沈鹏　白伦浩　李彬

[摘要] 目的 观察比较关节镜下肩峰成形术配合肩峰下间隙封闭治疗肩峰下撞击综合征的临床效果。 方法 将2013年5月～2014年8月中国医科大学附属盛京医院56例肩峰下撞击综合征患者随机分为实验组及对照组。实验组30例患者给予关节镜下肩峰成形术及肩峰下封闭治疗，对照组26例患者同样给予关节镜下肩峰成形术及生理盐水安慰治疗。比较两组患者的视觉模拟评分（VAS）、美国加州大学肩袖评分（UCLA）及疗效。 结果 术后1个月实验组VAS疼痛评分[（2.72±0.27）分]低于对照组[（3.22±0.18）分]，差异有统计学意义（P < 0.05）；实验组UCLA评分[（32.32±3.84）分]优于对照组[（31.14±3.65）分]，差异有统计学意义（P < 0.05）。术后3个月实验组VAS疼痛评分[（1.25±0.23）分]低于对照组[（2.18±0.17）分]，差异有统计学意义（P < 0.05）；实验组UCLA评分[（34.25±3.27）分]优于对照组[（33.18±3.18）分]，差异有统计学意义（P < 0.05）。 结论 与单独肩峰成形术比较，关节镜下肩峰成形术配合术中肩峰下间隙封闭治疗可明显提高肩峰下撞击综合征的治疗效果，可作为肩峰下撞击综合征的更有效的治疗手段。

[关键词] 封闭；关节镜检测；肩峰成形术；肩峰下撞击综合征

[中图分类号] R687.3 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0078-04

[Abstract] Objective To investigate the clinical effect of arthroscopic acromioplasty combined with intraoperative subacromial block in the treatment of subacromial impingement syndrome. Methods 56 patients with subacromial impingement syndrome from May 2013 to August 2014 in Shenjing Hopital of China Medical University were divided into experimental group and control group randomly. 30 cases of the experimental group were given the treatment of arthroscopic acromioplasty combined with intraoperative subacromial block， and 26 cases of the control group were given the treatment of arthroscopic acromioplasty combined with placebo of saline. The visual analogue scale （VAS）， UCLA score and efficacy of two groups were compared. Results One months after operation， VAS score of the experimental group [（2.72±0.27） scores] was lower than that of the control group [（3.22±0.18） scores]， the difference was statistically significant （P < 0.05）； the UCLA score of the experimental group [（32.32±3.84） scores] was better than that of the control group [（31.14±3.65） scores]， the difference was statistically significant （P < 0.05）. 3 months after operation VAS pain score of the experimental group [（1.25±0.23） scores] was lower than that of the control group [（2.18±0.17） scores]， the difference was statistically significant （P < 0.05）； the UCLA score of the experimental group [（34.25±3.27） scores] was better than that of the control group [（33.18±3.18） scores]， the difference was statistically significant （P < 0.05）. Conclusion Compared with the single arthroscopic acromioplasty， arthroscopic acromioplasty combined with intraoperative subacromial block therapy can improve clinical efficacy， and is a safe and efficient treatment for subacromial impingement syndrome.

[Key words] Block therapy； Arthroscopy； Acromioplasty； Subacromial impingement syndrome

肩峰下撞击综合征（subacromial impingement syndrome，SAIS）是由于肩峰前外侧形态异常、增生、肱骨大结节的增生及其他因素导致肩峰与肱骨头间距减小，肩峰下结构受到挤压及撞击，反复的撞击使肩峰下滑囊、肩袖等软组织发生损伤、退变乃至断裂。1972年Neer[1]通过尸体解剖和临床研究提出SAIS的概念，并认为其是导致慢性肩痛的主要原因之一。Bigliani等[2]将肩峰分为三型：Ⅰ型平直形肩峰，Ⅱ型弧形肩峰，Ⅲ型钩状肩峰，并认为Ⅱ、Ⅲ型肩峰更易出现肩峰下撞击。

现代医学由于关节镜技术及关节镜器械的改良，镜下手术已经成为目前SAIS手术治疗的首选方法，其中主要包括肩峰成形术[3]。术后48 h的康复锻炼是影响手术效果的重要因素，但是由于严重的术后疼痛及康复锻炼中引起的剧烈疼痛，使患者在康复过程中举步维艰，从而影响术后恢复效果。……