强直性脊柱炎合并巨大肩袖损伤1例报告 并文献复习

Ankylosing Spondylitis Complicated by Massive Rotator Cuff Tear: A Case Report and Literature Review

摘要: 目的：探讨强直性脊柱炎(AS)合并巨大肩袖损伤的临床特点、发病机制及围手术期管理策略。方法：报告1例47岁男性AS患者，因外伤后右肩疼痛、活动受限3周入院，术前MRI证实为冈上、冈下肌腱巨大撕裂(约5 cm)，行关节镜下肩袖缝合联合肱二头肌长头腱转位固定术，并复习相关文献。结果：术中见滑膜增生明显，肌腱脆性大、回缩显著，印证AS慢性附着点炎导致的肌腱退变基础。术后疼痛明显缓解，切口愈合良好，短期疗效满意；围手术期经风湿免疫科会诊，启用依托考昔并计划后续生物制剂治疗，实现多学科协作(MDT)管理。结论：AS是肩袖损伤的重要危险因素，其机制涉及肌腱附着点炎症致肌腱质量下降、脊柱后凸畸形所致肩关节生物力学异常及继发性肩峰下撞击。对此类患者，关节镜修复局部损伤与MDT控制全身炎症相结合，可能是一种有前景的治疗思路。

Abstract: Objective: To investigate the clinical characteristics, pathogenesis, and perioperative management strategies for ankylosing spondylitis (AS) complicated by a massive rotator cuff tear. Methods: A 47-year-old male patient with AS was admitted with right shoulder pain and limited range of motion persisting for 3 weeks following trauma. Preoperative MRI confirmed a massive tear of the supraspinatus and infraspinatus tendons (approximately 5 cm). Arthroscopic rotator cuff repair combined with transfer and fixation of the long head of the biceps tendon was performed, and the relevant literature was reviewed. Results: Intraoperatively, marked synovial hyperplasia was observed, and the tendons were notably friable and retracted, confirming the tendon degeneration underlying chronic enthesitis in AS. Postoperatively, the patient’s pain was significantly relieved, the wound healed well, and the short-term outcome was satisfactory. During the perioperative period, following consultation with the rheumatology department, etoricoxib was initiated, and subsequent biologic therapy was planned, thereby achieving multidisciplinary team (MDT) management. Conclusion: AS is an important risk factor for rotator cuff tears. The underlying mechanisms involve enthesitis-induced deterioration of tendon quality, abnormal shoulder biomechanics resulting from kyphotic deformity, and secondary subacromial impingement. For such patients, combining arthroscopic repair of the local injury with MDT-based systemic inflammation may be a promising therapeutic strategy.