肩关节镜下270°松解术治疗原发性冻结肩

目的 探讨肩关节镜下270°松解术治疗原发性冻结肩的临床疗效。方法 采用肩关节镜下270°松解术治疗52例原发性冻结肩患者。测量肩关节前屈上举、外展上举和体侧外旋角度,采用肩关节疼痛VAS评分、UCLA评分和Constant-Murley评分评估肩关节功能。结果 患者均获得随访,时间12～24个月。术后未发生感染、神经损伤和关节脱位不稳。肩关节活动度及肩关节功能评分术后2周、3个月、12个月与术前1周比较差异均有统计学意义(P 0. 05),术后3、12个月各项指标均较前一时段进一步改善(P 0. 05)。结论采用肩关节镜下270°松解术治疗原发性冻结肩可有效缓解疼痛,改善肩关节活动度,临床效果良好。     

关节镜下直接松解后行肩袖修复术治疗老年冻结肩合并肩袖损伤的临床疗效研究分析

目的研究分析肩关节镜直接松解法联合肩袖修复术治疗老年冻结肩合并肩袖损伤的临床疗效。方法选取2015年1月至2017年1月本院收治的肩袖损伤伴合并冻结肩老年患者106例,治疗医师按照治疗方法不同将患者平分为两组:其中A组行肩关节镜下直接松解、肩袖修复术治疗;B组行手法松解、肩关节镜肩袖修复术治疗。观察A组、B组患者治疗前、治疗后1、3、6个月的VAS评分,ASES评分,Constant-Muley肩关节功能评分。记录并比较A、B两组患者手术时间、术中出血量、住院时间、术后疾病减轻时间。结果 A组与B组在术后1个月、术后6个月的VAS评分无显著差异(P0.05);A组在术后3个月的VAS评分略高于B组,差异具有统计学意义(P0.05);A组在治疗后3个月、6个月的ASES评分略低于B组,差异具有统计学意义(P0.05);A组患者术后3个月、6个月的Constant-Muley肩关节功能评分略低于B组患者、差异具有统计学意义(P0.05)。结论本研究两种方法治疗老年冻结肩合并肩袖损伤均可获得比较满意的临床效果,关节镜下直接松解联合肩袖修复术对患者的创伤度更小,术后恢复速度更快,适合应用于手术后关节功能预期要求尚可,且需要完全微创治疗的老年患者。     

开放式与肩关节镜下肩袖修补术治疗中度肩袖撕裂近期疗效分析

目的观察肩关节镜下与开放式肩袖修补术治疗中度肩袖撕裂的近期疗效。方法以80例中度肩袖撕裂患者为研究对象,对照组(40例)行开放式肩袖修补术,研究组(40例)行全肩关节镜下肩袖修补术。统计两组手术指标,比较两组手术前后疼痛反应及肩关节功能评分,观察术后3个月内并发症。结果两组手术耗时差异不具有统计学意义(P0.05),而研究组术中出血量和创口愈合时间均显著短于对照组(P0.05);术后3个月,两组VAS、ASES、Constant、UCLA评分、前屈活动度和外展活动度差异均不具有统计学意义(P0.05);研究组术后并发症发生率(7.50%)显著低于对照组(25.00%)(P0.05)。结论肩关节镜下与开放式肩袖修补术均可有效治疗中度肩袖撕裂,然而肩关节镜下肩袖修补术医源性创伤更小,术后并发症更少。     

肩关节镜手术联合ERAS治疗肩袖损伤合并冻结肩的临床价值

目的比较肩关节镜手术联合与未联合快速康复外科(Enhanced recovery after surgery,ERAS)治疗肩袖损伤合并冻结肩的临床疗效。方法回顾性分析自2018-01—2019-12诊治的62例肩袖损伤合并冻结肩,32例采用肩关节镜手术联合ERAS治疗(观察组),30例单纯采用肩关节镜手术治疗(对照组),比较2组住院时间、术后并发症、术后1 d、2 d、3 d、6周疼痛VAS评分,比较2组术后1、3、6个月Constant-Murley评分、ASES评分、肩关节UCLA评分、肩关节活动度。结果 62例均顺利完成手术并获得至少6个月的随访。观察组住院时间、并发症数较对照组少,差异有统计学意义(P0.05)。观察组术后1、2、3 d疼痛VAS评分较对照组低,差异有统计学意义(P0.05),术后6周2组疼痛VAS评分比较差异无统计学意义(P0.05)。术后1个月及术后3个月观察组Constant-Murley评分、ASES评分、肩关节UCLA评分高于对照组,差异有统计学意义(P0.05),术后6个月2组Constant-Murley评分、ASES评分、肩关节UCLA评分比较差异无统计学意义(P0.05)。术后1个月及术后3个月观察组内旋、外旋、外展、前屈活动度高于对照组,差异有统计学意义(P0.05);术后6个月2组内旋、外旋、外展、前屈活动度比较差异无统计学意义(P0.05)。结论肩关节镜手术联合ERAS治疗肩袖损伤合并冻结肩能取得较好临床效果,能减轻疼痛与并发症,可有效促进术后肩关节功能恢复。     

肩关节镜松解术联合关节腔内几丁糖注射治疗原发性冻结肩

[目的]比较关节腔内注射医用几丁糖联合肩关节镜下松解术与单纯肩关节镜下松解术治疗原发性冻结肩的临床疗效。[方法]选取2014年6月～2015年12月本院收治的原发性冻结肩患者46例,均采用肩关节镜下行松解术,根据关节腔内是否注射医用几丁糖将患者分为两组,其中23例患者接受关节镜松解术联合几丁糖关节腔内注射治疗(几丁糖组);另外23例患者仅接受单纯关节镜松解术治疗,未行几丁糖关节腔内注射(非几丁糖组),比较两组术后肩关节疼痛视觉模拟评分(VAS)、美国肩肘外科医师协会(ASES)肩关节功能评分和UCLA肩关节功能评分等评估指标。[结果] 46例患者均顺利完成肩关节镜下松解术。术后1个月随访时,几丁糖组和非几丁糖组患者术后VAS评分、ASES评分、UCLA评分均较术前明显改善,差异有统计学意义(P0.05)。两组间比较丁糖组VAS评分、ASES评分及UCLA评分均优于非几丁糖组,差异具有统计学意义(P0.05);术后1年时,两组间VAS评分、ASES评分及UCLA评分差异均无统计学意义(P0.05)。[结论]肩关节镜下松解术治疗冻结肩可显著提高术后肩关节功能,术中及术后多次联合关节腔内注射医用几丁糖可在一定程度上提高冻结肩短期治疗效果。     

80例肩袖损伤患者行肩关节镜肩袖修复术治疗的临床疗效探讨研究

目的研究分析肩关节镜肩袖修复术治疗肩袖损伤的近期临床疗效。方法选取2013年9月至2016年9月本院收治的80例肩袖损伤患者,治疗医师根据数字表将所有患者平分为两组。其中A组患者40例,行肩关节镜肩袖修复术治疗;B组40例,行小切口肩袖修复术治疗。观察并评估两组患者术前、术后、1个月、3个月、6个月的视觉疼痛模拟评分(VAS),美国肩与肘协会评分(ASES)、美国加利福尼亚大学洛杉矶分校评分(UCLA)及肩关的前屈,外旋活度角度情况。结果 A组患者术后1、3个月的VAS评分均显著低于B组患者(P0.05);A、B两组术后6个月的VAS评分无显著差异(P0.05);A组患者术后1个月、3个月的ASES评分均明显高于B组(P0.05);A组患者术后1个月、3个月、6个月的UCLA评分均显著高于B组患者(P0.05);A组患者术后1个月、3个月的肩关节前屈、外旋活动度均大于B组患者(P0.05)。结论肩关节镜肩袖损伤可取得与常规小切口修复术相同的治疗效果,术后近期疗效比较,肩关节镜肩袖修复术可以更快速地促进肩关节活动功能恢复,且创伤程度更小,在治疗肩袖损伤的同时,也可处理肩关节其他疾病及损伤,适合临床医师选择应用。     

肩关节镜下松解联合快速康复治疗原发性冻结肩的疗效观察

目的 探讨肩关节镜下松解联合快速康复治疗原发性冻结肩的临床疗效.方法 回顾性分析自2014-01-2017-12采用肩关节镜下松解联合快速康复治疗的30例原发性冻结肩,比较术前、术后1个月、术后6个月、术后12个月疼痛VAS评分与肩关节功能评分(包括Constant-Murley评分、ASES评分、UCLA评分).结果...     

关节镜下微创治疗肩袖钙化性肌腱炎

目的 探讨关节镜下微创钙化灶清除保留喙肩韧带预防性肩峰成形术治疗肩袖钙化性肌腱炎的适应证、手术方法及疗效.方法 2006年1月至2011年6月间采用肩关节镜下手术治疗肩袖钙化性肌腱炎12例,男3例,女9例;左肩5例,右肩7例;年龄32～72岁,平均54.6岁;病程3个月～2.5年,平均12个月.术前对患者肩关节功能按照加利福尼亚大学洛杉矶分校(universityofCalifornia at Los Angeles,UCLA)评分法进行评估,平均(16.14±2.10)分.本组患者常规进行预防性肩峰成形术.对于本身存在肩峰下骨赘的患者充分去除增生骨质,而对于无明显骨赘的患者则仅做轻度的肩峰成形,去除2 mm左右的骨质,并且保护喙肩韧带完整,从而保护了肩关节上方的被动稳定性结构.对4例钙化灶特别巨大、在彻底清除病灶及被钙化灶侵蚀和破坏的肩袖组织后,评估肩袖缺损深度超过肌腱厚度的50％者使用了锚钉行肩袖修补术.结果 术后随访6～25个月,平均16.4个月.术后疼痛程度及功能评分均有显著提高.肩关节活动范围明显改善.对手术前后UCLA各项进行配对t检验,两组差异有统计学意义(t=37.08,P＜0.01).结论 关节镜下钙化灶清除及保留喙肩韧带的预防性肩峰成形术,是治疗经保守治疗无效的肩袖钙化性肌腱炎患者一种安全有效的方法,具有损伤小、恢复快的优点.     

关节镜下治疗肱骨近端骨折内固定术后冻结肩

目的探讨肩关节镜下治疗肱骨近端骨折术后冻结肩的疗效。方法对61例肱骨近端骨折切开复位内固定术后冻结肩患者采用全身麻醉肩关节镜下治疗联合关节松解、内固定装置取除术。比较手术前后肩关节活动范围、UCLA评分及ASES评分。结果关节镜下肱骨近端骨折内固定术后冻结肩常见有关节内病变。52例完成术后12~18个月的随访,9例失访。52例肩关节活动度、UCLA评分和ASES评分末次随访均较术前改善(P<0.05)。结论肩关节镜下治疗联合关节松解、内固定装置取除术有助于改善肱骨近端骨折内固定术后冻结肩患者的肩关节功能。     

关节镜下肩袖钙化灶去除率的相关性研究

目的分析关节镜下治疗肩袖钙化性肌腱炎中钙化灶去除率与术后功能恢复的关系及其影响因素。方法回顾性研究1999年1月～2005年3月接受肩关节镜治疗的77例（81侧）肩袖钙化性肌腱炎患者的临床资料，分别记录其肩袖钙化灶的部位、X线片上的类型、大小和手术前后的功能评分，并分析相互之间的相关性。结果术后患者平均随访7．2个月，肩关节功能按Constant和Murley的评分绝对值自术前的61．3分提高至术后最后随访时79．6分，钙化灶的平均去除率为83％。术前钙化灶的大小与肩关节术前功能不相关。钙化灶的去除率与患者的年龄、钙化灶的类型、大小不相关。术后肩关节功能的改善与钙化灶的去除率无相关性。但钙化灶的部位影响其去除率及术后功能改善，尤其是冈下肌的钙化灶去除比较困难且功能改善不显著。结论肩关节镜治疗肩袖钙化性肌腱炎疗效良好。钙化灶的去除率与肩关节功能不相关，但钙化灶的清除率与钙化灶的部位有关。彻底清除钙化灶可避免术后疼痛爆发。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020