Arthroscopic Bankart repair combined with Reimplissage for the treatment of recurrent anterior dislocation of shoulder in adults with Hill-Sachs defect / 中国骨伤

OBJECTIVE@#To investigate the method and clinical effects of the treatment of recurrent anterior dislocation of shoulder with Hill-Sachs injury by arthroscopic Bankart repair and Remplissage.@*METHODS@#From March 2016 to March 2019, 106 patients with recurrent anterior dislocation of shoulder with glenoid bone defect less than 20% underwent arthroscopic Bankart repair, including 76 males and 30 females, aged from 18 to 45 (27.3±8.6) years, 59 cases of left shoulder and 47 cases of right shoulder. Range of motion (ROM), American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score and Rowe score were used to evaluate shoulder functionand stability before and after operation.@*RESULTS@#All patients were followed up, and the duration ranged from 21 to 60 months, with a mean of (41.5± 8.5) months. One patient developed infection after operation, and the infection was controlled after arthroscopic debridement again. The remaining patients did not have clinical complications such as infection, intra articular hematocele and redislocation. Shoulder flexion and lifting increased from (158.33±15.72) ° preoperatively to (169.43±10.04) ° at the latest follow up, and internal rotation changed from T7 (T4 to T10) preoperatively to T8 (T5 to T10) at the latest follow up;the average lateral external rotation and abduction 90 ° external rotation decreased from (58.46±15.51) ° preoperatively and (99.37±14.09) ° to (53.18±14.90) ° and (92.52±13.10) ° at the latest follow up, respectively. The ASES score, Constant -Murley score and Rowe score were significantly improved.@*CONCLUSION@#The clinical effect of rehabilitation of Bankart repair combined with Remplissageunder arthroscopy in the treatment of recurrent dislocation of shoulder joint in adults with Hill-Sachs defect is satisfactory. Although the external rotation function is weaker than that before operation, it can effectively reconstruct the shoulder function and avoid the occurrence ofdislocation after operation.

Total joint arthroplasty and deep venous thrombosis / 中华创伤骨科杂志

Deep venous thrombosis (DVT) is initiated intraoperatively and may display symptoms postopera- tively following total hip or total knee arthroplasties. Pulmonary embolism (PE) and DVT cause morbidity and mortality. It has been established that patients who undergo a major lower-extremity joint replacement should receive prophylaxis due to the increased risk of DVT. Despite use of thrombo-prophylaxis, elective replacement surgery carries a high risk of venous thromboembolic complications. The early detection of DVT and treatment with systemic anticoagulation to pre- vent DVT are essential in the management of patients undergoing total joint arthroplasty. Extended medical throm- bo-prophylaxis is indicated for some high-risk patients. Routine postoperative duplex surveillance for DVT may be clinically useful. In the early post-operative phase, combined prophylaxis such as low-molecular-weight heparins and mechanical methods may be more effective than single intervention measures. However, the efficacy and safety of an- ticoagulation therapy, using various medicines administered after total arthroplasty of large joints are still undetermined and controversial.We should also be alert to the frequency and extent of postoperative hematomas. There are still many uncertainties in treatments to prevent DVT in terms of safety and cost-effectiveness. Therefore, prospective, ran- domised, controlled and multicenter studies may be necessary to obtain valuable information according to evidence based medicine.