RESUMO
BACKGROUND: To investigate the effectiveness of reverse total shoulder arthroplasty (RTSA) in treating irreparable massive rotator cuff tears (RCTs). METHODS: Twenty-nine patients who underwent RTSA for the treatment of irreparable massive RCTs and completed follow-up for at least 1 year were selected. Their mean age was 69.7 years (range, 59-80 years). The mean follow-up was 17.7 months (range, 12-42 months). The shoulder range of motion was measured preoperatively and at final follow-up. The functional result was evaluated using visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) score, and Korean Shoulder Society (KSS) score. Additionally, the shoulders were categorized into two groups depending on prior history of surgery and the clinical outcomes were analyzed between two groups. RESULTS: Mean pain VAS improved, from 6.6+/-1.2 to 2.7+/-0.9 (p=0.001), and the mean functional VAS from 35.7+/-4.2 to 73.3+/-5.4 (p=0.006). The mean ASES score improved from 37.2+/-2.8 to 75.0+/-3.8 (p=0.012). The mean KSS improved from 36.5+/-7.2 to 75.6+/-5.4 (p=0.009), the mean forward elevation from 66.3+/-4.7 to 135.6+/-8.4 (p=0.0001), and the mean abduction from 45.2+/-4.2 to 119.0+/-6.5o (p=0.0001). Internal rotation differed significantly from the first sacral to the third lumbar vertebrae (p=0.036). External rotation did not change significantly (p=0.076). There was also no statistically significant difference between groups (no previous operation versus none). Four complications occurred: one superficial infection, one with anterior dislocation, one acromial fracture, and one clavicle fracture. CONCLUSIONS: RTSA provides reliable pain relief and recovery of shoulder function in patients with massive irreparable RCTs in short-term follow-up.
Assuntos
Humanos , Artroplastia , Clavícula , Luxações Articulares , Cotovelo , Seguimentos , Vértebras Lombares , Amplitude de Movimento Articular , Manguito Rotador , Ombro , Escala Visual AnalógicaRESUMO
BACKGROUND: To investigate the effectiveness of reverse total shoulder arthroplasty (RTSA) in treating irreparable massive rotator cuff tears (RCTs). METHODS: Twenty-nine patients who underwent RTSA for the treatment of irreparable massive RCTs and completed follow-up for at least 1 year were selected. Their mean age was 69.7 years (range, 59-80 years). The mean follow-up was 17.7 months (range, 12-42 months). The shoulder range of motion was measured preoperatively and at final follow-up. The functional result was evaluated using visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) score, and Korean Shoulder Society (KSS) score. Additionally, the shoulders were categorized into two groups depending on prior history of surgery and the clinical outcomes were analyzed between two groups. RESULTS: Mean pain VAS improved, from 6.6+/-1.2 to 2.7+/-0.9 (p=0.001), and the mean functional VAS from 35.7+/-4.2 to 73.3+/-5.4 (p=0.006). The mean ASES score improved from 37.2+/-2.8 to 75.0+/-3.8 (p=0.012). The mean KSS improved from 36.5+/-7.2 to 75.6+/-5.4 (p=0.009), the mean forward elevation from 66.3+/-4.7 to 135.6+/-8.4 (p=0.0001), and the mean abduction from 45.2+/-4.2 to 119.0+/-6.5o (p=0.0001). Internal rotation differed significantly from the first sacral to the third lumbar vertebrae (p=0.036). External rotation did not change significantly (p=0.076). There was also no statistically significant difference between groups (no previous operation versus none). Four complications occurred: one superficial infection, one with anterior dislocation, one acromial fracture, and one clavicle fracture. CONCLUSIONS: RTSA provides reliable pain relief and recovery of shoulder function in patients with massive irreparable RCTs in short-term follow-up.
Assuntos
Humanos , Artroplastia , Clavícula , Luxações Articulares , Cotovelo , Seguimentos , Vértebras Lombares , Amplitude de Movimento Articular , Manguito Rotador , Ombro , Escala Visual AnalógicaRESUMO
PURPOSE: The purpose of this study was to analyze clinical and radiological results after debridement arthroplasty during primary elbow arthroplasty. MATERIALS AND METHODS: This study involved 25 primary elbow osteoarthritis cases that were treated by debridement arthroplasty from January 1996 to December 2004 with at least a 2 year follow up (mean: 41.3 months). Mean patient age was 45.5 years. Clinical outcomes were analyzed using preoperative and postoperative ranges of motion, Mayo Elbow Performance Scores (MEPS), and Visual Analogue Scale scores. Radiologic analysis was based on plain radiographs. RESULTS: Average flexion-extension arc improved from 72degrees ROM preoperatively to 110.5degrees postoperatively (p<0.001). Mean MEPS was 89.5 points preoperatively and increased postoperatively (p<0.05). Humeral fenestration size decreased from 27% to 20.5%. Bony spurs of the olecranon and coronoid process recurred in 8 cases. Postoperative LOM was found to be associated with spur recurrence (p<0.05). CONCLUSION: Debridement arthroplasty may be recommendable for primary elbow osteoarthritis as it reduces pain and improves functional outcomes, including range of motion. Spur recurrence was found to be associated with a reduced range of motion.
Assuntos
Humanos , Artroplastia , Desbridamento , Cotovelo , Seguimentos , Olécrano , Osteoartrite , Amplitude de Movimento Articular , RecidivaRESUMO
STUDY DESIGN: A retrospective analysis of lumbar disc herniation in elderly patients. OBJECTIVES: To evaluate the clinical picture and surgical outcome of a lumbar disc herniation in elderly patients. SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is less common in older persons, but there has been an increasing concern in elderly patients. MATERIALS AND METHODS: A retrospective review evaluated 34 patients (men:12, female:22) over 65 years old or with a T score -2.5 or below below on the BMD and/or over 60 years old with systemic comorbid disease who underwent surgery for a lumbar disc herniation between January 1991 and June 2001. All patients had at least a 2-year follow-up evaluation. They were analyzed for their physical status, comorbid condition, preoperative, follow-up symptoms and signs, the long-term clinical outcome based on the ASA (American society of anesthesiology) class and operative findings. RESULTS: There were 7 ASA class I patients, 22 ASA class II patients, 5 ASA class III patients, and comorbidity was found in 20 patients. Higher rates of negative straight leg raising were observed in the elderly patients compared to the younger patients, and 8 patients had a neurological claudication history. 25 patients had excellent or good results and better results were obtained with the sequestration and extrusion type, respectively, as compared with protrusion type. However, there was no correlation between the ASA class, postoperative complications, and clinical outcome. CONCLUSIONS: Clinical picture of disc herniation in the elderly patients may be nonspecific. Therefore, it is believed that the surgical indication is different from young patients, and requires a proper examination and diagnosis.
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Idoso , Humanos , Pessoa de Meia-Idade , Comorbidade , Diagnóstico , Seguimentos , Perna (Membro) , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
The classification of thoracolumbar spinal injuries has been based on morphological criteria, mechanism or both. Recently Denis and Macfee insisted no the middle column of the spine but their classification is useful as a morphologic description. Especially, the classification and decision of treatment are difficult in the burst fracture. So we have applied the new classification described by Gertzbein that considers the morphologic patterns and mechanism of injury and compared with another classifications. We studied 28 cases of the thoracolumbar burst fracture who were treated and followed up at Wonkwang university hospital from May, 1988 to March, 1992. We classified burst fracture according to the three kind of classifications and CT finding. 1. The burst fracture associated with flexion-distraction injury was revealed 5 cases(about 18%). 2. In the treatment, Type A injuries requires the use of distractive and type B requires compressive forces in the correcting the deformity.
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Classificação , Anormalidades Congênitas , Traumatismos da Coluna Vertebral , Coluna VertebralRESUMO
No abstract available.