ABSTRACT
Objective:To investigate the clinical value of the modified lateral approach to the shoulder for the treatment of proximal humeral fractures.Methods:A total of 64 patients with proximal humeral fractures who received treatment in Zhoushan Branch, Ruijin Hospital, Shanghai Jiaotong University School of Medicine from May 2018 to May 2022 were included in this study. They were randomly divided into observation and control groups ( n = 32/group). The observation group was treated using a modified lateral approach to the shoulder. The control group was treated using the anteromedial approach to the shoulder. Perioperative indexes (operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, and incision length) were compared between the two groups. Before surgery, 1 week and 3 months after surgery, the visual analogue scale score and the Constant-Murley shoulder assessment score were compared between the two groups. Before surgery and 3 months after surgery, the shoulder range of motion was compared between the two groups. The incidence of complications was also compared between the two groups. Results:The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, and incision length in the observation group were shorter or lower than those in the control group ( t = 7.42, 26.85, 10.90, 2.73, 10.59, all P < 0.05). At 1 week and 3 months after surgery, the visual analogue scale score in the observation group was significantly lower than that in the control group ( t = 5.80, 6.06, both P < 0.001). At 1 week and 3 months after surgery, the Constant-Murley shoulder assessment score in the observation group was (62.96 ± 12.05) points and (74.96 ± 14.52) points, respectively, which were significantly higher than (56.74 ± 9.62) points and (67.88 ± 12.25) points in the control group ( t = 2.28, 2.10, both P < 0.05). After surgery, the range of motion of the shoulder joint in the observation group was greater than that in the control group, including forward flexion, backward extension, external rotation, and internal rotation ( t = 2.54, 3.19, 2.40, 4.00, all P < 0.05). The incidence of complications in the observation group was 6.25% (2/32), which was significantly lower than 28.13% (9/32) in the control group ( χ2 = 5.39, P < 0.05). Conclusion:The modified lateral approach to the shoulder has a marked effect on proximal humeral fractures. The approach can improve shoulder function, shorten operation time, and decrease the incidence of complications.
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Objective:To investigate the effects of Manchester Pain Management Model (MPMM) on postoperative pain and joint function for patients undergoing rotator cuff repair surgery.Methods:A total of 66 patients undergoing rotator cuff repair surgery from February 2017 to October 2020 in the First People′s Hospital of Hefei were divided into experimental group and control group by random digits table method, with 33 cases in each group. The control group received routine nursing; based on the routine care, the experimental group implemented MPMM-based intervention. The degree of pain and shoulder function of the two groups were assessed by Visual Analogue Scale (VAS) and Constant-Murley Scale (CMS).Results:During the study period, 1 case in the experimental group was lost, 32 cases in the final experimental group and 33 cases in the control group. There was no significant difference in the score of VAS and CMS before surgery between the two groups ( P>0.05). At 1 day, 3 days, 3 weeks and 6 weeks after surgery, VAS scores in the experimental group were 5.47 ± 1.72, 4.63 ± 1.16, 3.25 ± 0.78, 1.81 ± 0.52, lower than those scores in the control group 6.42 ± 1.03, 5.45 ± 1.54, 4.30 ± 0.64, 2.39 ± 0.47, the differences were statistically significant ( t values were 2.36-3.11, all P<0.05). At 3, 6, 12 weeks after surgery, CMS scores in the experimental group were 57.09 ± 4.32, 67.75 ± 4.60, 81.94 ± 4.18, higher than those scores in the control group 52.27 ± 5.39, 64.24 ± 3.76, 78.91 ± 4.36, the differences were statistically significant ( t=3.97, 3.37, 2.89, all P<0.01). Conclusions:MPMM can effectively alleviate the postoperative pain and promote the recovery of joint function in patients undergoing rotator cuff repair surgery.
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Objective To evaluate the curative effect of arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions.Methods Retrospectively analyzed the clinical data of 35 cases who were admitted into our hospital from June 2015 to October 2016 and underwent arthroscopic surgery for the treatment of first-time shoulder dislocation.All the 35 cases were combined with Bankart lesions,and the lacerated glenoid labrum were repaired with suture anchorsy.The postoperative ASES scroe and Rowe score were adopted for the final evaluation.Results All the 35 cases were followed up for 1 to 6 months,3 months averagely.All the patients had satisfactory shoulder function,with no shoulder dislocation occured again.The ASES score and Rowe score after surgery was better than that before surgery with statistically significant difference(P<0.05).Conclusion Arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions has many advantages such as mini-invasion,rapid recovery and satisfactory outcome in function and motion.
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PURPOSE: To evaluate the post-operative functional reduction of the shoulder joint and the impacting factors to post-operative shoulder joint function in interlocking IM nailing treatment of humeral shaft fracture. MATERIALS AND METHODS: From April 1999 to August 2004, 35 patients (35 cases) whom admitted to hospital for humeral shaft fracture and treated using interlocking intramedullary nail were followed up for more than 1 year. 1 year post-operative shoulder joint function were evaluated using American Shoulder Elbow Surgery Scale (ASES). Pre-operative shoulder joint pain, radiologically degenerative change and extent of nail protrusion were evaluated, and each factor was correlated with function of the shoulder joint. RESULTS: 33 cases out of 35 cases showed union and average union period was 12 weeks. Complications consisted of 2 cases of nonunion, 1 case of infection, 1 case of loosening of distal fixing screw, 1 case of radial nerve palsy and 1 case of axillary nerve palsy. Shoulder joint function 3 months after operation : mean ASES score 78.2, 12 months after operation : mean ASES score 89.6. Pre-operative shoulder joint pain and nail protrusion showed to be statistically related to shoulder joint function. CONCLUSION: If the operation leaves no protrusion of intramedullary nail, it can be concluded to be relatively safe and effective.