Progress in arthroscopic surgery for injury of superior labrum anterior posterior of shoulder joint / 中国骨伤

Superior labrum anterior posterior (SLAP) injury is a major challenge for orthopedic surgeons, due to the poor healing ability of the injured labrum. Although arthroscopic surgery is the gold standard for the treatment of SLAP injury, there are still disputes about the adaptation of different surgical techniques, the choice of anchors during operation, knotted or knotless anchors, and fixation methods. The authors believe that arthroscopic repair of SLAP lesions is effective for young patients with intact glenoid labrum(<35 years old) or with extensive activity, where single and knotless anchor is preferred. For the older patients(≥35 years old) with degeneration and wear of glenoid labrum, biceps tenodesis is more preferable, and interference screw fixation technique is recommended. As for patients with failed SLAP repair, biceps tenodesis can achieve a high success rate as a revision surgery. By review of the relevant literature in recent years, this paper summarizes the adaptation of different surgical methods of arthroscopic treatment of SLAP injury, intraoperative anchoring techniques, fixation methods and other improved surgical techniques.

Research progress of optical motion capture technology in shoulder biomechanics / 中国骨伤

The shoulder joint is the most flexible joint in the body with the largest range of motion, and the movement pattern is more complex. Accurate capture of three-dimensional motion data of the shoulder joint is crucial for biomechanical evaluation. Optical motion capture systems offer a non-invasive and radiation-free method to capture shoulder joint motion data during complex movements, enabling further biomechanical analysis of the shoulder joint. This review provides a comprehensive overview of optical motion capture technology in the context of shoulder joint movement, including measurement principles, data processing methods to reduce artifacts from skin and soft tissues, factors influencing measurement results, and applications in shoulder joint disorders.

Early efficacy analysis on arthroscopic autologous osteochondral grafting in the treatment of recurrent anterior shoulder dislocation / 中国骨伤

OBJECTIVE@#To investigate the early efficacy of arthroscopic autologous osteochondral grafting in the treatment of recurrent anterior shoulder dislocation.@*METHODS@#From January 2019 to January 2021, 17 patients with recurrent anterior dislocation of shoulder who underwent arthroscopic autologous osteochondral grafting were selected, including 12 males and 5 females, ranging in age from 17 to 55 years old, with a mean of (32.88±12.33) years old. Rowes rating system for Bankart repair(Rowe), Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test (SST) were compared before operation, 6 months after operation and at the latest follow-up. OSIS and SST used to evaluate shoulder function were recorded before surgery and at the latest follow-up. The shoulder mobility and intraoperative and postoperative complications were also recorded.@*RESULTS@#All 17 patients were followed up, and the duration ranged from 7 to 25 months, with a mean of (18.4±5.4) months. During the follow-up period, there was no re-dislocation, no vascular or nerve injury. Rowe score increased from 26.2±6.0 before operation to 74.4±4.0 and 82.4±3.1 after 6 months and the latest follow-up. There was significant difference in Rowe score between different time points after operation and before operation (P<0.05). The OSIS increased from 37.0±3.6 before operation to 47.4±2.6 and 52.7±2.6 after 6 months and the latest follow-up. There was significant difference in OSIS between different time points after operation and before operation (P<0.05). The SST score increased from 6.8±0.7 before operation to 9.8±0.8, 11.6±2.6 after 6 months and the latest follow-up. There was significant difference in SST score between different time points after operation and before operation (P<0.05). At the latest follow-up, the lateral external rotation and abduction external rotation activities of the patient were significantly improved compared with those before operation.@*CONCLUSION@#This study provides preliminary evidence that arthroscopic autologous osteochondral grafting can achieve satisfactory early clinical outcomes and stability in patients with recurrent anterior shoulder dislocation with glenoid fracture and defect less than <20%, which is a reliable and effective procedure.

Progress on arthroscopic surgery for massive rotator cuff tears / 中国骨伤

The surgical treatment of massive rotator cuff tears is a clinical challenge for orthopaedic surgeons. Moreover, tendon retraction, adhesions and fatty infiltration after rotator cuff tear will further increase the difficulty of surgical repair. Therefore, it has become a hotspot and difficulty to repair massive rotator cuff tears with a better way in current research. In recent years, with the continuous development of arthroscopic techniques, shoulder arthroscopic surgery has become the gold standard for the treatment of massive rotator cuff tears, but the adaptations, effects and combined application of different surgical methods are still controversial. The author believes that arthroscopic debridement of shoulder joint and acromioplasty or tuberoplasty could relieve shoulder pain in the short-term for elderly patients with lower functional requirements;long biceps tenotomy or tenodesis is effective for patients with biceps long head tendon injury; complete repair is still the first line treatment for massive rotator cuff tears, but partial repair is possible for massive rotator cuff tears that could not be completely repaired;patch augmentation technology could bring good results for young patients with high functional requirements;for patients with limited internal and external rotation of the shoulder joint and high functional requirements, tendon transfers surgery is recommended;superior capsular reconstruction is more advantageous for young patients with no obvious glenohumeral arthritis, better deltoid muscle strength and higher functional requirements. In addition, subacromial spacer implantation has become a current research hotspot due to its advantages of small trauma, low cost and relative safety, and its long-term effect still needs to be further confirmed.

Progress on arthroscopic surgery for recurrent anterior shoulder dislocation / 中国骨伤

The surgical treatment of recurrent anterior shoulder dislocation is a difficult problem in the field of sports injury medicine. The main reason focus on dynamic and osseous constraints of shoulder joint could not recover well. At present, arthroscopic surgery is used at home and abroad, and could receive statisfied postoperative effect, but the choice of specific surgical methods is still controversial. According to presence and size of glenoid and humeral skull defects, different treatments should be selected in clinic. The author recommends that no articular glenoid defect or glenoid defect 40% or Bristow-Latarjet if the surgical repair fails, bone grafting is used. In addition, if (humeral avulsion of glenohumeral ligaments, HAGL) injury existed, HAGL injury repair should be used. In addition to considering the important factor of bone defects, it is necessary to combine patient's age, exercise level and surgeon's technique to comprehensively select the bestsurgical method.

Suture technique for rotator cuff tears' repair under arthroscopic / 中国骨伤

Shoulder arthroscopic as a conventional method usually is applied to repair rotator cuff tears. In clinical, plenty single-row, double-row and transosseous tunnels suture technique are performed, but the ideal suture technique for rotator cuff repair is not found. Compared with single-row, double-row has better strength in biomechanics property. As the two best suture technique among the single-row, massive cuff stitch and modified Mason-Allen suture have the strongest biomechanics property. Clinical trials indicate that double-row could improve healing rates, but there are no significant difference in clinical outcome functional scores. Transosseous tunnel techniques possess a better bio-mechanic property, which could improve regional micro-environment and induce tendon-bone healing. Transosseous tunnel techniques are better for small to media size rotator cuff tears and osteoporosis patient. The author suggest that optimal rotator cuff repair technique should performed according to skill of performer and individual of patient by analysing bio-mechanic properties, clinical outcome, operative complexity and patient situation. The technique should follow simple opertaion, rapid, less trauma, stable fixation and utility to perform.

Progress on the treatment of recurrent anterior dislocation of shoulder with bone defect / 中国骨伤

Recurrent anterior dislocation of shoulder with bone defect is one of the common diseases of shoulder joint. How to effectively repair glenoid bone defect and reduce recurrence rate of shoulder dislocation is a problem that clinicians focus on. Bone grafting could stimulate bone, promote bone regeneration and bone remodeling, and restore the normal anatomical structure of glenoid. Among them, Bristow-Latarjet procedure is a classic operation for recurrent shoulder dislocation. Latarjet procedure could repair larger glenoid bone defects, but with higher surgical skills for surgeons;autogenous iliac grafting is the first choice for revision once Latarjet procedure failed;osteochondral grafting (autogenous and allogenous) has certain advantages in reconstructing original articular surface and preventing joint degeneration, but autologous osteochondral grafting may cause secondary injury, while immune rejection is difficult to avoid for allogenous osteochondral grafting. With the improvement of composite materials, and the mechanism of bone regeneration and remodeling, as well as the advantages and disadvantages of bone grafting, tissue engineering technology may become an effective method for the treatment of glenoid bone defect in the future.

Research advance in surface modification of titanium alloys with chitosan / 中国骨伤

Titanium alloy has good biological properties and is commonly used in orthopedics, but its bone integrity and antibacterial properties are poor, so surface modification is needed to make up for its shortcomings. Chitosan has good biocompatibility and film forming ability, and can be used as a carrier to introduce the target drug to the surface of titanium alloy, which can effectively improve the biological properties of titanium alloy materials and increase its application range. In this paper, the related research of chitosan surface modified titanium alloy materials in recent years is summarized. The modification methods of chitosan coating, the improvement of osteogenesisand antibacterial properties of titanium alloy materials are discussed in order to provide guidance for the clinical application of coating modification of titanium alloy materials.

Progress on effect of osteoporosis on rotator cuff repair / 中国骨伤

The rate of rotator cuff injury repair and retear is high in elderly patients due to the combination of different degrees of osteoporosis. To solve this problem, many surgeons try to reduce retear rate of rotator cuff injuries in these patients by increasing the initial fixation strength of anchors and changing local bone conditions. The rapid advances of tissue engineering have made it possible to use growth factors as an aid. However, repair of rotator cuff injury with osteoporosis is still a great challenge for clinical workers. How to better increase anchor fixation strength, improve micro-environment of tendon and bone healing, reduce the rotator cuff retear rate have become the research focus in recent years. The paper reviewed literatures on the relationshipbetween osteoporosis and rotator cuff injury, effect of osteoporosis in rotator cuff tendon healing, methods of reducing osteoporosis on rotator cuff tendon healing, in order to guide clinical treatment, improve operative effect and postoperative satisfaction.

Progress on improving tendon-to-bone healing for the enthesis of rotator cuff / 中国骨伤

Rotator cuff repair is a common treatment for rotator cuff tear, which could effectively relieve shoulder pain and improve shoulder movement, and the incidence of rotator cuff retear after rotator cuff repair is still high. The main reason is poor tendon-bone healing in rotator cuff enthesis after rotator cuff repair and could not recover the original histological structure and biomechanical properties. Therefore, the key to solve the problem is how to effectively improve the healing of tendon bone at the end of rotator cuff. With the in-depth study of rotator cuff enthesis, various treatments have made great progress on improving tendon to bone healing of rotator cuff. Our study will discuss the researchprogress on tendon to bone healing of rotator cuff in recent years from three following aspects to provide some guidance for the clinical treatment of rotator cuff tear:the factors affecting the tendon to bone healing of rotator cuff, the recovery of tendon to bone interface promoting the tendon to bone healing of rotator cuff and the application of tissue engineering in tendon to bone healing.

Follow-up study on autogenous osteochondral transplantation for cartilage defect of knee joint / 中国骨伤

OBJECTIVE@#To evaluate clinical effect of autologous osteochondral transplantation in treating localized knee cartilage defects.@*METHODS@#Fifteen patients with knee cartilage defects were treated by autologous osteochondral transplantation from January 2007 to January 2008, including 8 females and 7 males, aged from 23 to 45 years old. Preoperative and postoperative KSS score at 10 years were compared.@*RESULTS@#All patients were followed up for 10.0 to 10.7 years, with an average of(10.2±0.3) years. Clinical score of KSS was improved from 38.86±4.09 to 85.07±2.19 at 10 years after operation(0.05). All patients had no other complications.@*CONCLUSIONS@#Through long-term follow-up of patients with cartilage defect in knee treated by autologous bone cartilage transplantation showed that this method could effectively improve function of knee joint and alleviate pain. So it is an effective method for repair of osteochondral defect.

Clinical observation of high tibial osteotomy for knee osteoarthritis:10 years follow-up / 中国骨伤

OBJECTIVE@#To explore long-term following-up clinical effects of lateral closed high tibial osteotomy for the treatment of knee osteoarthritis.@*METHODS@#Twenty patients with medial unicompartmental knee osteoarthritis were treated with lateral closed high tibial osteotomy and screw fixation from June 2005 to December 2015. Among them, including 17 females and 3 males, aged from 43 to 76 years old with an average of (57.80±8.05) years old. VAS score and KSS score were applied to evaluate recovery degree of pain and function before operation and after operation at 1, 5 and 10 years, and postoperative complications were observed.@*RESULTS@#Sixteen patients were followed-up, the time ranged from 9 to 11(10.0±0.8) years, 4 patients were loss to follow-up. Preoperative VAS score was 7.88±1.15 and decreased to 3.19±0.91, 3.44±0.96, 3.69±1.20 at 1, 5 and 10 years after operation, and there were statistical differences in VAS score between before and after operation at different time points (<0.05). Clinical score of KSS increased from 61.94±5.74 before opertaion to 75.50±4.62, 80.13±3.97, 77.38±6.40 at 1, 5 and 10 years after operation, and there were statistical differences in clinical score of KSS between before and after operation at different time points(<0.05); functional score of KSS increased from 62.81±13.03 before operation to 77.50±8.56, 81.88±6.55, 76.88±10.78, and there were statistical differences in functional score of KSS between before and after operation at different time points(<0.05). All incisions healed well without complications such as fibula nerve injury and fracture nonunion.@*CONCLUSIONS@#Lateral closed high tibial osteotomy and screw fixation for knee osteoarthritis could receive good clinical results, stop and delay progress of knee osteoarthritis, and long-term following-up could achieve the same effect as total knee arthroplasty.

Reconstruction of complex proximal tibial defects using the long-stem tibial component combined with metallic wedge / 中国骨伤

<p><b>OBJECTIVE</b>To investigate results of total knee arthroplasty using the long-stem tibial component combined with metallic wedge of knee prosthesis for the treatment of proximal defects.</p><p><b>METHODS</b>From January 2011 to May 2013, 10 patients (11 knees) were treated with total knee arthroplasties using the long-stem tibial component with metallic tibial wedge of knee prosthesis. All the patients were female and the average age was 67 years old (ranged, 60 to 77 years old). All the patients were osteoarthritis. All the patients were classified as T2A style. The patients were evaluated according to knee score system (KSS).</p><p><b>RESULTS</b>All the patients were followed up for 12 months on average (ranged 3 to 29 months). The clinical outcome was assessed using KSS score, including knee pain score, knee stability score, knee range of motion score and knee walking score, knee stairs score. There were significantly differences at 6 weeks, 3 months, 6 months and 12 months between pre-and postoperative KSS score.</p><p><b>CONCLUSION</b>The mechanical stability of tibial fixation in primary TKA is significantly increased by using the long-stem tibial component with metallic wedge of knee prosthesis, even in the presence of poor proximal bone.</p>

Treatment of tibial intercondylar eminence fracture under arthroscopy through patellofemoral joint space / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of arthroscopy techniques for the treatment of tibial intercondylar eminence fractures through patellofemoral joint space.</p><p><b>METHODS</b>From September 2008 to September 2012,45 patients (32 males, 13 females; ranging in age from 15 to 22 years old) with intercondylar eminence fractures (29 left knees and 16 right knees) were treated with reduction and fixation through patellofemoral joint space under arthroscopy. All fractures were fresh fracture and were treated within 10 days after trauma. The fractures were confirmed by X-ray. According to Meyers and McKeever classification, 27 patients had fractures with type III and 18 patients had fractures with type II. After operation, X-ray films were taken to evaluate fracture heal,and Lysholm criteria was used to evaluate therapeutic effects.</p><p><b>RESULTS</b>All the patients were followed up, and all fractures healed at 3 months after operation. During the follow-up period, all the patients had excellent or good results,without complications such as nonunion, limit extension caused by intercondyloid fossa knocking of knee joint, strengthening pain and anterior instability of knee joint. The mean Lysholm score was 92 (ranged, 85 to 96) of patients with type II fractures,and 93 (ranged, 83 to 96) of patients with type II fractures.</p><p><b>CONCLUSION</b>Treatment of tibial intercondylar eminence fractures under arthroscopy through patellofemoral joint space has follow advantages: simple reduction and fixation, easy operation and good clinical outcome.</p>

Reconstruciton of medial patellofemoral ligament (MPFL) for the treatment of recurrent patellar dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the middle term effectiveness of medial patellofemoral ligament (MPFL) reconstruction for the treatment of recurrent patellar dislocation.</p><p><b>METHODS</b>From February 2007 to January 2010, 65 patients including 6 males and 59 females with recurrent patellar dislocation received the MPFL reconstruction. The reconstruction was performed using ipsilateral semitendinosis tendon to restore the damaged MPFL. Patients were evaluated pre-operatively and post-operatively by physical and subjectively with the IKDC (International Knee Documentation Committee), Tegner, and Lysholm questionnaires and radiographic examination.</p><p><b>RESULTS</b>The average follow-up duration was 20 months (ranged, 15 to 23 months). No recurrent episodes of dislocation or subluxation occurred. A firm endpoint to lateral patellar translation was noted in all patients at most recent follow-up. The Lysholm subjective knee evaluation score improved from (60.6 +/- 3.7) preoperatively to (89.8 +/- 4.6) postoperatively; and Tegner scores improved from (3.6 +/- 0.4) to (5.6 +/- 0.3), IKDC from (40.0 +/- 3.5) to (82.0 +/- 3.6). Radiographic evaluation demonstrated improvements in the congruence and sulcus femoral angles.</p><p><b>CONCLUSION</b>MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation.</p>

Study on the long-term effects of the quadratus femoris muscle pedicle bone graft with screw fixation for the treatment of femoral neck fractures in young adults / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the long-term effects of the quadratus femoris muscle pedicle bone graft with screw fixation for the treatment of femoral neck fractures in young adults.</p><p><b>METHODS</b>From 2002 to 2008, 38 patients with femoral neck fractures were operated. There were 22 males and 16 females, with an average age of 40 years (ranged 25 to 60 years). Twenty-six patients injured from high velocity road traffic accident, among which 14 patients injured in automobile accident, 8 in two wheeler accident and 4 in fall from height. Twelve patients had serious associated injuries. Femoral neck fractures were classified by Garden classification: 25 patients were Graden II and 13 patients were Graden III. Thirty-six patients underwent emergency operation and 2 had delayed operation. Clinical scores were evaluated based on Sanders scores and the radiological criteria which was judged by the diminution of density in the necrotic portion of the femoral head.</p><p><b>RESULTS</b>All the patients were followed up for at least 2 years (ranged 2 to 5 years). There were significant differences between preoperation and postoperation in pain, function, muscle power and walk ability. All the patients with fractures were healed in an average of 5 months after operation and walked without aids and no complications occurred.</p><p><b>CONCLUSION</b>This technique provides a high union rate with a low complication rate. In addition, the surgical procedure is relatively simple and has a nice long-term result.</p>

Effect of the intraperitoneal injection of ATP on denervated skeletal muscle atrophy and neurotrophic factor-3 in spinal cord motor neuron after brachial plexus injuries / 中华显微外科杂志

Objective To observe the influence of ATP protection after brachial plexus injuries. Methods A total of 80 female Wistar rats,weighting 280～300 g,were randomly divided into ATP and con- trol groups.The right C_5～T_1 nerve roots were transected and then the intraperitoneal injection of 4m[ of ATP or normal saline was given immediately and once daily to the rats,respectively.The rats were sacrificed on postoperative days 14,28 and 42 respectively.The C_5-T_1 segments of the spinal cord were harvested.NT-3 activity was measured by enzymo-histochemistry method.Four weeks and 6 weeks postoperatively,ultrastruc- ture of the denervated skeletal muscles was observed.Results Compared to the control group,the expres- sions of NT-3 was increased in the treated groups with ATP injection (P