Heydar Ahmed M, Kıyak Görkem
Orthopedics and Traumatology, Bahçelievler Memorial Hospital, Istanbul, TUR.
Orthopedics and Traumatology, Academic Hospital, Istanbul, TUR.
Cureus. 2024 Apr 30;16(4):e59426. doi: 10.7759/cureus.59426. eCollection 2024 Apr.
Introduction Acromioplasty is a widely performed procedure for various rotator cuff pathologies with good outcomes and high patient satisfaction. However, few studies have focused on its potential complications. Previous cadaveric studies have demonstrated that a considerable portion of the deltoid muscle is detached from its acromial origin following arthroscopic acromioplasty, but the clinical relevance of this muscle detachment has not been investigated. The goal of our research was to examine the influence of arthroscopic acromioplasty on abduction strength and to assess whether acromial anatomy plays a role in any potential effect. Methods From a preliminary sample of 87 individuals who were diagnosed with isolated impingement syndrome and underwent arthroscopic acromioplasty, 74 patients who met the inclusion criteria were ultimately included in the study. The patients were divided into two groups according to their acromion morphology: Bigliani type 2 (33 patients) and type 3 (41 patients). The isometric abduction strength of the two groups was measured by a handheld dynamometer (Isobex®; Cursor AG, Berne, Switzerland) at different abduction angles preoperatively and at the first, third, and sixth months following surgery and was statistically compared. Results Both groups showed reduced abduction strength postoperatively; however, the strength of abduction in the Bigliani type 3 group returned to near preoperative values in the third month. Although increased mean abduction strength was recorded at 30° abduction in the sixth month, this difference was not statistically significant (p=0.78). In the Bigliani type 2 group, compared with those in the sixth-month group, the preoperative abduction strength decreased from 8.32 kg to 6.0 kg (p = 0.047), 6.57 kg to 5.15 (p = 0.025), and 6.1 kg to 4.56 kg (p = 0.006) at 30, 60, and 90° abduction, respectively. Conclusions Arthroscopic acromioplasty decreased isometric abduction strength in patients with a Bigliani type 2 acromion. Patients should be counseled about this loss, which might be especially important for professional athletes and heavy manual workers.
引言
肩峰成形术是针对各种肩袖病变广泛开展的一种手术，效果良好且患者满意度高。然而，很少有研究关注其潜在并发症。先前的尸体研究表明，关节镜下肩峰成形术后相当一部分三角肌与其肩峰附着点分离，但这种肌肉分离的临床相关性尚未得到研究。我们研究的目的是探讨关节镜下肩峰成形术对外展力量的影响，并评估肩峰解剖结构在任何潜在影响中是否起作用。
方法
从87例被诊断为孤立性撞击综合征并接受关节镜下肩峰成形术的个体的初步样本中，最终有74例符合纳入标准的患者被纳入研究。根据肩峰形态将患者分为两组：比利亚尼2型（33例患者）和3型（41例患者）。术前以及术后第1、3和6个月，使用手持测力计（Isobex®；Cursor AG，瑞士伯尔尼）在不同外展角度测量两组的等长外展力量，并进行统计学比较。
结果
两组术后外展力量均降低；然而，比利亚尼3型组的外展力量在术后第3个月恢复到接近术前值。虽然在术后第6个月记录到30°外展时平均外展力量增加，但这种差异无统计学意义（p = 0.78）。在比利亚尼2型组中，与术后第6个月组相比，在30°、60°和90°外展时，术前外展力量分别从8.32千克降至6.0千克（p = 0.047）、从6.57千克降至5.15千克（p = 0.025）、从6.1千克降至4.56千克（p = 0.006）。
结论
关节镜下肩峰成形术降低了比利亚尼2型肩峰患者的等长外展力量。应告知患者这种力量损失，这对于职业运动员和重体力劳动者可能尤为重要。
