Beach W R, Caspari R B
Tuckahoe Orthopedic Associates, Ltd, Glen Allen, Va.
Orthopedics. 1993 Sep;16(9):1007-15. doi: 10.3928/0147-7447-19930901-10.
The etiology of rotator cuff disease is controversial, but is not always secondary to cuff impingement between the humeral head and the coracoacromial arch. Rotator cuff disease, and not impingement syndrome, more accurately describes this process. The spectrum of rotator cuff disease begins with rotator cuff inflammation (Stage I) and progresses to tendinitis (Stage II) and partial or full thickness tears (Stage III). Refractory Stage II and III disease without rotator cuff tears undergoes subacromial bursectomy and acromioplasty. Partial thickness tears are debrided with an acromioplasty, bursectomy, and removal of inferior clavicular osteophytes. Full thickness tears are treated arthroscopically or open, depending on the tear size and the patient expectations. In general, tears from 0 to 5 cm in active patients undergo subacromial decompression and a mini-open repair. Low demand patients with 0 to 5 cm tears or tears greater than 5 cm are treated with subacromial decompression and rotator cuff debridement.
肩袖疾病的病因存在争议，但并不总是继发于肱骨头与喙肩弓之间的肩袖撞击。肩袖疾病而非撞击综合征，能更准确地描述这一过程。肩袖疾病的范围始于肩袖炎症（I期），并进展为肌腱炎（II期）以及部分或全层撕裂（III期）。对于无肩袖撕裂的难治性II期和III期疾病，需进行肩峰下囊切除术和肩峰成形术。部分厚度撕裂需通过肩峰成形术、囊切除术以及去除锁骨下骨赘来进行清创。全层撕裂则根据撕裂大小和患者期望，采用关节镜或开放手术治疗。一般而言，活动患者中0至5厘米的撕裂需进行肩峰下减压和小切口修复。对于0至5厘米撕裂或大于5厘米撕裂的低需求患者，采用肩峰下减压和肩袖清创术治疗。
