ABSTRACT
Objective:To investigate the clinical outcome of arthroscopic suture-button Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability.Methods:A retrospective case series study was conducted to analyze 28 patients with recurrent anterior shoulder instability admitted to Shanghai Sixth People’s Hospital from March 2015 to September 2018，including 26 males and 2 females，aged 18-36 years ［（24.1 ± 3.2）years］. Preoperative MRI showed Bankart injury and three-dimensional CT showed glenoid bone defect > 15%. The Hill-Sachs injury was found in 27 patients. Arthroscopic Bristow procedure was used to fix coracoid process graft with the suture-button plate and glenoid labial complex was repaired with the suture anchor to treat anterior instability of the shoulder joint. The visual analogue scale （VAS），American shoulder and elbow surgeon （ASES） scale，Constant score and Rowe score were used to evaluate the shoulder joint function preoperatively，at postoperative 3，6，12 months and at the last follow-up. The postoperative infection，neurovascular injury，redislocation and other complications were recorded，and the incidence rate was calculated. The bone resorption and bone healing of coracoid process graft were analyzed by CT.Results:All patients were followed up for 22 - 36 months ［（24.5 ± 6.3） months］. Three months after operation，the VAS，ASES scale and Constant score were not significantly different from those before operation （ P > 0.05）. In comparison，the Rowe score was significantly higher than that before operation （ P < 0.05）. Six and twelve months after operation，the VAS，ASES scale，Constant score and Rowe score were significantly improved from those before operation （ P < 0.05）. At the last follow-up，the VAS decreased from （2.7 ± 1.5）points preoperatively to （0.8 ± 0.3）points，the ASES scale increased from （78.6 ± 12.7）points preoperatively to （92.4 ± 8.4）points，the Constant score increased from （43.4 ± 5.2） points preoperatively to （81.6 ± 6.7） points，the Rowe score increased from （52.3 ± 7.1）preoperatively to （92.7 ± 5.4） points （ P < 0.05）. During the follow-up，there was no infection，neurovascular injury，re-dislocation and other complications. In addition，24 （86%） out of the 28 patient showed healing of coracoid process grafts，and the overall bone resorption rate was （18.4 ± 6.1）%. No patients had glenohumeral joint osteoarthritis. Conclusion:Arthroscopic Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability has advantages of a low rate of postoperative complications and a high union rate，indicating an effective and safe surgical procedure.
ABSTRACT
Objective To evaluate the effects of transplant adductor brevis and gracilis to correct scissors gait in spastic cerebral palsy. Methods From July 2000 to December 2004, 73 patients with scissors gait of spastic cerebral palsy were treated with transplantation of adductor brevis and gracilis, 47 were males and 26 were females, with the average of 12.06 years old. According to Ashworth's standard, the muscle tension was evaluated before surgery. 12 cases were in degree Ⅰ, 38 cases were in degreeⅡ, 18 cases in degree Ⅲ and 5 cases in degree Ⅳ. The end of adductor brevis was cut off and sutured with tensor fasciae latae through the tunnel under the skin, the end of gracilis was cut off and transplanted to the lateral condylus of femur through the back of the knee. Some certain surgery completed at the same time, the semitendious and biceops muscle was transplanted to the front of the knee(37 cases) and extended(13 cases), the soft tissue was released in hip joint(55 cases), the gastrocnemius cut off (32 cases), the Achilles's tendon extended(30 cases) and tibialis anterior lateral transplantation (31 cases), only peroneus longus lateral transplantation (8 cases). After operation the lower limbs was fixed with plaster cast for 6 weeks, then the plaster cast was removedassociating with functional exercise. The orthopaedic results were evaluated on the function of hip, knee, foot-malleoious and the gait, then classified four grades. Results All patients were followed up an average of 24.4 months. The scissors gait was corrected completely, 61 cases were excellent, 10 cases were good, 2 cases were fair. The majority symptom of whem was the knee flexure, but can be relieved by medicine. There were significant differences compared pre-operation with post-operation in four groups, and also between degree Ⅳ group and degree Ⅰand Ⅱgroup(P