Shi Lewis L, Edwards T Bradley
Department of Orthopaedics, University of Chicago, 5841 S. Maryland Avenue, MC 3079, Chicago, IL 60637, USA.
Adv Orthop. 2012;2012:467571. doi: 10.1155/2012/467571. Epub 2012 Dec 19.
The incidence of acromioplasty has increased dramatically in recent decades, but its role in rotator cuff surgery has been debated. Neer popularized the extrinsic theory of rotator cuff pathology, where mechanical compression of the coracoacromial arch leads to tearing of the rotator cuff. Under this theory, acromioplasty is advocated to modify acromial morphology as an essential part of rotator cuff surgery. Proponents of the intrinsic theory suggest rotator cuff tendons undergo degeneration through aging and overuse, and that bursectomy alone without acromioplasty is sufficient. There exist cadaveric studies, expert opinions, and numerous case series espousing both sides of the argument. Recently, however, numerous high-quality prospective randomized controlled trials have been published examining the role of acromioplasty. They have similar study design and randomization protocols, including groups of arthroscopic rotator cuff repair with bursectomy and acromioplasty versus isolated bursectomy. The results have been consistent across all studies, with no difference in the outcomes of the acromioplasty and isolated bursectomy groups. Current evidence does not support the routine use of acromioplasty in the treatment of rotator cuff disease.
近几十年来，肩峰成形术的发生率急剧上升，但其在肩袖手术中的作用一直存在争议。Neer推广了肩袖病理的外在理论，即喙肩弓的机械性压迫导致肩袖撕裂。根据这一理论，肩峰成形术被提倡作为肩袖手术的重要组成部分来改变肩峰形态。内在理论的支持者认为，肩袖肌腱会因衰老和过度使用而发生退变，仅进行滑囊切除术而不进行肩峰成形术就足够了。有尸体研究、专家意见以及众多病例系列支持这两种观点。然而，最近发表了大量高质量的前瞻性随机对照试验来研究肩峰成形术的作用。它们具有相似的研究设计和随机方案，包括关节镜下肩袖修复联合滑囊切除术和肩峰成形术组与单纯滑囊切除术组。所有研究的结果都是一致的，肩峰成形术组和单纯滑囊切除术组的结果没有差异。目前的证据不支持在治疗肩袖疾病时常规使用肩峰成形术。
