Rockwood C A, Lyons F R
Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78284-7774.
J Bone Joint Surg Am. 1993 Mar;75(3):409-24.
Seventy-one patients who had shoulder impingement syndrome were managed operatively with a modified Neer acromioplasty: thirty-seven, who had an intact rotator cuff, had a modified acromioplasty, and thirty-four, who had a torn cuff, had a modified acromioplasty and repair of the cuff. In the classic anterior acromioplasty as described by Neer, emphasis is placed on resection of the inferior prominence of the acromion. We believe that the removal of only the inferior prominence is insufficient, as often too much of the anterior aspect of the acromion protrudes beyond the anterior border of the clavicle. This portion of the acromion continues to irritate the subacromial bursa and the rotator cuff and to produce symptoms of impingement. Our modified acromioplasty is done in two steps: the portion of the acromion that projects anteriorly beyond the anterior border of the clavicle is resected vertically and then an anteroinferior acromioplasty is performed. We studied the results in patients who had been operated on by the senior one of us and who had been followed clinically for a minimum of two years. At the most recent follow-up visit, no difference in terms of pain and function was found between the patients who had had the modified acromioplasty only (Group I) and the patients who had had the modified acromioplasty and repair of the rotator cuff (Group II); thirty-three (89 per cent) of the patients in Group I and thirty (88 per cent) of those in Group II had a good or excellent result.
71例患有肩部撞击综合征的患者接受了改良的Neer肩峰成形术手术治疗：37例肩袖完整的患者接受了改良肩峰成形术，34例肩袖撕裂的患者接受了改良肩峰成形术并修复肩袖。在Neer描述的经典前路肩峰成形术中，重点是切除肩峰的下突出部分。我们认为仅切除下突出部分是不够的，因为通常肩峰的前侧太多部分突出于锁骨前缘之外。肩峰的这部分继续刺激肩峰下囊和肩袖并产生撞击症状。我们的改良肩峰成形术分两步进行：垂直切除向前突出于锁骨前缘之外的肩峰部分，然后进行前下肩峰成形术。我们研究了由我们中的年长者进行手术且临床随访至少两年的患者的结果。在最近的随访中，仅接受改良肩峰成形术的患者（第一组）和接受改良肩峰成形术并修复肩袖的患者（第二组）在疼痛和功能方面没有差异；第一组33例患者（89%）和第二组30例患者（88%）的结果为良好或优秀。
