Jaffe M, Frank A, Beaufils P
Hôpital de Versailles, Hôpital André Mignot, Le Chesnay.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(5):369-78.
The authors have conducted a study to evaluate the possible efficacy of endoscopic decompression without repair in the treatment of rotator cuff tears.
We report 42 cases of endoscopic acromioplasty realized for full-thickness rotator cuff tears. Mean follow-up was 28.8 months. The principal presenting symptom was pain, with a mean duration of 29 months. Antero-external acromioplasty was realized by endoscopy using motorized drill bits, with sectioning or resecting the acromio-coracoid ligament. Revision consisted of a standard clinical examination, following the protocol of Constant, and a radiologic examination by sub-acromial frontal and scapular profile x-rays as advised by Liotard.
The functional results were very good, with 94 per cent of patients satisfied. The mean Constant score was 67.4 (14-100) corresponding on the average to 84 per cent of the score of a healthy shoulder for the same age and sex. The improvement concerned essentially the score of the pain, which increased on the average 7.4 points out of 15 (10.2/15 at revision) and of the activity level (14.8/20 as opposed to 8/20 initially). Less important was the improvement of the active mobility score (from 25.2 to 34/40 at revision). The force was measured according to the Constant scale, with a mean of 8.3 points out of 25. The mean duration of absence from work for the active patients was 2.4 months. Neither infectious nor neurological complications were noted. The radiographic analysis showed a decrease of the acromial edge, significative as compared to the opposite side. On the profile x-ray, we observed 48 per cent flat acromions in contrast to 80 per cent curved types on the opposite side. The only element influencing the pain score was the size of the rupture, but the statistical result was weak. The final Constant score was strongly influenced by by the size of the rupture, the active mobility, the pre-operative active and passive mobility, as well as by the presence of head excentration on pre-operative x-rays.
Comparison with other series of endoscopic acromioplasty for full-thickness rotator cuff tears has permitted us to confirm the validity of our series. We have especially evaluated this series in comparison to those with surgical repair. The subjective results, as well as those for pain, are equivalent; results on active mobility and force were not as good. We propose, therefore, this technique of low morbidity, in the presence of total ruptures in older and sedentary patients. The antalgic effect of endoscopic acromioplasty allows, in these patients, a functionally satisfying rehabilitation.
作者开展了一项研究，以评估不进行修复的关节镜减压术治疗肩袖撕裂的可能疗效。
我们报告了42例因全层肩袖撕裂而实施关节镜下肩峰成形术的病例。平均随访时间为28.8个月。主要症状为疼痛，平均持续时间为29个月。采用电动钻头通过关节镜进行前外侧肩峰成形术，切断或切除肩峰喙突韧带。复查包括按照康斯坦特方案进行的标准临床检查，以及按照利奥塔尔建议通过肩峰下正位和肩胛侧位X线进行的放射学检查。
功能结果非常好，94%的患者感到满意。康斯坦特平均评分为67.4（14 - 100），平均相当于同年龄和性别的健康肩部评分的84%。改善主要涉及疼痛评分，平均提高了15分中的7.4分（复查时为10.2/15）以及活动水平评分（复查时为14.8/20，而最初为8/20）。主动活动度评分的改善相对较小（从25.2提高到复查时的34/40）。根据康斯坦特量表测量肌力，平均为25分中的8.3分。活动患者的平均误工时间为2.4个月。未发现感染或神经并发症。放射学分析显示肩峰边缘下降，与对侧相比有显著差异。在侧位X线上，我们观察到48%的肩峰变平，而对侧为80%的弧形。影响疼痛评分的唯一因素是撕裂的大小，但统计结果不显著。最终的康斯坦特评分受撕裂大小、主动活动度、术前主动和被动活动度以及术前X线片上是否存在肱骨头偏心的强烈影响。
与其他全层肩袖撕裂关节镜下肩峰成形术系列的比较使我们能够确认本系列的有效性。我们特别将本系列与手术修复系列进行了比较。主观结果以及疼痛结果相当；主动活动度和肌力结果则没那么好。因此，对于年龄较大且久坐不动的患者出现完全撕裂的情况，我们推荐这种低发病率的技术。关节镜下肩峰成形术的止痛效果使这些患者能够获得功能上令人满意的康复。
