劉海鵬郝宗文徐雅強(qiáng)劉振剛張培訓(xùn)

·論著·

ASD聯(lián)合三維重建技術(shù)治療肩峰下撞擊綜合征療效分析

劉海鵬1郝宗文1徐雅強(qiáng)1劉振剛1張培訓(xùn)2

目的評(píng)價(jià)關(guān)節(jié)鏡肩峰下間隙減壓術(shù)（arthroscopic subacromial decompression，ASD）聯(lián)合三維重建技術(shù)治療肩峰下撞擊綜合征的療效。方法回顧性分析自2014年1月至2015年6月在昌邑市人民醫(yī)院采取ASD聯(lián)合三維重建技術(shù)治療的肩峰下撞擊綜合征患者共58例，術(shù)前應(yīng)用三維重建技術(shù)對(duì)肩關(guān)節(jié)進(jìn)行模擬成像，在其三維圖像上測(cè)量同一患者患側(cè)及健側(cè)頭頂肩峰距（head to acromion distance，HAD）、肱骨頭的相對(duì)高度（the relative height of the humerus head，HH）、肩峰喙突距（acromion to coracoid distance，ACD）、結(jié)節(jié)肩峰距（tuberosity to acromion distance，TAD）。根據(jù)每個(gè)患者的測(cè)量結(jié)果，明確引起撞擊的原因，在ASD中行個(gè)性化操作，精確磨除相應(yīng)骨贅治療肩峰下撞擊綜合征。采用美國(guó)加州大學(xué)（University of California, Los Angeles，UCLA）肩關(guān)節(jié)功能標(biāo)準(zhǔn)評(píng)價(jià)手術(shù)療效。結(jié)果患側(cè)HH的平均值為（0.87±0.19）cm，健側(cè)HH的平均值為（1.08±0.21）cm，患側(cè)較健側(cè)距離低，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；患側(cè)HAD的平均值為（0.54±0.11）cm，健側(cè)HAD的平均值為（0.66±0.15）cm，患側(cè)較健側(cè)的距離低，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；患側(cè)ACD的平均值為（2.90±0.39）cm，健側(cè)ACD的平均值為（2.91±0.40）cm，患側(cè)較健側(cè)的距離差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；患側(cè)TAD的平均值為（1.96±0.48）cm，健側(cè)TAD的平均值為（1.95±0.45）cm，患側(cè)較健側(cè)的距離差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。隨訪時(shí)間12～24個(gè)月，平均16.4個(gè)月。UCLA評(píng)分術(shù)前為（16.8±4.1）分，術(shù)后（32.4±1.5）分，兩者差異有統(tǒng)計(jì)學(xué)意義（P＜0.05），優(yōu)良率為91.4%。結(jié)論術(shù)前采用三維重建技術(shù)測(cè)量肩關(guān)節(jié)HAD、HH、ACD、TAD可明確引起撞擊的原因，為ASD提供精確的量化指標(biāo)，術(shù)中可精確磨除相應(yīng)骨贅，具有創(chuàng)傷小、精確度高、恢復(fù)快、并發(fā)癥少等優(yōu)點(diǎn)。

關(guān)節(jié)鏡肩峰下間隙減壓術(shù); 三維重建技術(shù); 個(gè)性化操作; 肩峰下撞擊綜合征

肩峰下撞擊綜合征最早由Neer提出,是導(dǎo)致肩部疼痛及功能障礙的常見原因[1］。目前關(guān)節(jié)鏡肩峰下間隙減壓術(shù)（arthroscopic subacromial decompression，ASD）已成為治療肩峰下撞擊綜合征的首選方法，取得了滿意的效果并得到了極大的推廣[2］。本研究回顧性分析自2014年1月至2015年6月期間在昌邑市人民醫(yī)院采用ASD聯(lián)合三維重建技術(shù)治療肩峰下撞擊綜合征患者58例，療效滿意，現(xiàn)報(bào)道如下。

資料與方法

一、一般資料

本組患者共58例，其中男26例、女32例;年齡27～81歲，中位年齡56歲。術(shù)前均行3～6個(gè)月保守治療，包括休息、物理治療、口服消炎止痛藥物和增強(qiáng)肌力鍛煉等，效果不佳。

二、術(shù)前測(cè)量

1.HAD：是指在肩關(guān)節(jié)三維重建圖像上測(cè)量肱骨頭最高點(diǎn)至肩峰前外側(cè)角之間的垂直距離，標(biāo)記為A1A2。

2.HH：是指在肩關(guān)節(jié)三維重建圖像上測(cè)量肱骨大結(jié)節(jié)與肱骨頭頂之間的距離，標(biāo)記為B1B2。

3.ACD：是指在肩關(guān)節(jié)三維重建圖像上旋轉(zhuǎn)肩胛骨，測(cè)量肩峰前外側(cè)角與喙突尖之間的距離，標(biāo)記為 C1C2。

4.TAD：是指在肩關(guān)節(jié)三維重建圖像上測(cè)量肱骨大結(jié)節(jié)外側(cè)緣至肩峰最外側(cè)緣之間的水平距離，標(biāo)記為D1D2。

圖1 三維重建圖像上測(cè)量HAD、HH、ACD、TAD骨性解剖結(jié)構(gòu) 圖A為頭頂肩峰距；圖B為肱骨頭的相對(duì)高度；圖C為肩峰喙突距；圖D為結(jié)節(jié)肩峰距

三、手術(shù)方法

（一）個(gè)性化操作的設(shè)計(jì)

通過術(shù)前測(cè)量患側(cè)及健側(cè)肩關(guān)節(jié)的HAD、HH、ACD、TAD等骨性解剖結(jié)構(gòu)，明確引起該患者肩峰下撞擊綜合征的原因，從而為患者術(shù)中行個(gè)性化操作。如患者術(shù)前三維重建圖像上可見明顯的肩峰下骨贅，使HAD的距離較該患者健側(cè)明顯變小，可參照健側(cè)的測(cè)量指標(biāo)，術(shù)中精確磨除相應(yīng)骨贅，防止術(shù)中過度磨除骨質(zhì)引起肩峰骨折或者因磨除不徹底，減壓不充分，使術(shù)后撞擊征繼續(xù)存在。對(duì)于術(shù)前三維重建圖像上患側(cè)HH明顯小于健側(cè)的患者，可根據(jù)測(cè)量的結(jié)果，術(shù)中精確磨除肱骨大結(jié)節(jié)骨贅。

（二）手術(shù)步驟

經(jīng)過十多年的發(fā)展，金山第二工業(yè)區(qū)已經(jīng)形成新型表面活性劑、功能性涂料、合成新材料、生物醫(yī)藥、化工物流五大產(chǎn)業(yè)集群，并產(chǎn)生了巴斯夫、三井、朗盛、亨斯邁、東曹、科萊恩等一批具有代表性的龍頭企業(yè)，成為上海重要的化工園區(qū)。

采用全身麻醉，沙灘椅位。常規(guī)后入路行盂肱關(guān)節(jié)檢查，然后行肩峰下間隙檢查，鏡檢完畢后行ASD。在關(guān)節(jié)鏡的觀察下,磨頭自肩峰的前外側(cè)逐漸向內(nèi)行“羽毛樣”研磨,根據(jù)術(shù)前三維重建測(cè)量的HAD數(shù)據(jù)結(jié)果，行個(gè)性化操作，精確磨除肩峰下表面骨贅，磨除的骨贅厚度在5～8 mm。對(duì)于術(shù)前三維重建測(cè)量確定HH明顯小于健側(cè)的患者，可根據(jù)測(cè)量的結(jié)果，施行精確的大結(jié)節(jié)成型術(shù)。探查肩峰下肩袖，對(duì)于肩袖的部分性損傷，應(yīng)用帶線骨縫合錨釘進(jìn)行縫合固定。充分地沖洗，射頻消融仔細(xì)止血。無菌輔料覆蓋，可放置引流管。術(shù)后可留置鎮(zhèn)痛泵（圖2）。

四、療效評(píng)價(jià)標(biāo)準(zhǔn)

采用美國(guó)加州大學(xué)（University of California,Los Angeles，UCLA）肩關(guān)節(jié)功能評(píng)分標(biāo)準(zhǔn)[3］評(píng)價(jià)療效。UCLA評(píng)分總分為35分，其中疼痛評(píng)分為10分，功能評(píng)分10分，前屈活動(dòng)度評(píng)分5分，前屈肌力評(píng)分5分，患者滿意度評(píng)分5分。34～35分為優(yōu)，29～33分為良， ＜29分為差。

五、統(tǒng)計(jì)學(xué)分析

采用SPSS 17.0軟件對(duì)數(shù)據(jù)進(jìn)行分析和處理，計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差（±s）表示，計(jì)量資料比較采用t檢驗(yàn)。P ＜0.05為差異有統(tǒng)計(jì)學(xué)意義。

結(jié) 果

患側(cè)HH的平均值為（0.87±0.19）cm，健側(cè)HH的平均值為（1.08±0.21）cm，患側(cè)較健側(cè)距離低，差異有統(tǒng)計(jì)學(xué)意義（P ＜0.05）；患側(cè)HAD的平均值為（0.54±0.11）cm，健側(cè)HAD的平均值為（0.66±0.15）cm，患側(cè)較健側(cè)的距離低，差異有統(tǒng)計(jì)學(xué)意義（P ＜0.05）；患側(cè)ACD的平均值為（2.90±0.39）cm，健側(cè)ACD的平均值為（2.91±0.40）cm，患側(cè)較健側(cè)的距離差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；患側(cè)TAD的平均值為（1.96±0.48）cm，健側(cè)TAD的平均值為（1.95±0.45）cm，患側(cè)較健側(cè)的距離差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），見表1。隨訪時(shí)間12～24個(gè)月，平均16.4個(gè)月。UCLA評(píng)分術(shù)前為（16.8±4.1）分，術(shù)后（32.4±1.5）分，兩者差異有統(tǒng)計(jì)學(xué)意義（P ＜0.05），見表2。根據(jù)UCLA評(píng)分，優(yōu)32例，良21例，差5例，優(yōu)良率為91.4%。

討 論

肩峰下撞擊綜合征是當(dāng)肩關(guān)節(jié)行前屈、外展動(dòng)作時(shí)，肱骨大結(jié)節(jié)與喙肩弓發(fā)生反復(fù)撞擊，導(dǎo)致肩峰下滑囊炎癥、肩袖組織退變，甚至肩袖撕裂，從而引起肩部疼痛和功能障礙等一系列癥狀[4-5］。

當(dāng)前，對(duì)肩關(guān)節(jié)骨性解剖結(jié)構(gòu)與肩峰下撞擊綜合征發(fā)生原因的相關(guān)性上，肩峰下間隙空間的大小與肩峰形態(tài)的改變是研究的主要部分，但是這種測(cè)量的缺點(diǎn)只針對(duì)局部部位，即肩關(guān)節(jié)單一骨性結(jié)構(gòu)，沒有對(duì)其整體及全局作出概括，從而影響了肩關(guān)節(jié)整體結(jié)構(gòu)的研究，使肩峰下撞擊綜合征的發(fā)病原因得不到深入的了解和探討。隨著研究測(cè)量方法的多樣化、評(píng)價(jià)標(biāo)準(zhǔn)的細(xì)化，學(xué)者們對(duì)肩關(guān)節(jié)骨性解剖結(jié)構(gòu)與肩峰下撞擊綜合征發(fā)生原因的相關(guān)性研究有各自的看法和見解[6］。本研究使用三維重建技術(shù)這種測(cè)量方法來探討肩峰下撞擊綜合征與骨性解剖結(jié)構(gòu)之間的相關(guān)性發(fā)現(xiàn)：患側(cè)HAD、HH比健側(cè)低，說明HAD、HH與肩峰下撞擊綜合征的發(fā)生有相關(guān)性，提示HAD、HH越低，肩峰撞擊越容易發(fā)生；而患側(cè)TAD、ACD與健側(cè)無明顯差別，說明TAD、ACD與肩峰下撞擊綜合征的發(fā)生不具有相關(guān)性。

在對(duì)肩關(guān)節(jié)骨性解剖結(jié)構(gòu)測(cè)量的精確度方面，經(jīng)三維重建技術(shù)測(cè)量得到數(shù)據(jù)的準(zhǔn)確性已經(jīng)得到了眾多學(xué)者的公認(rèn)[7］。三維重建技術(shù)具有強(qiáng)大的后臺(tái)整合功能，優(yōu)勢(shì)明顯，可以在患者肩關(guān)節(jié)骨性結(jié)構(gòu)的任意斜面上進(jìn)行任意角度的觀測(cè)，相較于X線片而言，三維重建技術(shù)能更加清楚地觀測(cè)出患者肩峰的骨性解剖結(jié)構(gòu)[8-9］。通過三維重建技術(shù)這種影像學(xué)測(cè)量方法及測(cè)量結(jié)果，證明在最終數(shù)據(jù)的準(zhǔn)確性方面，三維重建技術(shù)在測(cè)量肩關(guān)節(jié)骨性結(jié)構(gòu)的方面是最有優(yōu)勢(shì)的[10-11］。

圖2 ASD的手術(shù)過程 圖A為肩峰前外側(cè)增生骨贅及撞擊圖像；圖B為磨頭精確磨除增生骨贅；圖C為肩峰成型后圖像；圖D為磨頭行精確肱骨大節(jié)結(jié)成型；圖E為肩袖損傷縫合后圖像；圖F為術(shù)后拍片復(fù)查圖像

本研究通過應(yīng)用三維重建技術(shù)，對(duì)肩關(guān)節(jié)整體骨性結(jié)構(gòu)做了測(cè)量分析，這種技術(shù)方法臨床操作沒有難度，可以反復(fù)的測(cè)量直至得出準(zhǔn)確的數(shù)據(jù)。更加深入地了解肩關(guān)節(jié)骨性結(jié)構(gòu)與肩峰下撞擊綜合征的關(guān)系，并根據(jù)每個(gè)患者的測(cè)量數(shù)據(jù)，明確引起撞擊的原因，在ASD中做到個(gè)性化操作。在手術(shù)方式上，不僅僅單純行軟組織損傷的修復(fù)，更要注重糾正骨性結(jié)構(gòu)的異常。術(shù)中根據(jù)同一患者患側(cè)及健側(cè)測(cè)量數(shù)據(jù)的差異，精確磨除相應(yīng)骨贅，不僅達(dá)到了充分減壓的目的，而且避免了術(shù)中因過度磨除骨質(zhì)而引起肩峰骨折或磨除不充分而達(dá)不到減壓效果等并發(fā)癥的發(fā)生。本研究?jī)?yōu)良率為91.4%，遠(yuǎn)高于Chopp-Hurley等[12］報(bào)道的 77%。

綜上所述，本研究應(yīng)用ASD聯(lián)合三維重建技術(shù)治療肩峰下撞擊綜合征具有以下優(yōu)點(diǎn)：（1）與開放性手術(shù)相比，其手術(shù)的創(chuàng)傷小，精確度高，皮膚切口更小、更美觀，術(shù)后疼痛輕，恢復(fù)快；（2）手術(shù)的同時(shí)還能及時(shí)發(fā)現(xiàn)關(guān)節(jié)內(nèi)的其他損傷并予對(duì)癥治療；（3）保護(hù)三角肌附著點(diǎn)，避免了三角肌的剝離，對(duì)三角肌的損傷輕微；（4）可在鏡下直接觀察到肩袖損傷情況并及時(shí)給予縫合固定;（5）術(shù)后并發(fā)癥的發(fā)生率低而且住院時(shí)間短，臨床效果滿意。

表1 患側(cè)與健側(cè)HH、HAD、ACD、TAD測(cè)量結(jié)果比較（cm，±s）

表1 患側(cè)與健側(cè)HH、HAD、ACD、TAD測(cè)量結(jié)果比較（cm，±s）

側(cè)別 HH HAD ACD TAD患側(cè) 0.87±0.19 0.54±0.11 2.90±0.39 1.96±0.48健側(cè) 1.08±0.21 0.66±0.15 2.91±0.40 1.95±0.45t值 5.647 4.913 0.136 0.116P值 P＜0.05 P＜0.05 P＞0.05 P＞0.05

表2 肩峰下撞擊綜合征患者手術(shù)前后UCLA評(píng)分比較（分，±s）

表2 肩峰下撞擊綜合征患者手術(shù)前后UCLA評(píng)分比較（分，±s）

時(shí)間 總分 疼痛 功能 前屈角度 前屈肌力術(shù)前 16.8±4.1 3.1±1.5 5.1±1.9 4.1±1.6 4.3±1.9術(shù)后 32.4±1.5 8.3±1.3 9.0±1.1 4.8±1.4 4.7±0.3t值 27.213 19.951 13.528 2.508 1.584P值 P＜ 0.05 P＜ 0.05 P＜ 0.05 P＜ 0.05 P＜ 0.05

[1]Gomora-García M, Rojano-Mejía D, Solis-Hernández JL, et al.Effectiveness of physiotherapy on painful shoulder impingement syndrome[J］. Cir Cir, 2016, 84（3）: 203-207.

[2]Mulligan EP, Huang M, Dickson T, et al. The effect of axioscapular and rotator cuff exercise training sequence in patients with subacromial impingement syndrome: a randomized crossover trial[J］. Int J Sports Phys Ther, 2016, 11（1）:94-107.

[3]劉柱同, 孫小平. 關(guān)節(jié)鏡微創(chuàng)治療合并肩周炎的老年肩袖損傷的臨床療效[J］. 中國(guó)老年學(xué)雜志, 2015, 35（4）：986-988．

[4]Mihata T, Mcgarry MH, Kahn T, et al. Biomechanical effects of acromioplasty on superior capsule Reconstruction for irreparable supraspinatus tendon tears[J］. Am J Sports Med,2016, 44（1）: 191-197.

[5]潘昭勛, 崔巖, 孫超, 等. 肱骨頭的相對(duì)高度與肩峰下撞擊綜合征的相關(guān)性研究[J］. 中國(guó)臨床解剖學(xué)雜志, 2014, 32（3）：354-356．

[6]Lecouvet FE, Simoni P, Kouta?ssoff S, et al. Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with Mr arthrography and arthroscopic correlations[J］.Eur J Radiol, 2008, 68（1）: 120-136.

[7]Seehaus F, Olender GD, Kaptein BL, et al. Markerless roentgen stereophotogrammetric analysis for in vivo implant migration measurement using three dimensional surface models to represent bone[J］. J Biomech, 2012, 45（8）: 1540-1545.

[8]江凱, 葉如卿, 王蓼, 等. MSCT在肩峰分型及其與肩峰下撞擊綜合癥的相關(guān)性的應(yīng)用研究[J］. 醫(yī)學(xué)影像學(xué)雜志,2014, 24（8）：1362-1365．

[9]江凱, 葉如卿, 王蓼, 等. MSCT與MRI在肩峰下撞擊綜合癥診斷中的應(yīng)用價(jià)值[J］. 中華全科醫(yī)學(xué), 2015, 13（5）：800-803．

[10]龔繼承, 唐康來, 曹洪輝, 等. 肱骨近端三維解剖結(jié)構(gòu)的測(cè)量分析 [J］. 中國(guó)修復(fù)重建外科雜志, 2011, 25（9）:1074-1077.

[11]李亞超, 于蓓, 李曉麗. 肩峰下撞擊綜合征與MSCT下肩峰分型的關(guān)系研究[J］. CT理論與應(yīng)用研究, 2015, 24（5）:753-759.

[12]Chopp-Hurley JN, Langenderfer JE, Dickerson CR. A probabilistic or thopaedic population model to predict fatiguerelated subacromial geometric variability[J］. J Biomech,2016, 49（4）: 543-549.

Therapeutic effect analysis of ASD combined 3D reconstruction technique in the treatment of subacromial impingement syndrome

Liu Haipeng1, Hao Zongwen1, Xu Yaqiang1, Liu Zhengang1, Zhang Peixun2.1Department of Orthopaedics, Changyi People's Hospital, Changyi 261300, China;2Department of Trauma and Orthopedics, Peking University People's Hospital,Beijing 100044,China

Zhang Peixun, Email: zhangpeixun@126.com

BackgroundAcromial impingement syndrome was first proposed by Neer and is a common cause of shoulder pain and dysfunction. Currently, arthroscopic subacromial decompression （ASD）has become a preferred method for the treatment of subacromial impingement, which achieved satisfactory results and got a great promotion. In this study, 58 patients with acromial impingement syndrome were treated with ASD combined with threedimensional reconstruction technique in Changyi people's hospital from January 2014 to June 2015to evaluate the corresponding therapeutic effect.Methods（1） General information. Fifty-eight patients were involved in the group, including 26 males and 32 females; the age ranged from 27-81 years with an average of 56 years. All patients were treated conservatively for 3-6 months with poor outcomes, including rest, physical therapy, oral medication of NSAIDs and muscle strengthening exercise.（2）Preoperative measurement. The three-dimensional reconstruction technique was adopted to measure the relative height of the humerus head（HH）, the head to acromion distance（HAD）, the acromion to coracoid distance（ACD）, the tuberosity to acromion distance（TAD）.①HAD: the vertical distance between the highest point of the humeral head and the anterolateral acromial angle measured on the 3D reconstruction image of shoulder, marked as A1A2. ②HH:the distance between the greater tuberosity of humeral and the vertex of humeral head on the 3D reconstruction image of shoulder, marked as B1B2.③ACD: the distance between the anterolateral acromial angle and the tip of coracoid process measured on the 3D reconstruction image of the shoulder with rotation of scapula, marked as C1C2. ④TAD: the horizontal distance between the lateral margin of great tubercle of humerus and the outermost margin of acromion measured on the 3D reconstruction image of shoulder, marked as D1D2. （3）Surgical methods. ①Individualized operation design. Through preoperative measurements of HAD, HH, ACD, TAD and other anatomical structures of the affected and unaffected shoulder joints, the causes of subacromial impingement syndrome were clearly understood in order to perform individualized operation for the patient. If the visible subacromial osteophytes on preoperative images of 3-D reconstruction made HAD distance smaller than that of the uninjured side, the corresponding osteophytes could be removed intraoperatively based on the data measured for the uninjured side. This prevented the insufficient decompression caused by excessive or inadequate bone removal and the continuous existence of postoperative impingement syndrome. For patients with the ipsilateral HH much smaller than the contralateral HH on preoperative 3D reconstruction, osteophytes of the humeral greater tuberosity could be removed by accurate rubbing based on the measurement result.②Surgical procedures. Under general anesthesia, the patient was in beach chair position. The posterior approach was adopted regularly for examinations of glenohumeral joint and subacromial space. The decompression of subacromial space was performed after arthroscopic examination.Under the observation of arthroscopy, "feather like" rubbing was conducted medially from the anterolateral acromion using the motorizing bur. Individualized operation was performed based on the HAD data measured by preoperative 3D reconstruction to precisely removc the osteophytes on the inferior surface of acromion, and the thickness of removed osteophytes ranged from 5 to 8 mm. For patients with the ipsilateral HH much lower than the contralateral HH on preoperative 3D reconstruction, greater tuberosity plasty could be performed based on the measurement result.During the exploration, suture fixation should be carried out with suture anchors for partial tears of rotator cuff. After sufficient irrigation, hemostasis was performed carefully with radiofrequency ablation. The aseptic dressing was used for covering, and the drainage tube could be placed. The analgesic pump could be used postoperatively.（4）Evaluative criteria of therapeutic effect. The curative effect was evaluated by the shoulder functional score criteria of University of California,Los Angeles （UCLA）. The total score of UCLA was 35 points, including pain for 10 points,function for 10 points, range of anteflexion for 5 points, muscle strength of anteflexion for 5 points and patient satisfaction for 5 points. 34-35 points were considered excellent, 29-33 points were good, and ＜29 points were poor.（5）Statistical analysis. The SPSS 17.0 software was used for data analysis and process. The measurement data were expressed as mean±standard deviation.The measurement data were compared with t test.P＜0.05 was considered statistically significant.ResultsThe average HH value for the affected side was （0.87±0.19）cm, which was lower than the average HH value for the unaffected side（1.08±0.21）cm, and the difference was statistically significant（P＜0.05）. The average HAD value for the affected side was （0.54±0.11）cm,which was lower than the average HAD value for the unaffected side（0.66±0.15）, and thedifference was statistically significant（P＜0.05）. The average ACD value for the affected side was （2.90±0.39）cm, and the corresponding value for the unaffected side was（2.91±0.40）cm.There was no statistical difference in between （P＞0.05）. The average TAD value was（1.96±0.48）cm for the affected side and was（1.95±0.45）cm for the unaffected side. There was no statistical difference in between （P＞0.05）. The average follow-up time was 16.4 month with a range of 12-24 months. The UCLA score was （16.8±4.1） points preoperatively and（32.4±1.5）points postoperatively, and the difference in between was statistically significant （P＜0.05）. According to the UCLA score, 32 cases were excellent, 21 cases were good and 5 cases were bad. The excellent and good rate was 91.4%.ConclusionsThe research of ASD combined with 3D reconstruction technique for the treatment of subacromial impingement syndrome has the following advantages:（1） Compared to the open surgery, this operation has small trauma, high accuracy, smaller and more beautiful skin incision, less postoperative pain and quick recovery; （2） Other intra-articular damages can be discovered and treated during surgery; （3） The attachment point of deltoid muscle is protected to avoid stripping. Thus, little damage to the muscle is resulted; （4） The rotator cuff injury can be observed directly and sutured for fixation on time under arthroscopy; （5） The incidence of postoperative complications is low with short hospitalization, and the clinical effect is satisfactory.

Arthroscopic subacromial decompression; 3D reconstruction technique;Individualized operations; Subacromial impingement syndrome

2017-02-22）

（本文編輯：胡桂英；英文編輯：陳建海、張曉萌、張立佳）

10.3877/cma.j.issn.2095-5790.2017.02.005

國(guó)家自然科學(xué)基金（31571235）；國(guó)家自然科學(xué)基金（31171150）；國(guó)家自然科學(xué)基金（31271284）；國(guó)家自然科學(xué)基金（81171146）；教育部新世紀(jì)優(yōu)秀人才（BMU20110270）；國(guó)家科技部863計(jì)劃（SS2015AA020501）；教育部創(chuàng)新團(tuán)隊(duì)（IRT1201）

261300 昌邑市人民醫(yī)院骨關(guān)節(jié)外科1；100044 北京大學(xué)人民醫(yī)院創(chuàng)傷骨科2

張培訓(xùn), Email: zhangpeixun@126.com

劉海鵬,郝宗文,徐雅強(qiáng),等. ASD聯(lián)合三維重建技術(shù)治療肩峰下撞擊綜合征療效分析[J/CD］.中華肩肘外科電子雜志,2017,5（2）：102-107.