Seitz W H, Froimson A I, Shapiro J D
Department of Orthopaedic Surgery, The Mt. Sinai Medical Center, Cleveland, Ohio.
Orthop Rev. 1989 Mar;18(3):364-75.
Diagnosis of advanced rotator cuff impingement syndrome has been difficult due to dependence on plain radiographs and arthrography, which in the absence of complete tears are frequently inconclusive. Advances in ultrasonography have enabled accurate diagnosis of the more enigmatic partial thickness tears of the rotator cuff. Until recently, advanced impingement syndrome resistant to conservative therapy has been managed by open anterior acromioplasty as described by Neer. This has required a prolonged postoperative rehabilitation program before return to normal activities of daily living and athletic participation. Precise diagnosis with ultrasonography and refined arthroscopic techniques have enabled us to identify 50 patients with resistant impingement syndrome and partial thickness tears of the rotator cuff, and surgically decompress the subacromial space via arthroscopic resection of the coracoacromial ligament and anterior-inferior leading edge of the acromion. Postoperatively there has been minimal pain. Return of nearly full passive range of motion has been achieved in all but two patients within the first week. Active range of motion exercises are begun on the first postoperative day and resistive exercises commence two weeks after surgery. Mean return of normal functioning in activities of daily living has been two months, while return to prior level of athletic activity has averaged five months.
由于依赖X线平片和关节造影，晚期肩袖撞击综合征的诊断一直很困难，在没有完全撕裂的情况下，这些检查结果往往不明确。超声检查技术的进步使得能够准确诊断肩袖更难以捉摸的部分厚度撕裂。直到最近，对于保守治疗无效的晚期撞击综合征，一直采用Neer描述的开放性前肩峰成形术进行治疗。这需要在恢复正常日常生活活动和参加体育活动之前进行长时间的术后康复计划。超声检查的精确诊断和精细的关节镜技术使我们能够识别出50例患有顽固性撞击综合征和肩袖部分厚度撕裂的患者，并通过关节镜切除喙肩韧带和肩峰的前下边缘对肩峰下间隙进行手术减压。术后疼痛轻微。除两名患者外，所有患者在第一周内几乎恢复了全部被动活动范围。术后第一天开始进行主动活动范围锻炼，术后两周开始进行抗阻锻炼。日常生活活动恢复正常功能的平均时间为两个月，而恢复到之前运动活动水平的平均时间为五个月。
