Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Arthroscopy. 2018 Mar;34(3):771-780. doi: 10.1016/j.arthro.2017.08.255.
To investigate whether arthroscopic lateral acromioplasty reliably decreases the critical shoulder angle (CSA) and whether it is associated with damage to the deltoid or other complications.
Patients undergoing arthroscopic rotator cuff repair (RCR) with lateral but without anterior acromioplasty for degenerative, full-thickness rotator cuff tears and a CSA of 34° or greater were retrospectively reviewed. Patients with traumatic or irreparable rotator cuff tears, osteoarthritis, or previous surgery were excluded. Clinical and radiographic outcomes were assessed at a minimum of 12 months' follow-up.
We reviewed 49 consecutive patients (mean age, 56 years; age range, 39-76 years) at a mean of 30 months (range, 12-47 months). There were 7 RCR failures (14%). The mean CSA was reduced from 37.5° preoperatively (95% confidence interval [CI], 36.7°-38.3°) to 33.9° postoperatively (95% CI, 33.3°-34.6°; P < .001). There were no cases of dehiscence, increases in fatty infiltration, or significant atrophy of the deltoid. Scarring at the deltoid origin was noted in 18 patients (37%). The mean absolute and relative Constant scores increased from 59 points (95% CI, 54-64 points) to 74 points (95% CI, 70-78 points) and from 66% (95% CI, 61%-71%) to 83% (95% CI, 79%-87%) respectively, and the Subjective Shoulder Value increased from 45% (95% CI, 39%-50%) to 80% (95% CI, 74%-86%) (P < .001 for all 3 improvements). The postoperative CSA was significantly larger in failed than in healed repairs (P = .026). Patients with a healed RCR and a CSA corrected to 33° or less (n = 22) had 25% more abduction strength than patients with a healed cuff and a CSA corrected to 35° or greater (n = 14, P = .04).
Arthroscopic lateral acromioplasty performed in addition to arthroscopic RCR can reduce the CSA without significantly compromising the deltoid origin, deltoid muscle, or function. It is not associated with any additional complications of arthroscopic RCR. Insufficiently corrected, abnormally large CSAs are associated either with a higher retear rate or with inferior strength of abduction if the tears heal.
Level IV, case series, treatment study.
研究关节镜下外侧肩峰成形术是否能可靠地降低临界肩角（CSA），以及它是否与三角肌损伤或其他并发症有关。
回顾性分析了因退行性全层肩袖撕裂且 CSA 为 34°或更大而行关节镜下肩袖修复术（RCR）但无前外侧肩峰成形术的患者。排除创伤性或不可修复的肩袖撕裂、骨关节炎或既往手术的患者。至少在 12 个月的随访时评估临床和影像学结果。
我们对 49 例连续患者（平均年龄 56 岁；年龄范围 39-76 岁）进行了回顾性分析，平均随访时间为 30 个月（范围 12-47 个月）。有 7 例 RCR 失败（14%）。CSA 从术前的 37.5°（95%置信区间，36.7°-38.3°）降低至术后的 33.9°（95%置信区间，33.3°-34.6°；P<0.001）。无肩峰裂开、脂肪浸润增加或三角肌显著萎缩的病例。18 例（37%）患者在三角肌起点处有瘢痕。绝对和相对常数评分从 59 分（95%置信区间，54-64 分）增加至 74 分（95%置信区间，70-78 分）和 66%（95%置信区间，61%-71%）增加至 83%（95%置信区间，79%-87%），主观肩值从 45%（95%置信区间，39%-50%）增加至 80%（95%置信区间，74%-86%）（所有 3 项改善均 P<0.001）。与愈合修复相比，失败修复的术后 CSA 明显更大（P=0.026）。CSA 矫正至 33°或以下（n=22）的愈合 RCR 患者与 CSA 矫正至 35°或以上（n=14）的愈合肩袖患者相比，外展力量增加了 25%（P=0.04）。
关节镜下外侧肩峰成形术与关节镜下 RCR 联合使用可以降低 CSA，而不会显著损害三角肌起点、三角肌或功能。它与关节镜下 RCR 的任何其他并发症无关。如果撕裂愈合，未充分矫正的异常大 CSA 与较高的再撕裂率或外展力降低有关。
IV 级，病例系列，治疗研究。
