CUFF-TEAR ARTHROPATHY
CUFF-TEAR ARTHROPATHY
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DOI：
10.2106/00004623-198365090-00003
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发表时间：
1983-01-01
影响因子：
5.3
通讯作者：
FUKUDA, H
中科院分区：
文献类型：
--
作者：
NEER, CS;CRAIG, EV;FUKUDA, H
描述了26例肩袖撕裂关节病的临床和病理表现，并讨论了导致其发展的病理机制的鉴别诊断和假设。由于肩袖的独特解剖结构，这种病变被认为是盂肱关节特有的。在肩袖大面积撕裂后，肩关节不活动和废用，滑液渗漏和肱骨头不稳定。这些事件反过来导致营养和机械因素，导致盂肱关节软骨萎缩和肱骨头软骨下骨骨质疏松。巨大的撕裂也会使肱骨头向上移位，造成肩峰下撞击，最终侵蚀肩峰前部和肩锁关节。最后，软，萎缩的头部崩溃，产生的袖口撕裂关节病的完整综合征。不协调的头部最终可能会侵蚀关节盂，以至于喙突也被侵蚀。虽然肩袖撕裂关节病的治疗非常困难，但首选的方法似乎是全肩关节表面置换，肩袖重建和特殊康复。重要的是要认识到袖口撕裂关节病作为一个独特的病理实体，因为这样的认识提高了更常见的撞击病变的理解。肩袖撕裂关节病尤其难以治疗，尽管许多肩袖撕裂没有扩大到足以使这种情况发展，但在决定是否应该手术修复肩袖撕裂时，这是一个需要考虑的因素。
The clinical and pathological findings of cuff-tear arthropathy were described in 26 patients and the differential diagnosis and a hypothesis on the pathomechanics that lead to its development were discussed. This lesion is thought to be peculiar to the glenohumeral joint because of the unique anatomy of the rotator cuff. Following a massive tear of the rotator cuff there is inactivity and disuse of the shoulder, leaking of the synovial fluid and instability of the humeral head. These events in turn result in both nutritional and mechanical factors that cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head. A massive tear also allows the humeral head to be displaced upward, causing subacromial impingement that in time erodes the anterior portion of the acromion and the acromioclavicular joint. Eventually the soft, atrophic head collapses, producing the complete syndrome of cuff-tear arthropathy. The incongruous head may eventually erode the glenoid so deeply that the coracoid becomes eroded as well. Although treatment of cuff-tear arthropathy is extremely difficult, the preferred method appears to be a resurfacing total shoulder replacement with rotator-cuff reconstruction and special rehabilitation. It is important to recognize cuff-tear arthropathy as a distinct pathological entity, as such recognition enhances understanding of the more common impingement lesions. Cuff-tear arthropathy is especially difficult to treat, and although many tears of the rotator cuff do not enlarge sufficiently to allow this condition to develop, it is a factor to consider when deciding whether or not a documented tear of the rotator cuff should be surgically repaired.