Abstract

Purpose

To investigate whether arthroscopic lateral acromion resection can sufficiently reduce the critical shoulder angle (CSA) without damaging deltoid muscle insertion.

Methods

Ninety patients who underwent arthroscopic rotator cuff (RC) repair were retrospectively analysed. According to the preoperative CSA, patients were categorized as Group I (CSA < 35°) and Group II (CSA ≥ 35°). Additional arthroscopic lateral acromion resection was performed in Group II. The CSA was measured 1 week postoperatively, while RC integrity and the deltoid attachment were assessed at 3, 6 and 12 months via ultrasound. Deltoid function was evaluated using the Akimbo test, in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm.

Results

Large and massive RC tears were more prevalent in Group II (p = 0.017). In both groups, the CSA reduction was statistically significant (Group I = 1°: range 0°–3°, Group II = 3.7°: range 1°–8°; p < 0.001). When the preoperative CSA was > 40°, the respective postoperative CSA remained > 35° in 83.3% of cases (p < 0.001). Final shoulder strength was correlated with the amount of CSA reduction (rho = 0.41, p = 0.002). The postoperative CSA was higher, but not significantly different (n.s.), in patients with re-torn (36°, range 32°–40°) than with healed RC (33°, range 26°–38°). No clinical detachment or hypotrophy of the deltoid was observed with the Akimbo test and ultrasound evaluation.

Conclusions

Arthroscopic lateral acromion resection is a safe procedure without affecting deltoid muscle origin or function, and it is effective in significantly reducing the CSA. However, the CSA cannot always be reduced to < 35°, especially in patients with preoperative CSA values > 40°.

Level of evidence

III.

中文翻译：

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如果术前测量角度超过40°，则外侧肩峰成形术无法充分减小肩部临界角

摘要

目的

要研究关节镜下肩峰外侧切除术是否可以在不损害三角肌插入的情况下充分减小临界肩角（CSA）。

方法

回顾性分析了90例行关节镜袖套（RC）修复的患者。根据术前CSA，将患者分为I组（CSA <35°）和II组（CSA≥35°）。在第二组中进行了额外的关节镜下肩峰外侧切除术。术后1周测量CSA，而在3、6和12个月通过超声评估RC完整性和三角肌附着。使用Akimbo测试评估三角肌功能，其中患者将手放在the顶上，并在冠状平面内外展并肩关节内旋，同时弯曲肘关节并使前臂前旋。

结果

在第二组中，较大的RC泪液更为普遍（p  = 0.017）。在两组中，CSA降低均具有统计学意义（I组= 1°：范围0°–3°，II组= 3.7°：范围1°–8°；p  <0.001）。当术前CSA> 40°时，在83.3％的病例中，各自的术后CSA保持> 35°（p  <0.001）。最终肩部力量与CSA减少量相关（rho = 0.41，p  = 0.002）。撕裂（36°，范围32°–40°）患者的术后CSA高于治愈的RC（33°，范围26°–38°），但无显着差异（ns）。使用Akimbo测试和超声评估未观察到三角肌的临床脱离或肥大。

结论

关节镜侧肩峰切除术是一种安全的手术，不影响三角肌的起源或功能，并且可有效降低CSA。但是，CSA不能总是降低到<35°，尤其是术前CSA值> 40°的患者。

证据水平

三，