Morrison D S, Frogameni A D, Woodworth P
Southern California Center for Sports Medicine, Long Beach 90866, USA.
J Bone Joint Surg Am. 1997 May;79(5):732-7. doi: 10.2106/00004623-199705000-00013.
We performed a retrospective study of 616 patients (636 shoulders) who had subacromial impingement syndrome to assess the results of non-operative treatment. The diagnosis was made on the basis of a positive impingement sign and the absence of other abnormalities of the shoulder, such as full-thickness tears of the rotator cuff, osteoarthrosis of the acromioclavicular joint, instability of the glenohumeral joint, or adhesive capsulitis. All patients were managed with anti-inflammatory medication and a specific, supervised physical-therapy regimen consisting of isotonic exercises for strengthening of the rotator cuff. The average duration of follow-up was twenty-seven months (range, six to eighty-one months). Over-all, 413 patients (67 per cent) had a satisfactory result. One hundred and seventy-two patients (28 per cent) had no improvement and went on to have an arthroscopic subacromial decompression. Thirty-one patients (5 per cent) had an unsatisfactory result but declined additional treatment. Seventy-four (18 per cent) of the 413 patients who had a successful result had a recurrence of the symptoms during the follow-up period; the symptoms resolved with rest or after resumption of the exercise program. The patients were stratified according to age, the duration of symptoms, and acromial morphology. Patients who were twenty years old or less and those who were forty-one to sixty years old fared better than those who were twenty-one to forty years old. Patients who were more than sixty years old had the poorest results. Sixty-seven (78 per cent) of the eighty-six patients in whom the symptoms had been present for less than four weeks had a satisfactory result, compared with 144 (63 per cent) of the 228 who had had the symptoms for one to six months and with 202 (67 per cent) of the 302 who had had the symptoms for more than six months. Thirty-two (91 per cent) of the thirty-five patients who had a type-I acromion had a successful result, compared with 173 (68 per cent) of the 256 who had a type-II acromion and with 208 (64 per cent) of the 325 who had a type-III acromion. Shoulder dominance, gender, and concomitant tenderness of the acromioclavicular joint did not affect the result significantly (p = 0.084, 0.555, and 0.365, respectively).
我们对616例（636个肩部）患有肩峰下撞击综合征的患者进行了一项回顾性研究，以评估非手术治疗的效果。诊断基于阳性撞击征以及肩部无其他异常情况，如肩袖全层撕裂、肩锁关节骨关节炎、盂肱关节不稳定或粘连性关节囊炎。所有患者均接受抗炎药物治疗以及一种特定的、有监督的物理治疗方案，该方案包括等张运动以加强肩袖。平均随访时间为27个月（范围为6至81个月）。总体而言，413例患者（67%）取得了满意的结果。172例患者（28%）没有改善，继而接受了关节镜下肩峰下减压术。31例患者（5%）结果不满意但拒绝进一步治疗。在413例取得成功结果的患者中，74例（18%）在随访期间症状复发；症状通过休息或恢复锻炼计划后得以缓解。患者根据年龄、症状持续时间和肩峰形态进行分层。20岁及以下的患者以及41至60岁的患者比21至40岁的患者预后更好。60岁以上的患者结果最差。症状出现少于4周的86例患者中有67例（78%）取得了满意的结果，相比之下，症状持续1至6个月的228例患者中有144例（63%），症状持续超过6个月的302例患者中有202例（67%）。35例I型肩峰患者中有32例（91%）取得了成功结果，相比之下，256例II型肩峰患者中有173例（68%），325例III型肩峰患者中有208例（64%）。肩部优势、性别以及肩锁关节的伴随压痛对结果无显著影响（p值分别为0.084、0.555和0.365）。
