Hartig A, Rojczyk M
Unfallchirurgische Abteilung, Agnes-Karll-Krankenhaus Laatzen.
Unfallchirurg. 1993 Feb;96(2):109-15.
Between January 1989 and December 1991 614 arthroscopic subacromial decompressions were performed for impingement syndromes. The first 100 cases represented our learning curve. The first 74 of the remaining 514 cases were available for evaluation and form the basis of the results presented here. Twenty (27.02%) patients were rated stage II in Neer's classification and 54 (72.98%) were rated stage III, 33 (44.59%) of them with a small full-thickness tear (less than 1 cm) and 21 (28.37%) with larger defects. Patients were evaluated pre- and postoperatively utilizing the ULCA shoulder score. The average follow-up was 7.9 months. The overall results were satisfactory in 67 cases (90.5%) and unsatisfactory in 7 cases (9.5%). Within the satisfactory group, 28 results (37.8%) were rated excellent and 39 (52.7%) were rated good. In the unsatisfactory group four results (5.4%) were rated fair and three (4.1%) poor. The results in advanced stage III (n = 21), with an average follow-up of 8.4 months, were satisfactory in 20 cases (excellent in 8 and good in 12) and unsatisfactory in one case. It is concluded that arthroscopic subacromial decompression is an effective treatment for both stage II and III impingement syndromes, producing acceptable results that are comparable to those of open procedures. Technically, it seems necessary to perform synovectomy of the ventral synovia in the glenohumeral joint, to resect the coracoacromial ligament completely and also to remove calcifications completely. Depending on the findings of a preoperative sonographic examination of the shoulder joint, the extent of the acromioplasty may be minimized.
1989年1月至1991年12月期间，因撞击综合征进行了614例关节镜下肩峰下减压术。前100例代表我们的学习曲线。其余514例中的前74例可供评估，并构成此处呈现结果的基础。20例（27.02%）患者在Neer分类中为II期，54例（72.98%）为III期，其中33例（44.59%）有小的全层撕裂（小于1厘米），21例（28.37%）有较大缺损。术前和术后采用加州大学洛杉矶分校（UCLA）肩部评分对患者进行评估。平均随访时间为7.9个月。总体结果满意的有67例（90.5%），不满意的有7例（9.5%）。在满意组中，28例结果（37.8%）评为优秀，39例（52.7%）评为良好。在不满意组中，4例结果（5.4%）评为一般，3例（4.1%）评为差。III期晚期（n = 21）患者平均随访8.4个月，20例结果满意（8例优秀，12例良好），1例不满意。结论是，关节镜下肩峰下减压术是治疗II期和III期撞击综合征的有效方法，产生的可接受结果与开放手术相当。从技术上讲，似乎有必要对盂肱关节的腹侧滑膜进行滑膜切除术，完全切除喙肩韧带，并彻底清除钙化。根据术前肩关节超声检查结果，可尽量减少肩峰成形术的范围。
