Mullett Hannan, Benson Richard, Levy Ofer
Reading Shoulder Unit, Royal Berkshire Hospital, Reading, England.
Arthroscopy. 2007 Apr;23(4):446.e1-4. doi: 10.1016/j.arthro.2005.12.037. Epub 2006 Oct 16.
A healthy 75-year-old man presented with a 9-month history of an enlarging painless shoulder mass. On examination, there was a 10 x 10 cm firm mass overlying the acromioclavicular (AC) joint. The active range of motion of the shoulder joint was 130 degrees of forward elevation, 90 degrees of abduction, 60 degrees of abduction and internal rotation to the level of the waist. There was weakness of the rotator cuff. Plain radiographs showed degenerative changes of the AC joint with superior migration of the humeral head. Magnetic resonance imaging showed a large cyst arising from a degenerative AC joint with an associated major tear of both the supraspinatus and infraspinatus. Arthroscopy of the AC joint and debridement of the cyst was performed in the lateral decubitus position. The major rotator cuff tear of supraspinatus and infraspinatus was confirmed. A conservative subacromial decompression and AC joint excision arthroplasty was performed. As the superior AC ligament was opened, dark brown gelatinous material was seen emanating from the cyst. A thorough debridement of the cyst was performed until the lavage fluid was clear. At last follow-up 6 months after surgery, the shoulder remained asymptomatic with no evidence of recurrence of the cyst. Arthroscopic treatment of a massive AC joint cyst allows assessment of associated pathology, is minimally invasive, and allows early rehabilitation.
一名75岁健康男性，肩部出现无痛性肿块且逐渐增大，病程9个月。检查发现，肩锁关节上方有一个10×10厘米的硬块。肩关节的主动活动范围为前屈上举130度、外展90度、外展并内旋60度至腰部水平。肩袖肌力减弱。X线平片显示肩锁关节退变，肱骨头向上移位。磁共振成像显示，一个巨大囊肿起源于退变的肩锁关节，同时伴有冈上肌和冈下肌的严重撕裂。在侧卧位进行了肩锁关节镜检查及囊肿清创术。确认存在冈上肌和冈下肌的主要肩袖撕裂。进行了保守的肩峰下减压及肩锁关节切除成形术。打开肩锁关节上方韧带时，可见深棕色凝胶状物质从囊肿中流出。对囊肿进行了彻底清创，直至冲洗液清澈。术后6个月的最后一次随访时，肩部无症状，无囊肿复发迹象。关节镜治疗巨大肩锁关节囊肿可评估相关病变，具有微创性，并能实现早期康复。
