Jarvis D Landry, Waterman Brian R, Verma Nikhil N
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A..
Arthroscopy. 2019 Jun;35(6):1639-1640. doi: 10.1016/j.arthro.2019.04.008.
Based on data from a national healthcare insurance carrier in the United States between 2010 and 2012, orthopedic surgeons performed an acromioplasty procedure on 73 to 76% of their arthroscopic rotator cuff repairs. This has remained a prevalent arthroscopic adjunct despite the controversies disputing the role and etiology of external impingement on symptomatic rotator cuff disease. Within the past decade, several randomized studies have demonstrated negligible benefits with acromioplasty performed alongside rotator cuff repair, with no significant differences in either patient-reported outcome scores or retear rates). Conversely, other authors have suggested higher rates of reoperation with rotator cuff repair alone. Critical shoulder angle, an objective measure of lateral acromion extension and glenoid inclination that is considered a gauge of external impingement, has demonstrated an association with rotator cuff tears; Despite this, patient-reported outcomes do not consistently correlate with critical shoulder angle or other variants in acromial morphology after arthroscopic full-thickness rotator cuff repair. Evidenced-based data is currently lacking to support routine use of acromioplasty in all cases of rotator cuff repair. However, the current available studies do present design flaws, namely statistical underpowering, particularly in type III acromion morphology; inadequate short-term follow-up; lack of imaging data to assess cuff healing; and insensitive outcome measures to capture the theorized benefits of subacromial decompression. Additionally, several relevant merits of acromioplasty have been reported, including decreased abrasive wear with prominent type III acromial morphology, release of natural growth factors to improve rotator cuff healing, and improved visualization during rotator cuff repair. Further evaluation is needed to determine the correct indications for acromioplasty in the setting of cuff repair. Current data would indicate that acromioplasty can be used safely at the discretion of the operating surgeon based on preoperative and intraoperative findings.
根据美国一家全国性医疗保险机构2010年至2012年的数据，整形外科医生在其进行的关节镜下肩袖修复手术中，有73%至76%的手术同时进行了肩峰成形术。尽管对于外部撞击在有症状的肩袖疾病中的作用和病因存在争议，但肩峰成形术仍是一种普遍使用的关节镜辅助手术。在过去十年中，多项随机研究表明，肩袖修复同时进行肩峰成形术的益处微乎其微，患者报告的结局评分或再撕裂率均无显著差异。相反，其他作者则认为单纯肩袖修复的再次手术率更高。临界肩角是一种客观测量肩峰外侧延伸和肩胛盂倾斜度的指标，被认为是外部撞击的一种衡量标准，它已被证明与肩袖撕裂有关；尽管如此，在关节镜下全层肩袖修复后，患者报告的结局与临界肩角或肩峰形态的其他变异并不总是相关。目前缺乏循证数据支持在所有肩袖修复病例中常规使用肩峰成形术。然而，目前现有的研究确实存在设计缺陷，即统计效力不足，特别是在III型肩峰形态方面；短期随访不足；缺乏评估肩袖愈合的影像学数据；以及结局测量不敏感，无法捕捉肩峰下减压的理论益处。此外，已有多项关于肩峰成形术的相关优点的报道，包括减少III型突出肩峰形态的磨损、释放天然生长因子以促进肩袖愈合，以及在肩袖修复过程中改善视野。需要进一步评估以确定在肩袖修复中进行肩峰成形术的正确适应症。目前的数据表明，根据术前和术中的发现，手术医生可自行决定安全地使用肩峰成形术。
