Freedman K B, Williams G R, Iannotti J P
Department of Orthopaedic Surgery, the University of Pennsylvania School of Medicine, Philadelphia, USA.
Arthroscopy. 1998 Oct;14(7):665-70. doi: 10.1016/s0749-8063(98)70091-x.
Pain following total shoulder arthroplasty or humeral hemiarthroplasty is uncommon. Impingement syndrome can be an infrequent source of pain following shoulder arthroplasty. We retrospectively reviewed six patients with refractory impingement syndrome treated with arthroscopic acromioplasty following either total shoulder arthroplasty (four patients) or humeral hemiarthroplasty (two patients). Chronic impingement syndrome requiring acromioplasty affected 3% of all patients who underwent total shoulder arthroplasty or humeral hemiarthroplasty during the study period. A thorough history, physical examination, and radiographic findings made the clinical diagnosis of impingement syndrome. All six patients had positive impingement signs and a positive impingement test with subacromial lidocaine injection. Preoperative radiographs revealed a type II or III acromion and subacromial outlet narrowing in five of six patients. Other sources of shoulder pain including prosthesis loosening, infection, and rotator cuff tear were ruled out preoperatively by physical examination and radiographic findings, and were confirmed by arthroscopic examination. The results of arthroscopic acromioplasty were a reduction in pain from 7.5 preoperatively to 1.6 postoperatively, on a scale from 0 to 10. Five of six patients were completely satisfied with the results of their arthroscopic surgery. Overall, according to the University of California at Los Angeles end-result score, the results were rated as excellent or good in five patients, and unsatisfactory in one patient. Arthroscopic acromioplasty can be a successful technique for the treatment of chronic impingement syndrome following total shoulder arthroplasty or hemiarthroplasty in appropriate patients.
全肩关节置换术或肱骨头半关节置换术后疼痛并不常见。撞击综合征可能是肩关节置换术后较少见的疼痛来源。我们回顾性分析了6例难治性撞击综合征患者，这些患者在全肩关节置换术（4例）或肱骨头半关节置换术（2例）后接受了关节镜下肩峰成形术治疗。在研究期间，需要进行肩峰成形术的慢性撞击综合征在所有接受全肩关节置换术或肱骨头半关节置换术的患者中占3%。通过详细的病史、体格检查和影像学检查结果做出撞击综合征的临床诊断。所有6例患者均有阳性撞击体征，且肩峰下注射利多卡因后撞击试验阳性。术前X线片显示，6例患者中有5例为II型或III型肩峰，肩峰下间隙变窄。术前通过体格检查和影像学检查排除了包括假体松动、感染和肩袖撕裂在内的其他肩部疼痛来源，并通过关节镜检查得以证实。关节镜下肩峰成形术的结果是，疼痛评分从术前的7.5分降至术后的1.6分（评分范围为0至10分）。6例患者中有5例对关节镜手术结果完全满意。总体而言，根据加州大学洛杉矶分校的最终结果评分，5例患者的结果评为优秀或良好，1例患者不满意。对于合适的患者，关节镜下肩峰成形术可能是治疗全肩关节置换术或半关节置换术后慢性撞击综合征的一种成功技术。
