肩关节镜下肩袖修复术治疗肩袖损伤的临床效果

目的探讨肩关节镜下肩袖修复术治疗肩袖损伤的临床效果。方法将我院2018年2月至2019年2月收治的52例肩袖损伤患者随机分为对照组(26例,开放式肩袖修复术)和观察组(26例,全肩关节镜下肩袖修复术)。比较两组的治疗效果。结果治疗后,两组的肩关节前屈、内旋、外旋活动度及Constant-Muley肩关节评分均增加,数字评估量表(NRS)评分均降低,且观察组显著优于对照组(P<0.05);观察组的治疗优良率显著高于对照组(P<0.05)。结论肩关节镜下肩袖修复术治疗肩袖损伤的临床效果显著,能够有效减轻患者疼痛,加快患者术后肩关节功能的恢复,值得临床推广应用。     

肩袖撕裂的超声诊断

目的：评价超声检查肩袖撕裂的应用价值。方法：对55例（57个肩关节 ）临床怀疑肩袖损伤者行超声检查,诊断标准包括。（1）、肩袖部分缺损;（2）、肩袖不显示;（3）肩袖内局灶性回声异常;（4）、肩袖部发变薄,超声检查结果与手术、肩关节造影或MR结果比较。结果：超声诊断敏感性94％（33／35）,特异性86％（19／22）,准确性91％（52／57）。结论：超声检查肩袖撕裂具有很高的应用价值,作为首选的检查方法。     

肩袖超声成像研究

检查３０例正常人的６０个肩袖，对肩袖各肌腱的大小、形态及成像特点等进行了一系列的观察和分析，获得了有价值的资料和数据，为进一步研究超声检查肩袖疾病奠定了基础。     

MR mDIXON Quant技术定量的冈上肌及冈下肌脂肪浸润与肩袖损伤程度的相关性

目的 观察以MR mDIXON Quant技术定量的冈上肌及冈下肌脂肪浸润与肩袖损伤程度的相关性。方法 对82例单侧肩部疼痛伴活动受限患者行肩关节MR常规扫描及mDIXON Quant序列扫描，均显示肩袖损伤(均为冈上肌损伤)。根据MRI冈上肌损伤程度分为退变组、部分撕裂组和全层撕裂组。于mDIXON Quant序列后处理图像上测量冈上肌及冈下肌脂肪分数(FF)。比较3组间FF的差异，并分析冈上肌FF、冈下肌FF及肩袖损伤程度的相关性。结果 82例中，退变组31例，部分性撕裂组30例，全层撕裂组21例。全层撕裂组冈上肌FF[(2.09±0.39)%]高于部分撕裂组[(1.81±0.31)%]及退变组[(1.18±0.56)%,P均<0.05],部分撕裂组冈上肌FF高于退变组(P<0.05)。部分撕裂组[(1.61±0.45)%]及全层撕裂组[(1.72±0.61)%]冈下肌FF均高于退变组[(1.04±0.60)%,P均<0.05],部分性撕裂组与全层撕裂组冈下肌FF差异无统计学意义(P>0.05)。冈上肌FF(r_s=0.64,P<0...     

袖带与肢体的力学关系及其对血压测定的影响

为探讨袖带几何参数对间接血压测定的影响，采用物理模型研究了袖带内压与被测肢体内压的关系。结果表明，对于一定的袖压，肢体内压上升的高度与袖带气囊的宽度和长度正相关，而与肢体的周径负相关．经临床实验进一步证明，对于同一组病人，选用的袖带越窄、越短，血压读数越高，与物理模型所显示的规律相符合．这一结果提示，在血压测定中，袖带是一个重要的误差来源．我们建议研究一种“自适应”袖带，以克服传统袖带的这一缺陷。     

不同形状气管导管套囊对呼吸机相关性肺炎预防作用的对比研究

目的 通过模拟实验及临床研究,观察柱形套囊气管导管与锥形套囊气管导管的密封性能,比较两种形状套囊对呼吸机相关性肺炎（VAP）的预防作用。方法 （1）实验研究：将相同型号的柱形套囊气管导管与锥形套囊气管导管同时进行静态液体密封测试,观察10 min内套囊上液体渗漏情况;（2）临床研究：根据患者转入ICU选择不同形状套囊导管进行分组,柱形套囊组132例,锥型套囊组105例,两组病例均从气管导管冲洗管内注入0．2％亚甲蓝5 ml ,用纤维支气管镜观察气管黏膜染色情况,统计VAP发生率和发生时间。结果 （1）10 min内,相同型号的锥形套囊气管导管液体渗漏量明显少于柱形套囊气管导管;（2）锥形套囊组预防VAP的发生率优于柱形套囊组,特别是预防早期VAP发生率优于柱形套囊组;但在预防长期留置导管VAP方面,两组没有明显差异;锥形套囊组发生VAP的时间明显较柱形套囊组晚。结论 使用封闭效果良好的锥型套囊导管,可减少声门下滞留物的渗漏量,延迟VAP发生的时间。     

The relationship of preoperative factors to patient-reported outcome in rotator cuff repair: a systematic review

Background: Understanding preoperatively available factors that predict valid, patient-reported outcomes following rotator cuff repair can assist clinicians and their patients in making an informed, shared-decision on rotator cuff repair, and assist in setting an evidence-based prognosis.

Objectives: To perform a systematic review of the preoperative factors related to patient-reported outcome following rotator cuff repair.

Methods: A systematic review of the literature was performed to identify studies analyzing the relationship of preoperative factors to valid, patient-reported outcome measures. To be included in the review, outcome had to be measured by at least one valid upper extremity or shoulder-specific patient-reported outcome.

Results: Twenty-three studies met the criteria for inclusion. Of these, 15 studies scored 3 or less on a 7-point scale of study quality indicating a paucity of strong trials investigating these prognostic factors. Prognostic factors reviewed included age, sex, worker’s compensation status, involvement of dominant arm, fatty infiltration of the cuff musculature, duration of symptoms, comorbidities, and smoking status. Increasing age predicted worse Disabilities of Arm, Shoulder and Hand Scores (DASH) but did not predict outcome of any other patient-reported outcome. A worker’s compensation claim predicted a negative impact on patient-reported outcome. Evidence for the remaining factors indicated they do not predict patient-reported outcome.

Conclusion: Six of the eight preoperative factors reviewed did not show a relationship with patient-reported outcome following rotator cuff repair. Evidence indicates a worker’s compensation claim negatively impacts patient-reported outcomes and increasing age resulted in a less favorable DASH score. However, age was not predictive of other patient-reported outcomes such as the Constant score or American Shoulder and Elbow Surgeons Shoulder Score. Overall quality of the included studies was low and future studies with stronger methodologies should be conducted.     

Ultrasonography of rotator cuff tears: a review of 500 diagnostic studies

Ultrasonography of the rotator cuff has been shown to be of value in diagnosing rotator cuff tears. This report summarizes our experience with our first 500 diagnostic examinations. All patients were examined in the hyperextended internal rotation view with commercially available high-resolution real-time ultrasound equipment. Patients were diagnosed as having a rotator cuff tear if a focal echogenic lesion or a defect within the rotator cuff was identified. This study confirmed the value of ultrasonography for the diagnosis of rotator cuff tears. Accuracy, sensitivity, and specificity all exceeded 90%, and correlated with surgical findings. This was better than arthrography in the same patient population. Ultrasound is an accurate noninvasive method of examining the rotator cuff for the presence of tears. We suggest that rotator cuff ultrasonography is the procedure of choice for the diagnosis of tears if adequate instrumentation is available.     

Ultrasonography of the rotator cuff: Surgical correlation

Rotator cuff tears are a common orthopedic problem. The portions of the cuff most commonly torn are accessible to sonographic examination with appropriate positioning of the shoulder. This study was undertaken to correlate the sonographic appearance of the pathologic rotator cuff with findings at the time of surgical repair. Rotator cuff tears are readily seen with high-resolution real-time sonography. Sonography can demonstrate tears not demonstrated arthrographically. In the appropriate clinical setting arthrography may not be necessary if the sonogram demonstrates characteristic findings.     

人工气道气囊内压力与误吸量相关性动物实验研究

目的探讨人工气道气囊内压力与误吸的相关性。方法Sheridan气管导管气囊上缘伴行7．0Fr吸痰管，健康杂种犬麻醉后置入内径7．0mm的气管导管，给人工气道气囊充气，选择不同水平囊内压，在气囊上声门下通过伴行的吸痰管注入10mL生理盐水，保留5min，收集剩余液体量，漏出液体量即误吸量，观察比较各囊内压力下误吸量。结果囊内压力在29mmHg时误吸量为0mL，与囊内压力在26mmHg误吸量为（0．48±0．48）mL相比有显著差异P〈0．05。当囊内压力在15mmHg时误吸量为（1．3±1．57）mL，18mmHg时误吸量为（0．8±1．0）mL，22mmHg时误吸量为（0.75±0．8）mL，与囊内压力在26mmHg比较均无显著差异。囊内压力在11mmHg时已出现漏气。结论囊内压力在15-26mmHg时误吸量无显著差异，临床工作中可结合其他因素选择此范围内的压力。     

人工气道气囊内压力与误吸量相关性动物实验研究

目的探讨人工气道气囊内压力与误吸的相关性。方法Sheridan气管导管气囊上缘伴行7.0 Fr吸痰管,健康杂种犬麻醉后置入内径7.0 mm的气管导管,给人工气道气囊充气,选择不同水平囊内压,在气囊上声门下通过伴行的吸痰管注入10 mL生理盐水,保留5 min,收集剩余液体量,漏出液体量即误吸量,观察比较各囊内压力下误吸量。结果囊内压力在29 mmHg时误吸量为0 mL,与囊内压力在26 mmHg误吸量为(0.48±0.48)mL相比有显著差异P<0.05。当囊内压力在15mmHg时误吸量为(1.3±1.57)mL,18 mmHg时误吸量为(0.8±1.0)mL,22 mmHg时误吸量为(0.75±0.8)mL,与囊内压力在26 mmHg比较均无显著差异。囊内压力在11 mmHg时已出现漏气。结论囊内压力在15~26 mmHg时误吸量无显著差异,临床工作中可结合其他因素选择此范围内的压力。     

肩袖炎症性病变的超声诊断价值

目的探讨超声对肩袖炎症性病变的定位和定性诊断价值。方法高频超声检测162例患有肩痛和不同程度的肩关节活动障碍的患肩，对声像图进行分型研究。结果超声将162例患肩的声像图分为肱二头肌长头肌腱腱鞘炎（39例）、肱二头肌长头肌腱炎（33例）、冈上肌腱炎症（51例）、钙化性肌腱炎（19例）和肩关节周围滑囊炎（20例）六种类型，各型超声分别分为几个亚型。结论高频超声可以提供某些肩袖软组织病变的定位和定性诊断，对于临床针对性的治疗具有重要的价值。     

Cuff width influence on blood pressure measurement during the pregnant-puerperal cycle

BACKGROUND: The correct evaluation of blood pressure (BP) during pregnancy is a crucial factor in the prevention of eclampsia. Following American Heart Association (AHA) guidelines to employ a correct cuff width (CCW), 20% larger than arm diameter, we demonstrate that the standard cuff width (SCW), 12 cm wide, is too large for lean women causing underestimation of BP. AIMS: To identify the arm circumference (AC) in pregnant women and the corresponding cuff width; to compare BP records from CCW vs. SCW; and to identify under- and overestimation of BP in SCW reading. DESIGN: A follow up study of BP was performed in 104 pregnant women using two cuffs widths (CCW vs. standard one). The investigation was carried out during all antenatal appointments and postpartum stage in two maternity hospitals. In every appointment BP was registered three times with each type of cuff; and the means of those three readings were compared. METHODS: The CCW for each woman was selected according to AHA recommendation for cuff width size (20% larger than arm diameter), which was based on the classical European and North-American studies. Results. Arm circumference varied from 20 to 38 cm requiring a cuff width from 8 to 14 cm. The CCW most employed was 10 cm wide. The SCW (12 cm) was employed as CCW in only 13.4% of the subjects. Statistical difference was found on BP means when comparing both cuffs (P < 0.05), reaching 23 mmHg in systolic values and 20 in diastolic ones. Such differences showed a serious underestimation when SCW was employed in 80.8% of the subjects and overestimation in 5.8% of obese subjects. CONCLUSION: Our findings showed that the SCW underestimates BP of pregnant women. Our hypothesis is that such underestimation may lead to the misdiagnosis of pre-eclampsia, particularly in lean pregnant women.     

A Systematic Comparison on Postoperative Analgesia Effect Between Subacromial and Intravenous Analgesia Pumps for Arthroscopic Rotator Cuff Repair

PurposeArthroscopic rotator cuff repair is often associated with severe postoperative pain. Various agents, routes, and modes are used for the treatment of postoperative pain with a minimum of side effects. This systematic work was conducted to compare the postoperative effect of subacromial patient-controlled analgesia with intravenous patient-controlled analgesia after an arthroscopic rotator cuff repair surgery.DesignA systematic review of relevant studies were retrieved from electronic databases and included based on criteria and eligibility.MethodsThe articles were retrieved from 1997 to 2018 by computerized searches of Scopus, PubMed, and EMBASE using different combinations of search terms, such as shoulder, rotator cuff, analgesic, analgesia, arthroscopic, pain, cuff repair, rotator cuff repair, acromion, and intravenous.FindingsA total of 10 articles were included in this study from the initial search of 778 records. Compared with subacromial procedure, the intravenous procedure helps in reducing the postoperative pain but with more side effects.ConclusionsThis study described that the direct continuous infusion of anesthetic under subacromial analgesic pump showed a greater pain relief with less side effects compared with intravenous infusion for arthroscopic rotator cuff repair.