients underwent standard ASD. The outcome was assessed using the Constant score, performed preoperatively, at 3 weeks, 3 months, and at discharge. The eventual functional outcome was correlated with the results of the injection test and the operative findings.
There were 101 patients (53 male, 48 female), with a mean age of 52 years (range, 21 to 77 years) in the study. Patients were followed-up for a mean of 14 months (range, 3 to 24 months). All patients had an impingement lesion noted at arthroscopy. The mean preoperative Constant score for the entire group was 48 points (range, 20-67) with a postoperative mean of 81 (range, 46-98). Sixteen patients had a negative preoperative injection test. The mean improvement in this group was 21 points (47 rising to 68) compared with 35 points (48 to 83) in the positive group (P < .05, Mann-Whitney U test). The groups were otherwise similar for age, gender, and operative findings.
The steroid/local anesthetic injection test is a useful tool both diagnostically and prognostically in patients with subacromial impingement syndrome. In patients with a confirmed diagnosis but a negative test there is still a significant improvement in the postoperative Constant score, but this is of a lesser degree than in those with a positive result to local anesthetic injection.
Level III, Diagnostic Study of Nonconsecutive Patients.
评估类固醇/局部麻醉剂肩峰下注射作为关节镜下肩峰下减压术（ASD）后患者恢复的预后工具的应用情况。
前瞻性队列研究。
对所有临床诊断为肩峰下撞击综合征的患者进行局部麻醉剂/类固醇肩峰下注射。如果注射试验结果为阴性，则通过计算机断层扫描关节造影或磁共振成像来确诊。所有患者均接受标准的ASD。使用Constant评分在术前、术后3周、3个月及出院时对结果进行评估。最终的功能结果与注射试验结果及手术发现相关。
本研究中有101例患者（53例男性，48例女性），平均年龄52岁（范围21至77岁）。患者平均随访14个月（范围3至24个月）。所有患者在关节镜检查时均发现有撞击病变。整个组术前Constant评分的平均值为48分（范围20 - 67），术后平均值为81分（范围46 - 98）。16例患者术前注射试验结果为阴性。该组平均改善21分（从47分升至68分），而阳性组为35分（从48分升至83分）（P <.05，Mann-Whitney U检验）。两组在年龄、性别及手术发现方面其他方面相似。
类固醇/局部麻醉剂注射试验在肩峰下撞击综合征患者的诊断和预后评估中都是一种有用的工具。对于确诊但试验结果为阴性的患者，术后Constant评分仍有显著改善，但程度低于局部麻醉剂注射结果为阳性的患者。
III级，非连续患者的诊断性研究。
