CAJ | 학술논문

目的：探讨肩关节镜手术治疗冈上肌腱钙化性肌腱炎的疗效。方法术前24例均进行三维CT病变定位。术前均在门诊进行美国肩与肘协会评分系统( American shoulder and elbow surgeonsscores，ASES )功能评估、视觉模拟评分法( visual analogue scale，VAS )疼痛评分、肩关节前屈上举、外旋功能评分、及满意度评估；术后门诊随访时，再行同样的功能评估。术中发现24例钙化灶位于冈上肌腱，均行钙化灶清除术、肩峰下滑囊切除及肩峰成形术。所有患者术中均取部分沉着物组织进行病理检查。结果术后伤口平均长度为0.53 cm。病理结果显示为钙化物沉积形成实体，大量炎性细胞增生。24例术后平均随访(21.6±12.2)(3～40)个月。ASES 评分由术前的(50.42±10.10)分提高至术后的(86.50±5.95)分，差异有统计学意义( t＝-15.10，P＝0.00)。肩关节上举由术前(83.75±12.99)°增加至术后(136.67±11.55)°，差异有统计学意义( t＝-10.58，P＝0.00)。肩关节外旋由术前(22.92±9.20)°增加至术后(38.33±6.70)°，差异有统计学意义( t＝-6.64，P＝0.00)。满意度由术前(3.25±1.26)分增至术后(8.00±1.11)分，差异有统计学意义( t＝-13.90，P＝0.00)。VAS疼痛评分由术前(7.75±1.33)分减少至术后(2.25±1.19)分，差异有统计学意义( t＝-15.12，P＝0.00)。治疗后患者症状明显改善。结论在关节镜下作钙化灶清除、滑囊切除及肩峰成形术，是治疗冈上肌腱钙化性肌腱炎的一种微创、有效的方法，能减轻患者疼痛，改善活动度。术前进行三维CT能很好地评估钙化物沉积的位置。
목적：탐토견관절경수술치료강상기건개화성기건염적료효。방법술전24례균진행삼유CT병변정위。술전균재문진진행미국견여주협회평분계통( American shoulder and elbow surgeonsscores，ASES )공능평고、시각모의평분법( visual analogue scale，VAS )동통평분、견관절전굴상거、외선공능평분、급만의도평고；술후문진수방시，재행동양적공능평고。술중발현24례개화조위우강상기건，균행개화조청제술、견봉하활낭절제급견봉성형술。소유환자술중균취부분침착물조직진행병리검사。결과술후상구평균장도위0.53 cm。병리결과현시위개화물침적형성실체，대량염성세포증생。24례술후평균수방(21.6±12.2)(3～40)개월。ASES 평분유술전적(50.42±10.10)분제고지술후적(86.50±5.95)분，차이유통계학의의( t＝-15.10，P＝0.00)。견관절상거유술전(83.75±12.99)°증가지술후(136.67±11.55)°，차이유통계학의의( t＝-10.58，P＝0.00)。견관절외선유술전(22.92±9.20)°증가지술후(38.33±6.70)°，차이유통계학의의( t＝-6.64，P＝0.00)。만의도유술전(3.25±1.26)분증지술후(8.00±1.11)분，차이유통계학의의( t＝-13.90，P＝0.00)。VAS동통평분유술전(7.75±1.33)분감소지술후(2.25±1.19)분，차이유통계학의의( t＝-15.12，P＝0.00)。치료후환자증상명현개선。결론재관절경하작개화조청제、활낭절제급견봉성형술，시치료강상기건개화성기건염적일충미창、유효적방법，능감경환자동통，개선활동도。술전진행삼유CT능흔호지평고개화물침적적위치。
Objective To investigate the effectiveness of arthroscopic treatment of supraspinatus calcifying tendinitis.Methods 24 patients of supraspinatus calcifying tendinitis were reviewed. The leision position was assessed by the three-dimensional CT scans preoperatively. American Shoulder and Elbow Surgeons ( ASES ) scores, VAS scores, the shouder function of forward elevation and external rotation, and the satisfaction score were evaluated preoperatively and postoperatively. 24 patients of supraspinatus calcifying tendinitis underwent arthroscopic calcium removal, subacromial bursa excision and acromioplasty via posterior approach. Partial tissue deposits in all patients were taken during the surgery for pathological examination.Results The mean length of scar was 0.53 cm postoperatively. Pathological examination showed solid section of granular sediments with lymphocytes proliferation and chronic inlfammation. 24 patients were followed up for an average period of ( 21.6±12.2 ) months ( rang: 3-40 months ). The ASES score was improved from ( 50.42±10.10 ) points preoperatively to ( 86.50±5.95 ) points postoperatively, and the differences were statistically signiifcant (t=-15.10,P=0.00 ). The forward elevation of the shoulder was ( 83.75±12.99 ) ° preoperatively and ( 136.67±11.55 ) ° postoperatively, and the differences were statistically signiifcant (t=-10.58,P=0.00 ). The external rotation of the shoulder was ( 22.92±9.20 ) ° preoperatively and ( 38.33±6.70 ) ° postoperatively, and the differences were statistically significant (t=-6.64,P=0.00 ). The satisfaction score was improved from ( 3.25±1.26 ) points preoperatively to ( 8.00±1.11 ) points postoperatively, and the differences were statistically signiifcant ( t=-13.90,P=0.00 ). The VAS pain score was decreased from ( 7.75±1.33 ) points preoperatively to ( 2.25±1.19 ) points postoperatively, and the differences were statistically signiifcant (t=15.12, P=0.00 ).Conclusions Calcium removal, subacromial bursa excision and acromioplasty under the arthroscopie is an effective, safe and minimally invasive method for the treatment of supraspinatus calcifying tendinitis failed to conservative treatment, which can relieve pain and improve mobility. The preoperative lesion position was located by the three-dimensional CT scans commendably.