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重庆医科大学附属第一医院骨科
纸质出版日期:2008,
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[1]梁熙,黄伟,孟纯阳,蒋电明.冈上肌腱钙化性肌腱炎的关节镜治疗[J].重庆医科大学学报,2008(11):1371-1375.
LIANG Xi, et al. Arthroscopic treatment for the calcific tendonitis of supraspinatus tendon[J]. Journal of Chongqing Medical University, 2008,(11):1371-1375.
目的:观察关节镜治疗冈上肌腱钙化性肌腱炎的关节镜下表现、术后康复、临床疗效、并发症。方法:应用关节镜对我院2005年9月到2007年2月收治的9例亚急性(7例)、急性(2例)冈上肌腱钙化性炎进行治疗。全身麻醉后患者健侧卧位
关节镜经后入路观察盂肱关节和肩峰下滑囊
了解关节镜手术入路及其解剖危险因素;观察病变的关节镜下表现
分别经前入路和前上入路清理盂肱关节和肩峰下滑囊的钙化灶
撕裂的冈上肌肌腱予新鲜化
较小的撕裂让其自行修复
较大的撕裂作修复
无钙化物沉积的滑膜尽可能不予干扰。手术后立刻指导功能锻炼。观察手术后症状的缓解、功能的恢复、探讨可能发生的并发症。结果:关节镜下见肩胛盂和肱骨头关节软骨粘附点状、白色钙化沉积物
一般在肩胛盂关节软骨上粘附较多
关节囊滑膜、肩峰下滑囊上粘附片状或堆积白色钙化物
肱二头肌长头腱上粘附较少
滑膜轻微充血水肿;在冈上肌腱上往往可见成堆的钙化物
此处肌腱往往有撕裂
钙化灶越大
撕裂越大。术后当天疼痛减轻90%。手术后第1d即进行功能锻炼
术后1周肩关节外展可达90°
随着肌力的恢复
肩关节功能逐渐恢复接近正常。所有患者门诊平均随访3月
疼痛完全缓解
肩关节功能恢复好。目前尚未出现明显并发症。结论:关节镜下对亚急性和急性冈上肌腱钙化性肌腱炎进行微创治疗的手术创伤小、并发症少、术后症状缓解明显。术后及时的功能锻炼可使肩关节功能较快恢复。
Objective:To observe the arthroscopic treatment for the calcific tendinitis of supraspinatus tendon
postoperative rehabili- tation
clinical effects and complications. Methods:From the September of 2005 to the February of 2007
9 cases (7 subacute cases and 2 acute cases)of calcific tendonitis of supraspinatus tendon were treated with arthroscope. After general anaesthesia
the patients lay on unaffected side. Shoulder joint and mucous bursa of infraacromion were observed with arthroscope through posterior portal to study the anatomic dangerous factors of approach. The pathologic change was treated with arthroscopic survey through anterior and superioranterior portals: calcific lesion were debrided; tear supraspinatus tendon were freshed and healed by themselves for minor tears or otherwise repaired for other tears
while uncalcific synovial membrane should be protected. Functional exercise was applied imme- diately after operation. The relief of pain and the recovery of shoulder joint were observed. The complication of operation was dis- cussed. Results:Punctiform white calcific deposition adhered to cartilage of joints and synovial membrane which were with mild hyperemia and swelling
especially on scapula caverna cartilage. Calcific deposition also adhehered to long head of biceps with tears
the size of which was positively related to the amount of calcific deposition. The shoulder joint could abduct to 90° afte 1 week of operation
and the function of joint returned to normal with the recovery of muscle strength. Followed up for the average of 3 months
all cases presented total pain relief and no complication happened. Conclusion:The arthroscopic treatment for acute or subacute calcific tendinitis of supraspinatus tendon is minimals invasive surgery with less injury
evidently pain relief and less intra-and post-operative complication. Postoperative functional exercises as early as possible is helped to the quick recovery of joint function.
关节镜冈上肌腱钙化性肌腱炎微创
arthroscopyCalcific tendinitis of supraspinatusMinimus invasive
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