- 期刊
New Approaches to the Subacromial Decompression
肩峰下減壓新方法
摘要
俗稱的五十肩，很多是肩卡住症候群（Impingement syndrome），肩峰下減壓是手術療法的基本原則。年代已久的肩峰切除術（Acromionectomy）會造成許多併發症，時下常用的肩峰整型術（acromioplasty）亦非全無問題。作者提出兩種創新的肩峰下減壓療法:前方肩峰切骨術（Anterior acromionectomy）和肩峰截骨外移術（Proximal advancement of the acromion）。 本論文係以五付新鮮冰凍之屍體肩關節標本做研究，測量上述兩種新的手術方法對於三角肌在沿肩胛平面外展時力臂之影響。結果顯示，將外側肩峰切除時，中段三時肌之後半，其沿肩胛平面外展之力臂減少30%以上，而中段三角肌之前半部，力臂減少祇有10%以下。切除前方之肩峰，可達到很好的肩峰下減壓效果，而且對三角肌外展力臂影響不明顯。 將肩峰做-30∘斜式截骨並外移一公分，可同時增加五公童的肩峰下空間而達到減壓的效果。中段三角肌被外移後，其沿肩胛平面外展之力臂可增加17%至73%。然而由於截骨後之固定不易，此術式之可衛性尚需進一步的探究。 過去文獻中探討的肩峰下減壓方法不外肩峰完全切除和肩峰整型衛，本論文提出之前方肩峰切骨術保留了原來兩種方法之優點（肩峰下減壓和不影響三角肌）而避免其缺點和併發症（三角肌無力和減壓不完全），臨床上值得提倡推廣。
關鍵字
無資料並列摘要
The effect of the surgical procedures of subacromial decompression on the moment arm of the deltoid muscle during abduction of the glenohumeral joint in the plane of the scapula (POS) was evaluated in vitro by a cadaver shoulder model. The posterior portion of the middle deltoid is affected by an acrominectomy. The moment arm during 0∘to 75∘of glenohumeral abduction in the POS decrease 20% to 75% in lateral acromionectomy of 1 cm width, decrease 32% to 138% in a lateral acromionectomy of 2 cm width. While it was only 10% diminution of the moment arm for the anterior portion of the deltoid muscle. It implicates that the anterior part of the acromion can be removed in order to decompress the underlying soft tissue without adverse effect. Good results can be expected by the anterior acromionectomy. The moment arm of the middle deltoid during abduction is enhanced 17% to 73% by a lateral advancement of the acromion. A concomitant 5 mm proximal advancement of the acromion is achieved by transferring the osteotomized acromion along an oblique osteotomy plane of 30∘which is made through the base of the spine of the scapula. Although decompression is achieved by raising the acromion proximly, the difficulty of fixation of the osteotomized acromion makes the procedure skeptical.