Konishiike T, Hashizume H, Nishida K, Inoue H, Nagoshi M
Department of Orthopaedic Surgery, Okayama University Medical School, Japan.
J Bone Joint Surg Br. 1996 Jul;78(4):601-5.
We reviewed 166 adult patients on long-term haemodialysis, dividing them into three groups according to the presence and type of shoulder pain. The 24 patients in group A, with spontaneous pain related to a supine posture, had been under haemodialysis for significantly longer than the others, and had a much higher incidence of carpal tunnel syndrome. Open or arthroscopic resection of the coracoacromial ligament in 21 shoulders relieved pain during haemodialysis and night pain, and histological examination showed amyloid deposits and inflammatory-cell infiltration in the subacromial bursa in almost all cases, and in the tenosynovium of the bicipital groove in some. We conclude that one type of shoulder pain experienced by patients on long-term haemodialysis is caused by the subacromial impingement of amyloid deposits. This should be distinguished from other types of shoulder pain, because it can be relieved by resection of the coracoacromial ligament.
我们回顾了166例接受长期血液透析的成年患者，根据肩部疼痛的有无及类型将他们分为三组。A组的24例患者有与仰卧姿势相关的自发疼痛，其接受血液透析的时间明显长于其他患者，且腕管综合征的发生率高得多。对21例肩部进行开放或关节镜下喙肩韧带切除术，缓解了透析期间的疼痛和夜间疼痛，组织学检查显示几乎所有病例的肩峰下滑囊均有淀粉样沉积物和炎症细胞浸润，部分病例的肱二头肌沟腱鞘也有此类情况。我们得出结论，长期血液透析患者经历的一种肩部疼痛是由淀粉样沉积物的肩峰下撞击引起的。这应与其他类型的肩部疼痛相区分，因为切除喙肩韧带可缓解这种疼痛。
