Cooper H John, Milillo Ralph, Klein Devon A, DiFelice Gregory S
Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA.
Am J Orthop (Belle Mead NJ). 2011 Jun;40(6):E118-21.
We present the case of a 71-year-old man with a large acromioclavicular (AC) joint cyst successfully managed with surgical excision. AC joint cysts are soft tissue masses generally signifying underlying rotator cuff pathology. Traditionally, these cysts were identified with shoulder arthrography as a "geyser" of fluid escaping through the AC joint. Magnetic resonance imaging (MRI) is today's preferred imaging modality; we describe the MRI equivalent of the "geyser sign," signifying synovial fluid escaping through the cuff defect, across the subacromial bursa, and decompressing superiorly through a degenerated AC joint. Surgical management is preferred for symptomatic cysts. Based on a review of limited retrospective case series, recommendations for management of these lesions are as follows. Repair of the rotator cuff is preferable whenever possible. In the case of an irreparable defect, good results can be achieved through excisional AC joint arthroplasty and resection of the cyst base. Aspiration of these cysts should not be attempted, due to the high recurrence rate and potential for a draining sinus. Hemiarthroplasty also may be effective in indirectly decompressing these cysts; but given the invasive nature of this procedure, it should be reserved for patients who are also symptomatic from cuff arthropathy.
我们报告一例71岁男性，其患有巨大肩锁关节囊肿，通过手术切除成功治愈。肩锁关节囊肿是软组织肿块，通常提示潜在的肩袖病变。传统上，这些囊肿通过肩关节造影被识别为液体从肩锁关节喷出的“喷泉”现象。磁共振成像（MRI）是目前首选的成像方式；我们描述了MRI上相当于“喷泉征”的表现，即滑膜液通过肩袖缺损处溢出，穿过肩峰下滑囊，并通过退变的肩锁关节向上减压。对于有症状的囊肿，手术治疗是首选。基于对有限回顾性病例系列的综述，对这些病变的治疗建议如下。只要有可能，优先修复肩袖。对于无法修复的缺损，通过切除性肩锁关节成形术和囊肿基底切除术可取得良好效果。不应尝试抽吸这些囊肿，因为复发率高且有形成引流窦的可能性。半关节成形术也可能有效地间接减压这些囊肿；但鉴于该手术的侵入性，应仅用于同时患有肩袖关节病且有症状的患者。
