Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France.
Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece.
Knee Surg Sports Traumatol Arthrosc. 2021 Jan;29(1):240-249. doi: 10.1007/s00167-020-05951-4. Epub 2020 Apr 4.
To investigate whether arthroscopic lateral acromion resection can sufficiently reduce the critical shoulder angle (CSA) without damaging deltoid muscle insertion.
Ninety patients who underwent arthroscopic rotator cuff (RC) repair were retrospectively analysed. According to the preoperative CSA, patients were categorized as Group I (CSA < 35°) and Group II (CSA ≥ 35°). Additional arthroscopic lateral acromion resection was performed in Group II. The CSA was measured 1 week postoperatively, while RC integrity and the deltoid attachment were assessed at 3, 6 and 12 months via ultrasound. Deltoid function was evaluated using the Akimbo test, in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm.
Large and massive RC tears were more prevalent in Group II (p = 0.017). In both groups, the CSA reduction was statistically significant (Group I = 1°: range 0°-3°, Group II = 3.7°: range 1°-8°; p < 0.001). When the preoperative CSA was > 40°, the respective postoperative CSA remained > 35° in 83.3% of cases (p < 0.001). Final shoulder strength was correlated with the amount of CSA reduction (rho = 0.41, p = 0.002). The postoperative CSA was higher, but not significantly different (n.s.), in patients with re-torn (36°, range 32°-40°) than with healed RC (33°, range 26°-38°). No clinical detachment or hypotrophy of the deltoid was observed with the Akimbo test and ultrasound evaluation.
Arthroscopic lateral acromion resection is a safe procedure without affecting deltoid muscle origin or function, and it is effective in significantly reducing the CSA. However, the CSA cannot always be reduced to < 35°, especially in patients with preoperative CSA values > 40°.
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探讨关节镜下外侧肩峰切除术是否可以在不损伤三角肌止点的情况下充分降低临界肩角（CSA）。
回顾性分析了 90 例行关节镜肩袖（RC）修复的患者。根据术前 CSA，将患者分为 Group I（CSA＜35°）和 Group II（CSA≥35°）。Group II 患者行额外的关节镜下外侧肩峰切除术。术后 1 周测量 CSA，术后 3、6 和 12 个月通过超声评估 RC 完整性和三角肌附着情况。使用 Akimbo 测试评估三角肌功能，患者将手放在髂嵴上，在冠状面进行外展和肩关节内旋，同时弯曲肘关节和旋前前臂。
Group II 中更常见大型和巨大肩袖撕裂（p=0.017）。两组 CSA 均有显著降低（Group I=1°：范围 0°-3°，Group II=3.7°：范围 1°-8°；p＜0.001）。当术前 CSA＞40°时，83.3%（p＜0.001）的患者术后 CSA 仍＞35°。最终肩关节力量与 CSA 降低量相关（rho=0.41，p=0.002）。在 RC 再撕裂（36°，范围 32°-40°）的患者中，术后 CSA 较高，但无统计学差异（n.s.），高于 RC 愈合的患者（33°，范围 26°-38°）。在 Akimbo 测试和超声评估中未观察到三角肌的临床分离或萎缩。
关节镜下外侧肩峰切除术是一种安全的手术，不会影响三角肌止点的位置或功能，并且可以有效显著降低 CSA。然而，CSA 并不能总是降低到＜35°，特别是在术前 CSA 值＞40°的患者中。
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