Incidence and epidemiology of adhesive capsulitis during the covid-19 pandemic / Incidência e epidemiologia de capsulite adesiva durante a pandemia de covid-19

ABSTRACT Objective: To evaluate a possible increase of adhesive capsulitis incidence during the COVID-19 pandemic. Methods: A total of 1,983 patients with shoulder disorders were retrospectively analyzed regarding gender, age, development of adhesive capsulitis and comorbidities (systemic arterial hypertension, diabetes mellitus, dyslipidemia, hypothyroidism, hyperthyroidism, depression, and anxiety) in two different periods: from March 2019 to February 2020 and from March 2020 to February 2021. Descriptive and quantitative variables were statistically analyzed. The program used for the calculations was SPSS 17.0 for Windows. Results: During the pandemic, there was a 2.41-fold increase (p < 0.001) in cases of adhesive capsulitis (compared to the previous year). Patients with depression and anxiety had a significantly increased risk by 8.8 (p < 0.001) and 14 (p < 0.001) times, respectively, of developing frozen shoulder (regarding the two periods studied). Conclusion: A significant increase in the incidence of frozen shoulder was observed after the onset of the COVID-19 pandemic in addition to a simultaneous increase of psychosomatic disorders. Prospective studies would help to ratify the idea contained in this research. Level of Evidence III, Observational Cross-Sectional Study.

RESUMO Objetivo: Avaliar se houve aumento da incidência de capsulite adesiva durante a pandemia de COVID-19. Métodos: Foram analisados, retrospectivamente, 1.983 pacientes com desordens do ombro quanto a sexo, idade, desenvolvimento de capsulite adesiva e comorbidades (hipertensão arterial sistêmica, diabetes mellitus, dislipidemia, hipo/hipertireoidismo, depressão e ansiedade) em dois períodos distintos: de março de 2019 a fevereiro de 2020 e de março de 2020 a fevereiro de 2021. Procedeu-se à análise estatística das variáveis descritivas e quantitativas, utilizando o software SPSS 17.0 for Windows para os cálculos. Resultados: Durante a pandemia, houve aumento de 2,41 vezes (p < 0,001) de casos de capsulite adesiva em relação ao ano anterior. Considerando os períodos estudados, pacientes com depressão e ansiedade apresentaram um risco significativamente aumentado em 8,8 (p < 0,001) e 14 (p < 0,001) vezes, respectivamente, de desenvolver a patologia em questão. Conclusão: Observou-se um aumento significativo da incidência de ombro congelado após o início da pandemia de COVID-19, além de sua relação com distúrbios psicossomáticos. São necessários estudos prospectivos futuros para ratificar a ideia contida nesta pesquisa. Nível de Evidência III, Estudo Transversal Observacional.

Mid-term clinical outcome of arthroscopic vertical mattress suturing for recurrent anterior shoulder dislocation combined with joint laxity / 中华创伤杂志

Objective:To investigate the mid-term clinical outcomes of arthroscopic vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity.Methods:A retrospective case series study was performed on the clinical data of 11 patients with recurrent anterior shoulder dislocation combined with joint laxity admitted to the First Affiliated Hospital, Army Medical University from January 2018 to September 2021. The patients included 10 males and 1 female, aged 18-38 years [(22.8±5.5)years]. All the patients received treatment with arthroscopic vertical mattress suturing. The Oxford shoulder instability score, Rowe shoulder instability score, and simple shoulder test (SST) score were compared before operation, at 6 months after operation and at the final follow-up. The degree of joint capsule laxity and length of capsular redundancy (evaluated by MRI) were compared before operation and at the final follow-up. The results of the supine apprehension test, re-dislocation and postoperative complications such as iatrogenic vascular and nerve injuries were observed at the final follow-up. Also, the correlation between the radiological changes in the joint capsule and the shoulder function was analyzed by Spearman correlation coefficient.Results:All the patients were followed up for 20-64 months [(40.7±18.6)months]. Before operation, at 6 months after surgery and at the final follow-up, the values of Oxford shoulder instability score were (41.2±4.7)points, (49.5±3.0)points and (57.6±3.0)points; the values of Rowe shoulder instability score were (28.6±9.5)points, (77.7±7.2)points and (94.1±10.9)points; and the values of SST score were (7.6±1.3)points, (9.8±1.0)points and (11.6±0.9)points, respectively. The Oxford shoulder instability score, Rowe shoulder instability score and SST at 6 months after operation and at the final follow-up were significantly better than those before operation, and those at the final follow-up were significantly better than those at 6 months after operation (all P<0.05). The MRI showed that the degree of joint capsular laxity and length of capsular redundancy were 1.5±0.2 and (19.7±2.5)mm before operation and were 1.3±0.2 and (12.9±3.7)mm at the final follow-up, respectively ( P<0.05 or 0.01). The supine apprehension test was negative at the final follow-up, with no re-dislocation or postoperative complications such as iatrogenic vascular or nerve injuries. Correlation analysis showed a negative correlation between the degree of joint capsular laxity and the Oxford shoulder instability score ( r=-0.62, P<0.05) and that of the length of capsular redundancy with the Oxford shoulder instability score ( r=-0.80, P<0.01), the Rowe shoulder stability score ( r=-0.73, P<0.01) and the SST score ( r=-0.75, P<0.01). Conclusions:Arthroscopic vertical mattress suturing has good mid-term clinical outcome for recurrent shoulder anterior dislocation combined with joint laxity, improving the shoulder function and reducing complications, wihch is associated with decreased joint capsule laxity and length of capsular redundancy.

Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft / Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata

Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Resumo Objetivo O objetivo do presente estudo foi avaliar a eficácia e a segurança da reconstrução capsular superior (RCS) com a utilização do aloenxerto de fáscia lata. Métodos Uma série de casos prospectivos de 15 pacientes com ruptura irreparável do supraespinhal foi submetida a RCS com aloenxerto de fáscia lata, sendo adotada como desfecho primário a escala American Shoulder and Elbow Surgeons (ASES, na sigla em inglês) aos 12 meses do pós-operatório. Como desfechos secundários, foram adotadas as escalas da University of California Los Angeles (UCLA, na sigla em inglês), Constant-Murley, e Single Assessment Numeric Evaluation (SANE, na sigla em inglês), além da amplitude de movimento. Os parâmetros radiológicos também foram avaliados por radiografias simples e ressonância magnética (RM). Resultados Quinze pacientes completaram 12 meses de acompanhamento pós-operatório. O escore ASES aumentou de 34,0 para 73,0 (p= 0,005). As escalas UCLA, Constant-Murley e SANE também apresentaram diferenças estatisticamente significativas (p= 0,001; p= 0,005; e p= 0,046). Na avaliação da amplitude de movimento, houve melhora na elevação e rotação externa (95 a 140°, p= 0,003; 30 a 60°, p= 0,007). Seis pacientes (40%) tiveram cicatrização completa do enxerto. Os desfechos clínicos foram significativamente maiores nos pacientes que apresentaram cicatrização do enxerto. Conclusões A RCS com aloenxerto de fáscia lata é um procedimento seguro e eficaz com um curto acompanhamento de tempo. Nível de evidência IV; Estudo Terapêutico; Série de casos.

Analgesic effect of pericapsular nerve group block in elderly patients undergoing PFNA internal fixation under the concept of ERAS / 中国医师杂志

Objective:To investigate the analgesic effect of ultrasound-guided pericapsular nerve group (PENG) block combined with laryngeal mask general anesthesia and internal fixation of proximal femoral nail antirotation (PFNA) under ERAS concept in elderly patients.Methods:A total of 50 elderly patients with femoral trochanteric fractures treated with PFNA internal fixation who were admitted to Changsha Central Hospital from January 2021 to March 2022 were selected and according to the random number table method, they were divided into groups P and F, with 26 cases in group P (ultrasound-guided PENG block combined with laryngeal mask general anesthesia group) and 24 cases in group F [ultrasound-guided fascia iliaca compartment block (FICB)] combined with laryngeal mask general anesthesia group]. The bispectral index (BIS) of the two groups of patients was maintained within the range of 40-60, and the dosage of cyclopofol and remifentanil was adjusted according to the BIS and hemodynamic changes. Postoperative oxycodone was used for patient controlled intravenous analgesia (PCIA). When the Visual Analogue Scale (VAS) score ≥4, 1 mg intravenous oxycodone was administered as rescue analgesia. The VAS score was observed and recorded before nerve block (T 0), 10 minutes after nerve block (T 1), 20 minutes after nerve block (T 2), when the patients were placed in body position after bed (T 3), after laryngeal mask removal (T 4), 12 h after operation (T 5), 24 h after operation (T 6) and 48 h after operation (T 7). The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO 2) at each time point from T 0 to T 4 were observed and recorded; the intraoperative dose of remifentanil, the rescue dose of oxycodone at postoperative T 6 and T 7, Lovett muscle strength score, anesthesia operation time, anesthesia recovery time and postoperative anesthesia-related complications were recorded. Results:There was no significant difference between the two groups in VAS scores at T 0, T 4, T 5 and T 6, MAP, HR and SpO 2 at T 0, T 1, T 2 and T 4, the dosage of remifentanil during operation, the remedial dosage of oxycodone at T 6 after operation, anesthesia operation time and anesthesia recovery time (all P>0.05). Compared with group F, the VAS scores of group P at T 1, T 2, T 3 and T 7 were lower than those of group F (all P<0.05); At T 3, there was no significant difference in SpO 2 between the two groups ( P>0.05), but the MAP and HR in group P was lower than that in group F (all P<0.05); The remedial dose of oxycodone at T 7 in group P was lower than that in group F ( P<0.05), and the analgesic effect was longer; Lovett muscle strength score at T 6 and T 7 in group P was better than that in group F (all P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). Conclusions:Compared with FICB, ultrasound-guided PENG block used in PFNA internal fixation in elderly patients has faster effect, lower dosage of opioid analgesics, longer duration of analgesia, and less impact on postoperative lower limb muscle strength.

Eminectomía bilateral como tratamiento para luxación crónica de articulación temporomandibular. Reporte de caso / Bilateral eminectomy as a treatment for chronic temporomandibular joint dislocation. Case report

Introducción: la luxación de la articulación temporomandibular es un desplazamiento del cóndilo fuera de sus posiciones funcionales dentro de la fosa articular y la eminencia articular, la cual ocasiona una pérdida completa de la función articular. La luxación crónica es toda luxación aguda que progresa sin un tratamiento específico y que puede ser de carácter recurrente. La eminectomía es un tratamiento quirúrgico definitivo contra la luxación crónica de articulación temporomandibular. Objetivo: reportar el caso clínico de un paciente masculino, de la tercera década de su vida, con diagnóstico de luxación crónica de la articulación temporomandibular de cinco meses de evolución y presentar una revisión actualizada de la literatura sobre este procedimiento quirúrgico. Caso clínico: el paciente fue tratado quirúrgicamente con eminectomía bilateral. Discusión: la eminectomía es un procedimiento quirúrgico controversial; sin embargo, recientes investigaciones lo catalogan como seguro y efectivo. Conclusión: el caso clínico presentado muestra un buen resultado.

Background: Temporo-mandibular joint dislocation is a displacement of the condyle, out of its functional positions within the articular fossa and articular eminence, causing a complete loss of joint function. Chronic dislocation is any acute dislocation that progresses without specific treatment and that can be recurrent. Eminectomy is a definitive surgical treatment for chronic temporomandibular joint dislocation. Objective: To report the clinical case of a male patient in the third decade of his life with a diagnosis of chronic dislocation of the temporomandibular joint of 5 months of evolution and to carry out an updated review of the literature on this surgical procedure. Case Report: The patient was treated surgically with bilateral eminectomy. Discussion: Eminectomy is a controversial surgical procedure; recent research classifies it as safe and effective. Conclusion: The presented clinical case shows a good result.

Clinical effect of arthroscopic combined with open release in the treatment of severe and extremely severe post-traumatic elbow stiffness / 中华骨科杂志

Objective:To investigate the therapeutic effect of arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness.Methods:Data of 32 patients with severe post-traumatic elbow stiffness treated by arthroscopy combined with open release from January 2016 to September 2019 were retrospectively analyzed, including 13 males and 19 females. Age: 38.5±15.6 years (range, 17-66 years). For the original trauma, there were 12 cases of distal humeral fractures, 8 cases of radial head fractures, 8 cases of horrible triad of elbow, 2 cases of anterior dislocation of elbow through olecranon fracture, 1 case of Monteggia fracture, and 1 case of olecranon fracture. The range of motion (ROM), Mayo elbow performance score (MEPS) and visual analogue scale (VAS) of elbow joint at pre-operation, 6 months post-operation and the last follow-up were recorded and compared to evaluate the clinical effect of this operation on severe post-traumatic elbow stiffness.Results:The average operation time was 114.1±27.5 min (range, 70-170 min). Two patients developed mild ulnar nerve symptoms after operation, which were relieved after oral mecobalamin. The follow-up time was 38.5±14.4 months (range, 25-69 months). For elbow extension to flexion ROM, it was 47.66°±12.05° at pre-operation, 93.75°±12.89° at 6 months post-operation, and 106.88°±17.68° at the last follow-up, the differences were statistically significant ( F=148.87, P<0.001). For elbow rotation ROM, it was 132.19°±22.68° at pre-operation, 141.88°±21.91° at 6 months post-operation and 149.38°±23.27° at the last follow-up, and the differences were statistically significant ( F=4.64, P=0.012). At 6 months post-operative, the extension to flexion ROM of the elbow was significantly higher than that of pre-operation ( P<0.05); The rotation ROM was higher than that of pre-operation, but the difference was not statistically significant. At the last follow-up, the extentsion to flexion ROM and the rotation ROM were both significantly higher than those of pre-operation ( P<0.05). At the last follow-up, the VAS and MEPS were 1.38±0.94 and 93.44±5.15 respectively, which were significantly improved compared with those of pre-operation 3.91±1.09 and 37.97±7.71 ( P <0.001). Conclusion:Arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness can significantly increase the elbow ROM and functional score as well as significantly relieve the pain of the elbow. It can effectively release the elbow while keeping it minimal invasive, and maintain the stability of the elbow to the maximum, with reliable efficacy.

Modified Chevron osteotomy in the treatment of moderate and severe hallux valgus / 中国骨伤

OBJECTIVE@#To investigate the method and clinical effect of modified Chevron osteotomy of the distal end of the first metatarsal in the treatment of moderate and severe hallux valgus.@*METHODS@#From January 2015 to January 2019, 28 patients(30 feet) with moderate and severe hallux valgus were treated with modified Chevron osteotomy combined with lateral soft tissue release of the first metatarsophalangeal joint, including 2 males (2 feet) and 26 females (28 feet). The age ranged from 35 to 74 (57.3±9.3) years;10 feet on the left, 16 feet on the right, 2 cases on both sides(4 feet);the course of disease was 3 to 12 (9.32±3.89) years. The changes of hallux valgus angle(HVA), intermetatarsal angle(IMA) between the first and second metatarsals and distal metatarsal articular angle(DMAA) of the first metatarsal were measured and compared before and 6 months after operation. The American Orthopaedic Foot and Ankle Society(AOFAS) thumb joint scoring system was used to evaluate the curative effect.@*RESULTS@#All 28 patients were followed up for 8 to 16 (11.28±3.42) months. The incision healed well in all patients, and there were no complications such as incision infection and metatarsal head necrosis. The healing time of osteotomy site was 6 to 10(7.12±1.34) weeks. Preoperative HVA, IMA, DMAA and AOFAS were (36.06±6.02) °, (21.78±4.16) °, (8.21±2.65) ° and (52.90±10.97) respectively, at six months after operation, they were (8.87±2.46) °, (11.66±2.84) °, (3.65±1.00) ° and (87.45±10.55) respectively, there was significant difference between preoperative and 6 months after operation(P<0.05). At 6 months after operation, AOFAS score was excellent in 20 feet, good in 7 feet and poor in 3 feet. Among the 3 patients with poor scores, 2 were excellent after revision, and 1 was significantly improved after using custom insoles.@*CONCLUSION@#Modified Chevron can effectively correct HVA, IMA and DMAA and improve functional recovery. The modified Chevron osteotomy increases the moving distance and the contact of the osteotomy surface. It can be fixed with multiple screws, has strong correction ability, and can exercise early. It is one of the optional methods for the treatment of moderate and severe hallux valgus.

Eficacia de la infiltración periarticular con anestésico local y adyuvantes para control del dolor postquirúrgico en la artroplastía total de rodilla / Effectiveness of peri-articular infiltration with local anesthetic and adjuvants for post-surgical pain control in total knee replacement

Resumen: Introducción: La artroplastía total de rodilla (ATR) es uno de los tratamientos ortopédicos más exitosos; sin embargo, se ha asociado a dolor postquirúrgico intenso en 30-60% de los pacientes. Nosotros planteamos que la infiltración de la cápsula articular de la rodilla durante la cirugía disminuirá el dolor postquirúrgico. Material y métodos: Estudio experimental, aleatorio, doble ciego, en pacientes sometidos a ATR unilateral entre Abril de 2018 a Enero de 2019. Los pacientes fueron divididos en dos grupos, el primero infiltración con placebo y el segundo con solución anestésica y adyuvantes (fentanilo, epinefrina y ketorolaco). Se cuantificó mediante escala visual análoga (EVA) del dolor a las cuatro, seis, ocho, 12, 18, 24, 36 y 48 horas postquirúrgicas, así como del consumo de analgésicos opioides y antieméticos. Resultados: Veinte pacientes en cada grupo, con un seguimiento de cuatro semanas. No hubo diferencias significativas en las características demográficas entre ambos grupos. Se observó un mejor control del dolor postquirúrgico en el grupo que recibió infiltración con anestésico y adyuvante, además de una disminución en el consumo de analgésicos opioides y antieméticos. No hubo diferencia en sangrado ni en la incidencia de infecciones entre ambos grupos. Conclusión: La infiltración pericapsular es un método seguro y eficaz, como parte de la analgesia multimodal en la artroplastía total de rodilla, ya que disminuye el dolor postquirúrgico, el consumo de opioides y antieméticos y no incrementa el sangrado postquirúrgico.

Abstract: Introduction: Total knee arthroplasty (TKA) is one of the most successful orthopedic treatments, however, it has been associated with severe postsurgical pain in 30-60% of patients. We propose that infiltration of the articular capsule of the knee during surgery will decrease postsurgical pain. Material and methods: Experimental, randomized, double-blind study in patients undergoing unilateral TKA between April 2018 and January 2019. Patients were divided into two groups, the first infiltration with placebo and the second with anesthetic solution and adjuvants (fentanyl, epinephrine and ketorolac). Pain was measured with the visual analog scale (VAS) at 4, 6, 8, 12, 18, 24, 36 and 48 hours postsurgical, as well as the consumption of opioid analgesics and antiemetics. Results: 20 patients in each group, with a follow-up of 4 weeks. There were no significant differences in demographic characteristics between the two groups. Better control of postsurgical pain was observed in the group that received infiltration with anesthetic and adjuvant, as well as a decrease in the consumption of opioid analgesics and antiemetics. There was no difference in bleeding or in the incidence of infections between the two groups. Conclusion: Peri-capsular infiltration is a safe and effective method, as part of multimodal analgesia in total knee arthroplasty, as it decreases postsurgical pain, opioid and antiemetic use and does not increase postsurgical bleeding.

Comparison of efficacy of pericapsular nerve group block combined with lateral femoral cutaneous nerve block versus fascia iliaca compartment block in elderly patients undergoing total hip arthroplasty under general anesthesia / 中华麻醉学杂志

Objective:To compare the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block versus fascia iliaca compartment block (FICB) in elderly patients undergoing total hip arthroplasty under general anesthesia.Methods:Fifty-eight patients of both sexes, aged 65-85 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective direct anterior approach to total hip arthroplasty, were divided into 2 groups ( n=29 each) using a random number table method: PENG block plus LFCN block group (PL group) and FICB group (F group). In group PL, the mixture (20 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 3.3 mg was injected around the nerve innervating the hip joint capsule under ultrasound guidance.In group F, the mixture (30 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 5 mg was injected around the nerve innervating the fascia iliaca compartment under ultrasound guidance.All the patients received patient-controlled intravenous analgesia with oxycodone after surgery.When visual analogue scale scores≥4 points, oxycodone 1 mg was intravenously injected as rescue analgesic.The intraoperative consumption of remifentanil was recorded.First time to ambulation, discharge destination, length of hospital stay, and effective pressing times of analgesic pump, requirement for rescue analgesia and the incidence of quadriceps weakness, nausea and vomiting and nerve block related complications within 48 h after surgery were recorded. Results:Compared with F group, intraoperative consumption of remifentanil was significantly decreased, effective pressing times of analgesic pump and incidence of quadriceps weakness were decreased, first time to ambulation and length of hospital stay were shortened, and first discharge destination was prolonged ( P<0.05), and no significant change was found in the requirement for rescue analgesia and the incidence of nausea ( P>0.05) in group PL. Conclusion:PENG block combined with LFCN block can reduce intraoperative consumption of opioids, be helpful for inhibiting postoperative pain sensitivity, and improve early recovery than FICB when used for total hip arthroplasty under general anesthesia.

Comparison of mid-term clinical outcomes between traumatic stiff shoulder and frozen shoulder after arthroscopic capsule release combined with subacromial space recovery / 中华创伤骨科杂志

Objective:To compare the mid-term clinical outcomes between traumatic stiff shoulder and frozen shoulder after arthroscopic capsule release combined with subacromial space recovery.Methods:From January 2014 to December 2019, 55 patients were treated at Sports Medicine Center, The First Affiliated Hospital, Army Medical University for limited range of shoulder motion. Of them, 22 suffered from traumatic stiff shoulder (7 males and 15 females) (group A) and 33 from frozen shoulder (10 males and 23 females) (group B). All patients were treated with arthroscopic 270° capsule release combined with subacromial space recovery. Shoulder pain was evaluated by visual analogue scale (VAS) and shoulder function by Constant score before operation and at the final follow-up. The 2 groups were compared in improvements in flexion, abduction, external rotation and internal rotation of the shoulder.Results:No significant difference was observed between the 2 groups in gender, age, course of disease, preoperative internal rotation or external rotation of the shoulder ( P>0.05). Preoperative VAS score [2.5(2.0, 3.3) points] and Constant score [(33.7±9.6) points] in group A were significantly lower than those in group B [4.0(3.0,5.5) points and (45.8±12.3) points] ( P<0.05). No complication like infection or nerve injury was found during follow-ups. All the incisions healed at the first stage. The follow-up time averaged 37.0 months (from 20 to 79 months). At the last follow-up, VAS scores [1.0(1.0, 1.0) points and 1.0(1.0, 1.0) points] and Constant scores [(87.0±3.2) points and (85.7±4.3) points] for both groups were significantly improved compared with their preoperative values [2.5(2.0,3.3)分points and 4.0(3.0,5.5) points for VAS; (33.7±9.6) points and (45.8±12.3) points for Constant score] ( P<0.05). Compared with preoperation, the improvements at the last follow-up were 99.3°±19.9° and 83.3°±27.7° in shoulder anteflexion and 102.0°±21.5° and 83.9°±32.8° in abduction for groups A and B, with greater improvements in group A; the improvements in VAS score for groups A and B were 1.0(1.0, 2.3) points and 3.0(2.0, 4.5) points, with greater improvements in group B; the improvements in Constant score were (53.3±9.5) points and (39.8±12.9) points for groups A and B, with greater improvements in group A. The above comparisons all showed a significant difference between the 2 groups ( P<0.05). Conclusions:Arthroscopic 270° capsule release combined with subacromial space recovery can lead to good mid-term clinical outcomes similar for both traumatic stiff shoulder and frozen shoulder. However, the improvements in flexion, abduction and Constant score may be greater for traumatic stiff shoulder than for frozen shoulder.

Effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis / 中华创伤骨科杂志

Objective:To explore the effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis.Methods:A retrospective analysis was conducted of 31 patients who had undergone elbow arthrolysis due to elbow stiffness from April 2019 to November 2020 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. An observational group of 15 patients were subjected to combined administration of intravenous and topical tranexamic acid while a control group of 16 patients to no administration of tranexamic acid. In the observational group, 15 mg/kg of tranexamic acid was injected intravenously 5 to 10 minutes before surgery and 1.0 g of tranexamic acid was injected locally in the area of anterior and posterior joint capsules after incision was closed while drainage tubes were clamped for 2 hours before release. In the control group, there was no special operative procedure while drainage tubes were also clamped for 2 hours before release. The 2 groups were compared in terms of blood loss on day 1 and day 3 after operation, drainage volume on day 1 after operation, total drainage volume, time for indwelling drainage tube, complications, and Mayo elbow performance score (MEPS) at 3 months after operation.Results:There were no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05).On day 1 and day 3 after operation, the blood loss was respectively (533.4±318.3) mL and (792.0±375.6) mL in the observational group, and respectively (866.4±480.5) mL and (1,403.0±636.5) mL in the control group, showing significantly differences between the 2 groups ( P<0.05). The drainage volume on day 1 after operation was (151.3±90.1) mL in the observational group and (235.0±126.1) mL in the control group, showing a significant difference between the 2 groups ( P<0.05). There was no statistically significant difference in total drainage volume or time for indwelling drainage tube between the 2 groups ( P>0.05). There were no such complications as thromboembolic events in either group. There was no significant difference in MEPS between the 2 groups at 3 months after operation ( P>0.05). Conclusions:Combined administration of intravenous 15 mg/kg and topical 1.0 g tranexamic acid may reduce blood loss on day 1 and day 3 after operation and drainage volume on day 1 after operation, and may not increase the risk of thromboembolic events, but cannot reduce total drainage volume or time for indwelling drainage tube. Application of tranexamic acid may not affect early elbow joint function after operation.

Arthroscopic long head of biceps tendon transfer to reconstruct shoulder superior capsule for repairing massive rotator cuff tears / 中华创伤杂志

Objective:To evaluate the curative effect of arthroscopic long head of biceps tendon (LHBT) transfer to reconstruct shoulder superior capsule for repairing massive rotator cuff tears.Methods:A retrospective case-control study was conducted on clinical data of 64 patients with massive rotator cuff tears admitted to Shanghai Tenth People's Hospital of Tongji University between December 2017 to January 2019. There were 26 males and 38 females, with the age of 50-75 years [(62.5±4.8)years]. All patients were treated by arthroscopic superior capsular reconstruction with LHBT. The shoulder range of motion in flexion, abduction, external rotation, acromiohumeral distance, visual analogue scale (VAS), Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score were evaluated and recorded before operation and at the last follow-up. The MRI was used to evaluate the integrity of the reconstructed structure at the last follow-up and rotator cuff re-tear rate. Postoperative complications were detected.Results:All patients were followed up for 13-25 months [(18.2±4.3)months]. At the last follow-up, the shoulder range of motion was (149.5±7.8)° in flexion, (162.0±6.6)° in abduction, and (60.6±11.8)° in external rotation; the acromiohumeral distance was (7.4±0.6)cm, the VAS was 1.0(0.0, 1.0)points, the Constant-Murley score was (90.5±2.6)points, the ASES was (90.8±4.2)points, which were significantly improved compared with those before operation [flextion: (73.8±5.3)°, abduction: (85.8±5.5)°, external rotation: (34.3±5.8)°, acromiohumeral distance: (5.9±0.8)cm, VAS: 6.5(6.0, 7.0)points, Constant-Murley score: (41.8±5.4)points, ASES: (41.4±6.1)points, respectively]( P<0.01). of all, 56 patients had intact reconstruction structure at the last follow-up, 7 patient with smalll retears in the reconstruction were not revised, and 1 patient underwent revision operation after reconstruction failure. The retear rate after rotator cuff repair was 13% (8/64). There were no obvious surgical complications after operation, with the incision free from infection. Conclusion:Arthroscopic superior capsular reconstruction with LHBT for repairing massive rotator cuff is safe and reliable, which can effectively relieve the pain of shoulder joint, recover the function and improve the joint mobility.

High tibial osteotomy combined with lateral retinacular release for the treatment of knee varus osteoarthritis with lateral patellar compression syndrome / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of high tibial osteotomy combined with arthroscopic lateral retinacular release in the treatment of knee varus osteoarthritis.@*METHODS@#From October 2017 to April 2019, a retrospective analysis was performed on 43 patients with knee varus osteoarthritis and lateral patellar compression syndrome treated by high tibial osteotomy combined with arthroscopic lateral retinacular release. There were 15 males and 28 females, aged 53 to 72(62.05±5.17) years. The visual analogue scale(VAS), Lysholm, and the knee range of motion were used to evaluate knee pain and functional recovery before operation, 2 weeks, 3 months and 12 months after operation. And the congruence angle (CA), patellar tilt angle (PTA), and femala-tibial angle (FTA) were measured respectively before and 12 months after operation to evaluate the congruence of patellar joint, and the improvement of line of gravity of lower limb.@*RESULTS@#All 43 patients were followed up for more than 12 months, with a follow-up time of 14 to 28 (19.60±4.50) months. The VAS scores decreased from 6.65±0.65 before operation to 2.16±0.95, 0.51±0.77 and 0.33±0.64 at 2 weeks, 3 months and 12 months after operation, and the difference was statistically significant (@*CONCLUSION@#High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis.

Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach / Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.

Ultrasound-guided suprascapular nerve block combined with glenohumeral steroid injection for treatment of adhesive shoulder capsulitis / 中国介入影像与治疗学

Objective: To observe the effect of ultrasound-guided suprascapular nerve block combined with steroid injection of glenohumeral joint for treatment of adhesive shoulder capsular inflammation. Methods: Totally 60 patients with adhesive shoulder capsulitis were randomly assigned into research group and control group (each n=30). Patients in research group received ultrasound-guided suprascapular nerve block and glenohumeral steroid injection on the basis of conventional rehabilitation management, while patients in control group received only conventional rehabilitation management. The visual analogue scale (VAS), Constant shoulder scale (CSS) level and shoulder range of motion (ROM) were evaluated before, 2 weeks and 4 weeks after treatment. Results: VAS and CSS of research group after 2 and 4 weeks were lower than those before treatment (all P<0.01), also lower than those of control group (all P<0.01). The ranges of shoulder flexion, abduction, internal rotation and external rotation in research group were higher than before treatment (all P<0.01) and higher than those in control group (all P<0.01, except for the range of rotation after 2 weeks of treatment). The recurrence rate in research group 3 and 6 months after treatment were lower than those in control group (both P<0.05). Conclusion: Ultrasound-guided suprascapular nerve block and glenohumeral steroid injection can improve the rehabilitation effect of patients with adhesive shoulder capsulitis and decrease recurrence.

Related factors and biomechanical characteristicsof lumbar facet joint degeneration / 中国组织工程研究

BACKGROUND: Lumbar facet joint degeneration has become the focus of scholars’ research in recent years. Understanding the risk factors of lumbar facet joint degeneration plays a key role in preventing and reducing the damage to spine health. Moreover, comprehending its anatomy has important guiding significance for the treatment of spine-related diseases and related operations. OBJECTIVE: To briefly describe the anatomy and histological characteristics of the lumbar facet joints, and summarize the risk factors of lumbar facet joints degeneration. METHODS: A computer-based search of CNKI, Wanfang database, VIP database, PubMed, Elsevier and Web of Science was performed with the search terms “lumbar facet joint, joint capsule, articular direction, eneurosis, osteoarthritis, biomechanics, low back pain, intervertebral disc degeneration, lumbar spondylolisthesis, lumbar degenerative scoliosis” for articles published from March 2018 to September 2019. Review, basic research and clinical research were screened by reading title and abstract. The studies with low relevance to the subject were excluded, and 60 studies were included in the final analysis. RESULTS AND CONCLUSION: (1) The main risk factors for lumbar facet joint degeneration include age, gender, abnormal stress, articular surface orientation, joint asymmetry, lumbar segment and disc degeneration. (2) When the joints degenerate, it can cause low back pain, disc degeneration, lumbar spondylolisthesis, degenerative scoliosis and other clinical diseases, which seriously affect people’s daily life and work, and reduce people’s living quality. Therefore, lumbar facet joints should not be ignored in the treatment of spine-related diseases.

Treatment of rotator cuff tear in global stiff shoulder by arthroscopic 360° capsular release with concomitant rotator cuff repair / 中国骨伤

OBJECTIVE@#To evaluate the clinical effect of arthroscopic 360° capsular release with concomitant rotator cuff repair for patients with rotator cuff tears in global stiff shoulder.@*METHODS@#From December 2016 to December 2018, 247 patients full-thickness rotator cuff tear were treated with arthroscopic rotator cuff repair. Among them, 42 patients (17%) with global limitation of shoulder movement were treated with arthroscopic 360° capsular release operation at the same time of rotator cuff repair. The function of shoulder was evaluated by Constant-Murley score and visual analogue scales (VAS), flexion, abduction and external rotation on body side before and after operation. Sugaya classification was used to evaluatethe healing of rotator cuff. The number of shoulder dislocations during follow-up was recorded.@*RESULTS@#Thirty nine of the 42 patients were followed up for 12 to 36 (22±6) months. The patients were 43 to 73 (57±7) years old at the time of operation. The Constant- Murley score increased from (43.6±6.3) before operation to (87.5±2.8) at final follow-up (<0.001). VAS score decreased from (7.2±1.5) before operation to (1.0±0.9) at final follow-up (<0.001). The flexion of shoulder increased from (46±14)° before operation to (148±11)° after operation (<0.001), the abduction from (36±6)° before operation to (121±10)° after operation (<0.001), and the external rotation on body side from (5±10)° before operation to (42±8)° after operation(<0.001). One year after the operation, MRI showed thatⅠ-Ⅲ of Sugaya classification was clinical healing, 38 cases in total.@*CONCLUSION@#Arthroscopic 360° capsular release with concomitant rotator cuff repair was used to treat rotator cuff tear in global stiff shoulder. Themain observation indexes were improved after operation, and the clinical effect was definite.

Clinical application of wide awake technique in carpal tunnel syndrome / 中国骨伤

OBJECTIVE@#To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome.@*METHODS@#From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function.@*RESULTS@#Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair.@*CONCLUSION@#Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.

Research advances in pathomechanism and treatment of joint contracture / 中国骨伤

Joint contracture is one of the common musculoskeletal disorders. It has seriously disturbed patients' activities of daily living in various aspects. The pathogenesis of it is eager to explore to distinct degree. Nowadays the thickeness and fibrosis of joint capsular is redarded as the major reason to joint contracture. It is reported that excessive fibroblasts and myofibroblasts activity, collagen hyperplasia, and extracellular matrix (ECM) deposition in these fibrotic condtions lead to the contracture. In addition, upregulators of myofibroblast and collagen synthesis, transforming growth factor-beta 1 (TGF-β1), and connective tissue growth factor (CTGF) were shown to be increased. Altered levels of cytokines were also thought to play a role in this process as elevated levelsof tumor necrosis factor-α(TNF-α), matrix metalloproteinases(MMPs) and abnormal distribution tissue inhibitors of MMPs(TIMPs) were demonstrated in contracted capsules. At present, the methods for clinical treatment of joint contracture mainly include two major categories:stretching therapy, physical factor therapy, exercise therapy, botulinum toxin injection and other non-surgical treatments, arthroscopic lysis, open lysis, and other surgical treatments. Surgical treatment is performed when non-surgical treatment is difficult to achieve further improvement. It has a good effect on mild to moderate joint contracture, but it is difficult to completely restore joint activity for serious joint contracture. Although clinical treatment methods are diverse, the clinical effects are staggered and the effectiveness of their treatment is controversial. Joint contracture is an important challenge faced by orthopedics and rehabilitation physicians, therapists and patients. The review summarized the pathogenesisand treatment of joint contracture and provided a theoretical basis for clinical diagnosis and treatment.

Anatomic Evaluation of the Interportal Capsulotomy Made with the Modified Anterior Portal versus Standard Anterior Portal: Comparable Utility with Decreased Capsule Morbidity / 대한고관절학회지

PURPOSE: To identify potential differences in interportal capsulotomy size and cross-sectional area (CSA) using the anterolateral portal (ALP) and either the: (i) standard anterior portal (SAP) or (ii) modified anterior portal (MAP).MATERIALS AND METHODS: Ten cadaveric hemi pelvis specimens were included. A standard arthroscopic ALP was created. Hips were randomized to SAP (n=5) or MAP (n=5) groups. The spinal needle was placed at the center of the anterior triangle or directly adjacent to the ALP in the SAP and MAP groups, respectively. A capsulotomy was created by inserting the knife through the SAP or MAP. The length and width of each capsulotomy was measured using digital calipers under direct visualization. The CSA and length of the capsulotomy as a percentage of total iliofemoral ligament (IFL) side-to-side width were calculated.RESULTS: There were no differences in mean cadaveric age, weight or IFL dimensions between the groups. Capsulotomy CSA was significantly larger in the SAP group compared with the MAP group (SAP 2.16±0.64 cm2 vs. MAP 0.65±0.17 cm2, P=0.008). Capsulotomy length as a percentage of total IFL width was significantly longer in the SAP group compared with the MAP group (SAP 74.2±14.1% vs. MAP 32.4±3.7%, P=0.008).CONCLUSION: The CSA of the capsulotomy and the percentage of the total IFL width disrupted are significantly smaller when the interportal capsulotomy is performed between the ALP and MAP portals, compared to the one created between the ALP and SAP. Surgeons should be aware of this fact when performing hip arthroscopy.