Gartsman G M, Blair M E, Noble P C, Bennett J B, Tullos H S
Baylor College of Medicine, Division of Orthopaedic Surgery, Houston, Texas.
Am J Sports Med. 1988 Jan-Feb;16(1):48-50. doi: 10.1177/036354658801600108.
Anterior acromioplasty as described by Neer has been an effective procedure for shoulder impingement syndrome. Recent presentations by Ellman suggest that an effective acromioplasty may be performed arthroscopically. These clinical reports have not been supported by any laboratory experience. The purpose of our study was to examine the feasibility and attempt to quantitate the results of arthroscopic subacromial decompressions. Six acromioplasties were performed according to the recommended technique of Dr. Neer to create a standard for comparison. Fourteen fresh postmortem specimens were studied. In seven shoulders a standard acromioplasty was performed with an osteotome. In seven shoulders an acromioplasty was performed using standard arthroscopic approaches and motorized instruments. In five shoulders an isolated division of the coracoacromial ligament was performed arthroscopically. The coracoacromial ligament was completely divided in all five cases. In the osteotome group adequate bone was resected in 75% (21/28) measured locations. In the arthroscopic group adequate bone was removed at 86% (24/28) location. This difference is not statistically significant. In the cadaver, anterior acromioplasty was performed effectively and predictably with arthroscopic instruments. This compared favorably to a conventional osteotome acromioplasty. It was concluded that coracoacromial ligament division can be accomplished.
如Neer所描述的前肩峰成形术一直是治疗肩峰撞击综合征的有效方法。Ellman最近的报告表明，有效的肩峰成形术可以通过关节镜进行。但这些临床报告并未得到任何实验室经验的支持。我们研究的目的是检验关节镜下肩峰下减压的可行性，并试图对其结果进行量化。根据Neer医生推荐的技术进行了6次肩峰成形术，以建立一个比较标准。研究了14个新鲜的尸体标本。在7个肩部使用骨刀进行了标准的肩峰成形术。在7个肩部使用标准的关节镜入路和电动器械进行了肩峰成形术。在5个肩部通过关节镜进行了喙肩韧带的单独切断。在所有5例中，喙肩韧带均被完全切断。在骨刀组，75%（21/28）的测量部位切除了足够的骨质。在关节镜组，86%（24/28）的部位切除了足够的骨质。这种差异无统计学意义。在尸体上，使用关节镜器械有效地且可预测地进行了前肩峰成形术。这与传统的骨刀肩峰成形术相比具有优势。得出的结论是，可以完成喙肩韧带切断术。
