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Objective To investigate the clinical and MRI outcomes of the arthroscopic rotator cuff repair for massive ro tator cuff tear at minimum 2 years after surgery.Methods From October,2010 to March,2013,data of 79 shoulders in 77 patients with massive rotator cuff tear who were treated with arthroscopic rotator cuff repair were retrospectively analyzed.There were 42 male (44 shoulders) and 35 female (35 shoulders).The average age before surgery was 57.4 years (43.1-80.4 years).There were 64 right shoulders and 15 left shoulders.The dominate side were involved in 70 cases.A trauma history was documented in 52 shoulders.The symptoms persisted less than 3 months in 42 shoulders,between 3 and 6 months in 11 shoulders,between 6 and 12 months in 11 shoulders and more than 1 year in 15 shoulders.No revision case was included.The clinical results (range of motion,forward elevation strength,external rotation strength and American Shoulder & Elbow Surgeons (ASES) score and MRI results were collected.Results All 77 cases were followed up more than 2 years.The forward elevation (156.9°±20.0° to 103.2°± 54.5°),external rotation (40.6°±15.5° to 32.0°±21.4°),internal rotation (L1 to ~),forward elevation strength (9.7±4.7 lb to 4.6±4.9 lb),external rotation strength (11.1±5.1 lb to 8.3±5.4 lb) and ASES score (82.7±14.6 to 45.2± 17.4) were all improved significantly at the latest follow-up.During the surgery,complete repair were achieved in 68 shoulders.The forward elevation (146.4°±31.4° to 110.0°±56.7°),external rotation (45.0°± 14.8° to 34.1°±20.8°) and ASES score (78.6± 14.9 to 54.5± 13.9) were all improved signifi cantly at the latest follow-up in patients with partial repair during the surgery.But the forward elevation strength (10.5±4.9 lb to 6.2±3.2 lb) and external rotation strength (11.5±5.1 lb to 8.3±3.8 lb) were significantly better improved in patients who had complete repair.In 68 shoulders with complete repair during the surgery,20 shoulders were found to have rotator cuff re-tear.The retear rate was 29.4％.But none of the patient with postoperative re-tear received revision surgery.The forward elevation (152.0± 23.3 to 103.5±60.5),forward elevation strength (8.5±4.7 lb to 5.0±4.7 lb) and ASES score (76.9±16.5 to 40.8±18.6) were all improved significantly at the latest follow-up in patients with postoperative re-tear of the rotator cuff tendon.But the forward elevation (161.4°± 13.4° to 152.0°±23.3°),forward elevation strength (11.3±4.7 lb to 8.5±4.7 lb),external rotation strength (12.4±4.8 lb to 9.6±5.3 lb) and ASES score (86.0±13.0 to 76.9±16.5) were significantly better in patients with complete healed rotator cuff tendon comparing with the re-tear group.Conclusion The rotator cuff repair can significantly improve the shoulder function of massive rotator cuff tear even when the rotator cuff tendon can only be partially repaired or re-tear after the surgery.The shoulder function is significantly better in patients with complete healed rotator cuff tendon comparing with the partial repair group and the re-tear group.
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Objective To evaluate the outcome of arthroscopic fixation with suture-bridge technique for greater tuberosity fractures.Methods Between September 2014 to April 2016,data of 20 cases with greater tuberosity fractures who were treated with arthroscopic suture-bridge technique were retrospectively analyzed.There were 12 males and 8 females,with an average age of 51.2 years old (range,28-76 years).The average period from injury to surgery was 6 days (range,2-18 days).The postoperative X-ray of shoulder was collected.The active mobilization and strength rehabilitation were gradually introduced depended on patients' status.The preoperative and postoperative shoulder function were evaluated by Constant-Murley score,American Shoulder & Elbow Surgeons (ASES) score,visual analogue scale (VAS) pain score and UCLA score.Results All 20 patients were followed up for 15 months (range,12-30 months).There was no postoperative complication,including re-fracture,re-displacement,implant failure and wound infection.Shoulder joint activity at the last follow-up:lift on the proneness of motion 168°±7.54° (range,150°-180°),outer spin 65.5°±6.71° (range,50°-70°),and internal rotation averaged T6 (range,T4-T10).At the last follow-up,the mean Constant-Murley score was 93.50±3.24,mean ASES score 90.80±4.72,mean VAS pain score 0.30±0.57 and mean UCLA score was 32.40±1.90.At the last follow-up,the anterior flexion in the side of the shoulder joint,the external rotation and internal rota tion were compared with the healthy side,and no statistical difference was found,and the function of the shoulder joint was satisfactory.There were two cases of Bankart injury,and the Bankart restoration was fixed by the arthroscope.Conclusion The arthroscopic suture-bridge technique can achieve less trauma,more reliable fixation for fractures of greater tuberosity of humerus.The arthroscopic suture-bridge technique can effectively spread the shear force and torsion force,increase the fixed area,and promote fracture healing.The arthroscopic fixation with suture-bridge technique is an effective treatment for fractures of greater tuberosity of humerus.
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Objective:To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures.Methods:From January 2013 to December 2014,8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were ret-rospectively reviewed after the final follow-up.There were 1 man and 7 women with a mean age of (58.5 ±6.4)years,of whom 3 left shoulders and 5 right shoulders were involved.There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures,and 6 patients with hu-meral head necrosis as well as implant-associated infection after open reduction internal fixation for proxi-mal humeral fractures with the locking plate.The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery.At the first-stage surgery,all the patients underwent a thorough debridement,and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate.During the second-stage surgery,the cement spacer was removed,and then a revision shoulder arthroplasty with the reverse shoul-der prosthesis was performed in all the patients who were routinely followed up after the second-stage sur-gery.The visual analogue score (VAS ),Constant score and University of California Los Angeles (UCLA)score were employed to evaluate the postoperative shoulder function.Results:The mean follow-up time was (19.9 ±8.0)months (range 12 to 35 months).At the end of the follow-up,the median forward elevation [100°(60°,140°)vs.25°(0°,90°),P=0.011],the median external rotation [15°(0°,50°)vs.5°(0°,20°),P=0.048],and the median internal rotation [L4 (buttock,T12) vs.buttock (buttock,L3 ),P =0.041 ]were all significantly improved postoperatively.The median Constant score [53.5 (32,74)vs.29.0 (10,57),P=0.012],the median UCLA score [20.5 (9, 26)vs.9.5 (5,15),P=0.012],and the median VAS score [1.5 (0,5)vs.5.0 (0,8),P=0.018]were all significantly improved after the surgery.No recurrence of infection,prosthetic loosening or neurovascular injury was noted by the last follow-up.Conclusion:Two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures.The shoulder function was postoperatively improved to a certain degree.
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Objective:To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dis-locations.Methods:From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up.There were 49 men and 14 women with a mean age of (40.3 ±10.6) years.The mean time from injury to surgery was (10.3 ±5.3) d.According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with typeⅢinjury.All the patients with typeⅢinjury claimed high level of sport activi-ty.The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken.All the patients were rou-tinely followed up after the surgery.The visual analogue score ( VAS ) , American shoulder and elbow surgeons( ASES) score and University of California Los Angeles( UCLA) score were employed to evaluate the postoperative shoulder function.The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Re sults:The mean follow-up time was (29.6 ±6.0) months ( range:24 to 43 months) .No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient’ s age [(41.0 ±10.5) years vs.(38.0 ±10.8) years], gender (male/female,24/8 vs.25/6), classification (Ⅴ/Ⅲ,22/10 vs. 23/8), time from injury to surgery [(10.6 ±4.9) d vs.(10.1 ±5.7) d], dominant involvement (19/32 vs.17/31)and mean follow-up time [(29.8 ±6.4) months vs.(29.5 ±5.5) months], P>0.05.At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward elevation [(164.4 ±17.2) degrees vs.(162.6 ±12.9) degrees], mean external rotation [(60.9 ±17.0) degrees vs.(57.3 ±15.8) degrees], mean internal rotation [(T12 ±3 vertebrae) vs. (T12 ±3 vertebrae)], mean ASES scores (96.0 ±5.1 vs.94.5 ±3.8)and UCLA scores (34.2 ±1.5 vs. 33.7 ±1.4), P>0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group (1/32) compared with the open surgery group (7/31, P=0.026).Conclusion:Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function.The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.
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Objective: To investigate the results of treating patients with recurrent anterior shoulder dislocation using open Latarjet technique in a retrospective study, and to discuss the detail of the surgical technique and the results of the procedure.Methods: In the study, 22 patients with recurrent anterior shoulder dislocation treated with open Latarjet technique were followed up.The average duration of the follow-up was 66.0 months.An X-ray film and a CT scan were performed before the surgery to evaluate the degenerative change of the gleno-humeral joint and the bony defect of the glenoid.An X-ray film and a CT scan were repeated at the end of the final follow-up to find out if there was any progression of the de-generative change of the gleno-humeral joint and if the transferred coracoid process united.Physical ex-aminations, American Shoulder & Elbow Surgeons ( ASES ) score, Constant-Murley score and Rowe questionnaire were used to evaluate the patients’ shoulder function before the surgery and at the end of the final follow-up.Results:Before the surgery the average forward elevation, external rotation and inter-nal rotation were 158.2°±28.7°, 55.3°±15.2°and T10 ( T3 -buttock) respectively.The average ASES score, Constant-Murley score and Rowe score were 77.6 ±17.5, 88.3 ±12.5 and 40.2 ±12.0, respectively.At the end of the final follow-up, no redislocation happened.The average forward eleva-tion, external rotation and internal rotation were 167.7°±12.7°, 54.3°±16.5°and T10 (T3-L3), respectively(P=0.138, P=0.765, P=0.439).No sigificant restriction was detected after the surgery regarding forward elevation,external rotation and internal rotation.The mean ASES score, Constant-Mur-ley score, and Rowe score significantly improved to 93.7 ±9.1 (P=0.001), 95.6 ±5.6 (P=0.008) and 96.4 ±4.4 (P<0.001) respectively after the surgery.A progression of the degenerative change of the gleno-humeral joint was detected in 3 patients.A non-union of the transferred coarcoid was detected in 1 patient.Conclusion:Open Latarjet procedure is effective in treating the recurrent anterior shoulder dislocation patient with severe glenoid defect.No significant progression of the degenerative change of the gleno-humeral joint is detected in average 5-year follow-up.
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Objective:To present the surgical technique and to evaluate the results of the modified ar-throscopic Latarjet procedure.Methods: Arthroscopic Latarjet procedure has proven to be a reliable method of treatment for difficult anteroinferior instability of the shoulder joint.However, there is no ante-rior capsule reattachment and too much subscapularis damage for the classic procedure.From February 2013 , we modified the classic procedure with reattachment of anterior joint capsule and muscle-tendon junction splitting of subscapularis.Coracoid graft position was evaluated using CT scanning.Results:From March 2012 to August 2014, 51 modified Latarjet procedures were successfully performed arthro-scopically for patients with anterior shoulder instability.According to the CT scanning at the final follow up, the graft was flush with the glenoid in 94.1%, and medially placed in 5.9%.Vertical positioning was perfect in 96.0%(2 to 5 o’clock), too high in 2.0%, and too low in 2.0%.There were no cases of recurrent dislocation or subluxation.Conclusion: The modified arthroscopic Latarjet procedure has shown satisfactory results with good graft positioning.It is a minimal invasive and accurate approach, which combines the advantages of the open procedure.
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<p><b>OBJECTIVE</b>To evaluate and compare the clinical and radiographic outcomes of both acute and chronic two-part lesser tuberosity fracture with locked posterior dislocation and analyze the risk factors for the clinical outcomes.</p><p><b>METHODS</b>Between April 2003 and June 2010, 29 patients received surgical treatment for two-part lesser tuberosity fractures with a locked posterior shoulder dislocation. Eighteen of these patients received modified McLaughlin procedures and were available for both clinical and radiographic evaluation for more than 2 years. All of the 18 patients were male. The average age was (40 ± 11) years (range, 21-58 years). Nine patients had left arms involved while another 9 patients got right side involved, 9 of 18 patients had their dominant side involved. The average time from initial injury to surgery was (40 ± 42)days (range, 4-123 days). The patients received follow-up 3 months, 6 months and 1 year after the operation, and the follow-up was performed once a year. The shoulder range of motion and visual analogue scale (VAS) were recorded at the final follow-up. The functional outcomes were evaluated using University of California-Los Angeles Shoulder Scale (UCLA), Constant Score, and American Shoulder and Elbow Surgeons Shoulder Score (ASES). The degree of humeral head necrosis was analysed according to plain radiographs taken at the final follow-up. The risk factors including patients' age, dominant side involvement and time from injury to surgery on the final clinical outcomes and the degree of humeral head necrosis were also analysed using Pearson correlation analysis and Wilcoxon analysis methods.</p><p><b>RESULTS</b>The mean follow-up period was (38 ± 16) months (range, 24-72 months). All of the patients regained shoulder stability postoperatively. At the final follow-up, the average VAS was 0.6 ± 0.9 (0-3). The average UCLA was 28 ± 4 (23-33). The average Constant was 85 ± 8 (71-96). The average ASES was 83 ± 7 (75-95). The time from injury to surgery was identified as the risk factor regarding UCLA (r = 0.648, P = 0.004), Constant score (r = 0.506, P = 0.032) and ASES score (r = 0.517, P = 0.028).</p><p><b>CONCLUSIONS</b>Satisfactory results can be achieved with surgical treatment for lesser tuberosity fractures with locked posterior shoulder dislocations. The time from injury to surgery has a negative impact on the clinical function outcome.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Estudios de Seguimiento , Fijación Interna de Fracturas , Métodos , Fracturas del Húmero , Cirugía General , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Luxación del Hombro , Cirugía General , Factores de TiempoRESUMEN
Objective To evaluate the clinical results of arthroscopic repair of massive rotator cuff tear. Methods The study involved 16 patients with massive rotator cuff tears treated arthroscopically from September 2007 to June 2009. There were 6 males and 11 females at average age 61.5 years (45-75 years). The rotator cuff tears was repaired with arthroscopic double-row reconstruction. The range of motion, pain, strength of flexed elevation and function evaluation score were all recorded before operation and at final follow-up. The results were evaluated by t test and compared according to age and course of disease. Results All patients were healed without complications and the outcome was improved significantly ( P < 0.01 ). The mean VAS score was improved from preoperative 5.6 to postoperative 1.7,the average forward flexion from 69. 1°to 151.2°, the average external rotation from 14.7° to 32.2°, and internal rotation from L1 level to T10, the mean Constant-Murle from 39 to 85, the mean UCLA from 10.4 to 28, the mean SST from 2.8 to 8.8 and the strength of flexed elevation from 10.7% of normal side to 65.0%. Compared with preoperation, there was statistical difference in aspects of pain, range of motion, muscle strength and function in postoperation (P < 0.01 ). Conclusion Arthroscopic doublerow fixation can attain satisfactory results in repair of massive rotator cuff tear.
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Objective: To study the feasibility of percutaneous absorption of Compound Patch of Hyperosteogeny(CPH). Methods: The content of ferulic acid,an index composition in percutaneous receptor fluid and release receptor fluid were determined by HPLC.Results: The results of in vitro transdermal delivery experiment and in vitro release experiment showed that ferulic acid permeated at the constant speed of 0.2142?g?cm -2 ?h -1 in 24 hours and its release coincided with Higuchi Equation.Futhermore,the release rate was 14.53?g?cm -2 ?h -1/2 . Conclusion: CPH is a skeleton controlledtransdermal delivery system whose permeation speed is limited by skin.