Diminutive Incision Acromioplasty Assisted With Arthroscopy In The Treatment Of Subacromial Impingement Syndrome

Objection:To explore the methods and the clinical effects of diminutive incision acromioplasty assisted with arthroscopy for the treatment of subacromial impingement syndrome.Method:10 cases (11 shoulders) with subacromial impingement syndrome of shoulder were studied. Among them,4 were males and 6 females.7 right shoulders and 4 left shoulders were involved. The average age of patients was 56 years ranging from 17 to 80.0 injury was classified as degreeⅠ,3 asⅡ7asⅢaccording to Neer classification. All patients had a chronic injury and painful history around shoulder. The positive arce test, impingement test, Neer test, and drop arm test were presented in all 10 cases.8 cases were arce test positive,7 Neer sign positive,9 impingement positive and 5 drop arm test positive. All 10 patients received MRI examinations and 5 arthrographies of the shoulder. The routine check of 3-positive shoulder joint projection of x-ray were obtained before surgery. Among them,1 was diagnosed with flat scapular acromion,4 cases curved scapular acromion, and 5 cases hook scapular acromion.The procedures of arthroscopic acromioplasty consisted of the following 6 steps. The first was arthroscopic subacromial inspection with posterior portal; The second was the resection of abnormal synovia proliferation with electro-shaver or burr. The third was the abscise or partial resection of the coracoacromial ligament with hook scalpel. The fourth was the deltoid disartic ulation along the edge of acromion without the arthroscope. This procedure provides a direct and clear view of the surgical area allowing the surgeons to remove the abnormal tissue accurately and avoid the damage of the normal structures. The fifth was the wedge resection of the forward and lower part of the acromion. And 4 patients underwent reparation of the rotator cuff simultaneously. The sixth was the treatment with intra articular injection of sodium hyaluronate injection and the suture of the incision.Results:All cases were available for follow-up. The average time was 15 months ranging from 12 to 24 months. According to the UCLA scoring system, the average score was15.4±2.2 and 31.2±3.3 before and post operation respectively. The results were 7 excellent,2 good and 1 fair.Conclusion:Subacromial impingement sysdrome has attracted more and more attention of the physicians in recent ten years. And the adminutive incision acromioplasty assisted with arthroscopy is a reliable solution to subacromial impingement syndrome. The advantages can be listed as the follows, less trauma and retraction injury of nerve, shorter operative time, rapid recovery and early rehabilitation and so on. Above all, the direct and clear view of the surgical area allows the surgeons to stop bleeding accurately and avoid the damage of normal structures, which helps reduce the joint swelling. And with the thorough bad tissue resection and plasty, it can reduce the revision rate.