Ketola S, Lehtinen J, Arnala I, Nissinen M, Westenius H, Sintonen H, Aronen P, Konttinen Y T, Malmivaara A, Rousi T
Kanta-Häme Central Hospital, Hämeenlinna, Finland.
J Bone Joint Surg Br. 2009 Oct;91(10):1326-34. doi: 10.1302/0301-620X.91B10.22094.
We report a randomised controlled trial to examine the effectiveness and cost-effectiveness of arthroscopic acromioplasty in the treatment of stage II shoulder impingement syndrome. A total of 140 patients were randomly divided into two treatment groups: supervised exercise programme (n = 70, exercise group) and arthroscopic acromioplasty followed by a similar exercise programme (n = 70, combined treatment group). The main outcome measure was self-reported pain on a visual analogue scale of 0 to 10 at 24 months, measured on the 134 patients (66 in the exercise group and 68 in the combined treatment group) for whom endpoint data were available. An intention-to-treat analysis disclosed an improvement in both groups but without statistically significant difference in outcome between the groups (p = 0.65). The combined treatment was considerably more costly. Arthroscopic acromioplasty provides no clinically important effects over a structured and supervised exercise programme alone in terms of subjective outcome or cost-effectiveness when measured at 24 months. Structured exercise treatment should be the basis for treatment of shoulder impingement syndrome, with operative treatment offered judiciously until its true merit is proven.
我们报告了一项随机对照试验，以研究关节镜下肩峰成形术治疗II期肩部撞击综合征的有效性和成本效益。总共140例患者被随机分为两个治疗组：监督下的运动计划组（n = 70，运动组）和关节镜下肩峰成形术加类似运动计划组（n = 70，联合治疗组）。主要结局指标是在24个月时采用0至10的视觉模拟量表自我报告的疼痛程度，对有终点数据的134例患者（运动组66例，联合治疗组68例）进行测量。意向性分析显示两组均有改善，但两组间结局无统计学显著差异（p = 0.65）。联合治疗的成本要高得多。在24个月时进行测量，就主观结局或成本效益而言，关节镜下肩峰成形术与单纯有组织的监督运动计划相比，没有临床重要效果。结构化运动治疗应作为肩部撞击综合征治疗的基础，在其真正疗效得到证实之前，应谨慎提供手术治疗。
