• 1成都軍區(qū)總醫(yī)院骨科（成都，610083）;;
  • 2第三軍醫(yī)大學西南醫(yī)院骨科;

目的 探討小切口喙突成形術治療喙突下撞擊綜合征的方法和臨床療效。 方法2006年5月－2011年9月，收治喙突下撞擊綜合征患者4例。男3例，女1例；年齡20～56歲，平均36歲。病程6～22個月，平均11.2個月。先天性喙突發(fā)育異常3例，盂肱關節(jié)前方不穩(wěn)1例?；颊呔屑珀P節(jié)前方慢性疼痛和彈響史，內(nèi)收、內(nèi)旋和前屈時加重。Neer撞擊征試驗和Hawkins-Kennedy改良試驗呈陽性。內(nèi)收軸位CT示喙肱間距變小，喙突指數(shù)增大。術中截除喙突頸0.5～1.5 cm，游離肱二頭肌短頭及喙肱肌聯(lián)合肌腱止點，重疊縫合于截骨面近端。術后支具固定肩關節(jié)6周。 結(jié)果術后切口均Ⅰ期愈合，無并發(fā)癥發(fā)生。4例均獲隨訪，隨訪時間 8個月～5年?；颊呒珀P節(jié)疼痛和彈響均消失。末次隨訪時，疼痛視覺模擬評分（VAS）、美國加州大學洛杉磯分校（UCLA）肩關節(jié)評定標準評分、Constant評分表評分及簡單肩關節(jié)測試（SST）評分平均分別為0.25、34.25、91.25、0.25分，均較術前7.75、10.25、65.50、9.75分明顯改善。內(nèi)收軸位CT及三維重建和MRI顯示，過長喙突已切除，喙肱間距從術前平均4.16 mm增至13.38 mm，喙突指數(shù)從術前平均13.08 mm降至0.28 mm。 結(jié)論小切口喙突成形術是治療喙突下撞擊綜合征的有效方法，具有創(chuàng)傷小、術后恢復良好等優(yōu)點。

引用本文： 謝美明,唐康來,鄧銀栓,李輝,陶旭,許建中. 小切口喙突成形術治療喙突下撞擊綜合征. 中國修復重建外科雜志, 2012, 26(11): 1296-1299. doi: 復制

版權信息： ?四川大學華西醫(yī)院華西期刊社《中國修復重建外科雜志》版權所有，未經(jīng)授權不得轉(zhuǎn)載、改編

1. Dines DM, Warren RF, Inglis AE, et al. The coracoid impingement syndrome. J Bone Joint Surg (Br), 1990, 72(2): 314-316.
2. Kragh JF Jr, Doukas WC, Basamania CJ. Primary coracoid impingement syndrome. Am J Orthop (Belle Mead NJ), 2004, 33(5): 229-232.
3. Lo IK, Burkhart SS. The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy, 2003, 19(10): 1142-1150.
4. Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg (Br), 1985, 67(5): 703-708.
5. Ferreira Neto AA, Almeida AM, Maiorino R, et al. An anatomical study of the subcoracoid space. Clinics (Sao Paulo), 2006, 61(5): 467-472.
6. Giaroli EL, Major NM, Lemley DE, et al. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. AJR Am J Roentgenol, 2006, 186(1): 242-246.
7. Arrigoni P, Brady PC, Burkhart S. Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement. Arthroscopy, 2006, 22(10): 1139. e1-1139. e3.
8. Franceschi F, Longo UG, Ruzzino L, et al. Arthroscopic management of calcific tendinitis of the subscapularis tendon. Knee Surg Sports Traumatol Arthrosc , 2007, 15(12): 1482-1485.
9. Gerber C, Terrier F, Zehnder R, et al. The subcoracoid space. An anatomic study. Clin Orthop Relat Res, 1987, (215): 132-138.
10. Tham A, Purchase R, Kelly JD 4th. The relation of the coracoid process to the glenoid: an anatomic study. Arthroscopy, 2009, 25(8): 846-848.
11. Roche SJ, Kennedy MT, Butt AJ, et al. Coracoid impingement syndrome: a treatable cause of anterior shoulder pain. Ir J Med Sci, 2006, 175(3): 57-61.
12. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: a literature review. Curr Rev Musculoskelet Med, 2009, 2(1): 51-55.
13. Bhatia DN, de Beer JF, du Toit DF. Coracoid process anatomy: implications in radiographic imaging and surgery. Clin Anat, 2007, 20(7): 774-784.
14. Kleist KD, Freehill MQ, Hamilton L, et al. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. J Shoulder Elbow Surg, 2007, 16(2): 245-250.
15. Garofalo R, Conti M, Massazza G, et al. Subcoracoid impingement syndrome: a painful shoulder condition related to different pathologic factors. Musculoskelet Surg, 2011, 95 Suppl 1: S25-29.
  1. 1. Dines DM, Warren RF, Inglis AE, et al. The coracoid impingement syndrome. J Bone Joint Surg (Br), 1990, 72(2): 314-316.
  2. 2. Kragh JF Jr, Doukas WC, Basamania CJ. Primary coracoid impingement syndrome. Am J Orthop (Belle Mead NJ), 2004, 33(5): 229-232.
  3. 3. Lo IK, Burkhart SS. The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy, 2003, 19(10): 1142-1150.
  4. 4. Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg (Br), 1985, 67(5): 703-708.
  5. 5. Ferreira Neto AA, Almeida AM, Maiorino R, et al. An anatomical study of the subcoracoid space. Clinics (Sao Paulo), 2006, 61(5): 467-472.
  6. 6. Giaroli EL, Major NM, Lemley DE, et al. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. AJR Am J Roentgenol, 2006, 186(1): 242-246.
  7. 7. Arrigoni P, Brady PC, Burkhart S. Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement. Arthroscopy, 2006, 22(10): 1139. e1-1139. e3.
  8. 8. Franceschi F, Longo UG, Ruzzino L, et al. Arthroscopic management of calcific tendinitis of the subscapularis tendon. Knee Surg Sports Traumatol Arthrosc , 2007, 15(12): 1482-1485.
  9. 9. Gerber C, Terrier F, Zehnder R, et al. The subcoracoid space. An anatomic study. Clin Orthop Relat Res, 1987, (215): 132-138.
  10. 10. Tham A, Purchase R, Kelly JD 4th. The relation of the coracoid process to the glenoid: an anatomic study. Arthroscopy, 2009, 25(8): 846-848.
  11. 11. Roche SJ, Kennedy MT, Butt AJ, et al. Coracoid impingement syndrome: a treatable cause of anterior shoulder pain. Ir J Med Sci, 2006, 175(3): 57-61.
  12. 12. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: a literature review. Curr Rev Musculoskelet Med, 2009, 2(1): 51-55.
  13. 13. Bhatia DN, de Beer JF, du Toit DF. Coracoid process anatomy: implications in radiographic imaging and surgery. Clin Anat, 2007, 20(7): 774-784.
  14. 14. Kleist KD, Freehill MQ, Hamilton L, et al. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. J Shoulder Elbow Surg, 2007, 16(2): 245-250.
  15. 15. Garofalo R, Conti M, Massazza G, et al. Subcoracoid impingement syndrome: a painful shoulder condition related to different pathologic factors. Musculoskelet Surg, 2011, 95 Suppl 1: S25-29.