Schneider T, Straus J M, Fink B, Jerosch J, Menke W, Rüther W
Orthopedic Department, Heinrich Heine-University, Düsseldorf, Germany.
Acta Orthop Belg. 1996 Jun;62(2):94-9.
We performed arthroscopic subacromial decompression on 70 patients. Each of them had either type I or type II impingement according to Neer. Sixty-five patients were then observed for a postoperative period of three years. The follow-up checks were performed by ultrasound in order to assess the extent of passive inferior shift of the humeral head, compared with the preoperative stage. A shoulder score of 100 was used as a reference. Whereas the average preoperative score was 58.5 (standard deviation +/- 12.2), postoperative results showed an increased average value of 79.7 (standard deviation +/- 11.4). In twenty cases (31% of all treated patients), the postoperative score was less than 85 points, i.e. treatment had shown no results. Comparing these patients with the other 45 who had a score above 85 points, we noted that the age of patients, the preoperative duration of complaints, the preoperative score and duration of the postoperative stay in hospital were of no relevance to the results. However, among all patients, ultrasound measurements showed significant deviations in the extent of passive inferior shift of the humeral head. Patients in the group with unsuccessful treatment had an average shift value of 5.1 mm. (+/- 2.0 mm), compared with an average value of only 2.4 mm (+/- 0.9 mm) among patients in the successful group. The statistical negative Pearson correlation coefficient of -5.36 between postoperative score and inferior shift of the humeral head is very significant. We conclude that hypermobile glenohumeral joints or unstable joints should not be treated by subacromial decompression in the presence of any subacromial pathology.
我们对70例患者进行了关节镜下肩峰下减压术。根据Neer分类，他们均为I型或II型撞击综合征。随后对65例患者进行了为期三年的术后观察。通过超声进行随访检查，以评估与术前阶段相比肱骨头被动下移的程度。以100分的肩部评分作为参考。术前平均评分为58.5分（标准差±12.2），术后结果显示平均值增加至79.7分（标准差±11.4）。在20例患者（占所有治疗患者的31%）中，术后评分低于85分，即治疗无效。将这些患者与其他45例评分高于85分的患者进行比较，我们注意到患者的年龄、术前症状持续时间、术前评分和术后住院时间与治疗结果无关。然而，在所有患者中，超声测量显示肱骨头被动下移程度存在显著差异。治疗失败组患者的平均移位值为5.1毫米（±2.0毫米），而成功组患者的平均值仅为2.4毫米（±0.9毫米）。术后评分与肱骨头下移之间的统计负Pearson相关系数为-5.36，具有高度显著性。我们得出结论，在存在任何肩峰下病变的情况下，对于过度活动的盂肱关节或不稳定关节，不应采用肩峰下减压术进行治疗。
