Can the reverse total shoulder arthroplasty provide as good of an outcome as an anatomic shoulder arthroplasty

BackgroundReverse total shoulder arthroplasty (RTSA) is an excellent treatment option for a variety of shoulder pathologies. Anatomic total shoulder arthroplasty (TSA) remains an excellent treatment for patients with glenohumeral arthritis and a functioning rotator cuff. RTSA has become a much more common procedure than TSA in recent times. It is currently unclear if patients who have a good outcome following TSA outperform patients who have a good outcome following RTSA. The purpose of this study was to compare the 2-year outcomes of patients with good outcomes, defined as having forward flexion of >130° and American Shoulder and Elbow Surgeons score of >70, following TSA and RTSA.MethodsAll patients who underwent TSA or RTSA between 2015 and 2019 with minimum 2-year follow-up were eligible for inclusion. Patients were included if their postoperative forward flexion was >130° and American Shoulder and Elbow Surgeons score was >70. Patients were excluded if they were a revision surgery, were treated with an arthroplasty for fracture, or had a latissimus transfer. Demographic variables were analyzed between groups. Range of motion (ROM), strength, and patient-reported outcome (PRO) scores were compared between groups.ResultsOverall, 318 TSAs were included; 155 (49%) met the criteria for a “good” outcome. Among RTSAs, 428 were included; 154 (36%) met the criteria for a “good” outcome. When comparing PROs between groups, RTSA patients had worse preoperative and postoperative PRO scores (all P < .05). When comparing preoperative physical examination findings, RTSA patients had worse ROM and strength (all P < .05) and worse Constant Power scores and Constant scores (P < .001 in both cases). Postoperatively, RTSA patients had worse ROM and strength (all P < .05) and worse Constant scores (P = .028). The magnitude of change (delta) from preoperative to postoperative function was often greater following RTSA than TSA. There were no significant differences in whether expectations were met or exceeded between RTSA and TSA patients in regards to pain control (99% vs. 98%; P = .177), motion and strength (93% vs. 96%; P = .559), ability to return to activities of daily living (98% vs. 99%; P = .333), or return to sporting activities (95% vs. 91%; P = .268).ConclusionPatients do well following both TSA and RTSA. In patients who have a good outcome following either TSA or RTSA, those patients who underwent TSA have superior outcomes to patients following RTSA. However, the change in outcome scores from pre- to post-surgery is often more significant with RTSA, as they often start out with worse motion and clinical scores.     

Flexibility does not affect the dorsiflexion of foot and the popliteal angle in young adults

BackgroundThe aim of the study was to assess how flexibility affects the dorsiflexion of foot and the popliteal angle test results in junior high school students.MethodsThe subjects were 142 students from the 2nd, and 3rd year of Poznań junior high schools (age between 13 and 15).Each subject was examined 6 times: there were 3 raters, a specialist in orthopaedics, a resident doctor and a physical therapy student, and each of them performed 2 measurements. Flexibility was also measured using the Beighton scale (score from 0 to 9).ResultsSince the Beighton scale is ordinal in order to evaluate the relationship between flexibility and the range of motion Spearman's rank correlation coefficient was calculated. The statistical analysis showed no correlation between flexibility measured on the Beighton scale and the range of passive foot dorsiflexion and the popliteal angle.ConclusionsThe degree of flexibility does not affect the dorsiflexion of the foot and the popliteal angle in junior high students. At this age the range of dorsiflexion is determined by the length of the triceps surae muscle while the popliteal angle depends on the length of the muscles on the back of the thigh.     

丹参滴注液清洁验证检验方法的确认研究

目的建立丹参滴注液清洁方法,对清洁残留检验方法进行验证确认。方法丹参滴注液生产结束后清洁剂为1％氢氧化钠溶液、1％枸橼酸溶液和注射用水,清洁后残留物限度≤10mg·L^-1,棉签擦拭取样,采用HPLC测定丹参素钠和原儿茶醛的残留量,色谱柱为C18柱（250mm×4．6mm,5μm）,流动相为甲醇-0．5％冰醋酸溶液（5：95）,流速1．0mL·min^-1。结果丹参素钠和原儿茶醛在下述范围内与峰面积呈良好的线性：（I）5．456～27．898mg·L^-1（r=0．9999）、（Ⅱ）0．530～2．684mg·L^-1（r=0．9999）。精密度和准确度在设定范围。结论丹参滴注液清洁方式可行,清洁效果确切,残留活性成分检测准确、灵敏,通过确认证明该检验方法可用于丹参滴注液清洁验证残留活性成分的检测。     

How often is functional range of motion obtained by manipulation for stiff total knee arthroplasty?

Purpose

To evaluate how often manipulation under anesthesia (MUA) can achieve functional flexion ≥ 90 degrees and identify predictor for successful outcome of MUA for stiff total knee arthroplasty (TKA).

Methods

Demographic data, range of motion, and surgical and anesthetic information of 143 MUAs were retrospectively analyzed from 2000 to 2011.

Results

One-hundred thirty-six out of 143 patients (95 %) improved mean range of motion (ROM) from pre-MUA 62 ± 17° to final ROM 101 ± 21° (p < 0.001). Flexion ≥ 90 degrees was achieved in 74% (106/143) of patients. Regional anesthesia was identified as predictor of successful MUA outcome (p = 0.007, OR: 8.5, 95 % CI: 1.2-66.7).

Conclusions

Although the proportion of patients regaining flexion ≥ 90 degrees following MUA was less than those patients with simple overall ROM increase, the functional flexion ≥ 90 degrees was achieved in the vast majority of patients with stiff TKA following MUA.     

Range of motion of thoracic spine in sagittal plane

Study design

Imaging study of thoracic spine.

Objective

The purpose of this study was to investigate dynamic alignment and range of motion (ROM) at all segmental levels of thoracic spine.

Summary of background data

Thoracic spine is considered to have restricted ROM because of restriction by the rib cage. However, angular movements of thoracic spine can induce thoracic compressive myelopathy in some patients. Although few previous studies have reported segmental ROM with regard to sagittal plane, these were based on cadaver specimens. No study has reported normal functional ROM of thoracic spine.

Methods

Fifty patients with cervical or lumbar spinal disease but neither thoracic spinal disease nor compression fracture were enrolled prospectively in this study (34 males, 16 females; mean age 55.4 ± 14.7 years; range 27–81 years). After preoperative myelography, multidetector-row computed tomography scanning was performed at passive maximum flexion and extension position. Total and segmental thoracic kyphotic angles were measured and ROM calculated.

Results

Total kyphotic angle (T1/L1) was 40.2° ± 11.4° and 8.5° ± 12.8° in flexion and extension, respectively (P < 0.0001). The apex of the kyphotic angle was at T6/7 in flexion. Total ROM (T1/L1) was 31.7° ± 11.3°. Segmental ROM decreased from T1/2 to T4/5 but increased gradually from T4/5 to T12/L1. Maximum ROM was at T12/L1 (4.2° ± 2.1°) and minimum at T4/5 (0.9° ± 3.0°).

Conclusions

Thoracic spine showed ROM in sagittal plane, despite being considered a stable region. These findings offer useful information in the diagnosis and selection of surgical intervention in thoracic spinal disease.     

Dynesys动态内固定与融合术治疗腰椎退变疾病的对比研究

目的 比较Dynesys动态内固定与腰椎后路椎间融合术（posterior lumbar interbody fusion,PLIF）治疗腰椎退变疾病的临床疗效和影像学结果.方法回顾分析2008年7月-2011年3月采用Dynesys 动态固定治疗且随访时间＞2年的腰椎退变患者46例（Dynesys组）,以同期行PLIF的50例患者作为对照（PLIF组）.记录2组手术前后Oswestry 功能障碍指数（Oswestry disability index,ODI）和疼痛视觉模拟量表（visual analogue scale,VAS） 评分,摄腰椎正侧位和前屈后伸位X线片,测量手术节段椎间高度、活动度（range of motion,ROM）以及近侧邻近节段的椎间ROM,评估2组影像学和症状学邻近节段退变的发生情况.结果 2组患者术前资料差异无统计学意义,末次随访时的ODI及VAS评分均较术前明显改善（P＜0.05）,组间差异无统计学意义（P＞0.05）.末次随访时Dynesys组手术节段椎间高度较术前轻度升高（P＞0.05）,而PLIF组显著升高（P＜0.05）且大于Dynesys组,组间差异有统计学意义（P＜0.05）.Dynesys组手术节段ROM由术前的7.1°降至末次随访时的4.9°（P＜0.05）,而PLIF组手术节段ROM由术前的7.3°降至末次随访时的0°（P＜0.05）.2组近侧邻近节段椎间高度变化差异无统计学意义（P＞0.05）,ROM在末次随访时均较术前有所增加（P＜0.05）,且PLIF组大于Dynesys组（P＜0.05）.Dynesys组有6例患者出现影像学邻近节段退变,PLIF组患者有15例出现影像学邻近节段退变,差异有统计学意义（P＜0.05）,仅PLIF组有1例出现症状学邻近节段退变,行二次手术治疗.结论 Dynesys动态内固定与融合术均获得良好临床疗效.与融合术相比,Dynesys动态内固定能够保留手术节段部分ROM,邻近节段椎间ROM的增幅及邻近节段退变发生数均较低.     

建立性能管理为核心的仪器设备质量管理新模式

目的 对仪器设备质量管理中存在的问题进行分析,探讨仪器设备质量管理的核心模式.方法 结合药品检测质量控制实验室仪器设备性能管理的实践,比较了几种性能验证的方式,并以中国食品药品检定研究院（NIFDC）药品质量控制实验室作为实例进行论证.结果与结论（1）仪器设备性能管理应是质量控制实验室仪器设备管理的核心. （2）性能管理通过仪器设备的检定、校准和核查来实现.（3） NIFDC药品质量控制实验室已经建立了符合世界卫生组织《药品质量控制实验室良好操作规范》（WHO GPCL）的仪器设备性能管理质量体系.     

Application of Innovative Methods of Predictive Control in Projects Involving Intelligent Steel Processing Production Systems

This paper describes the enhancement of the existing predictive system of quality management in the processes of metallurgic manufacturing. Specifically, it addresses steel-strip manufacturing. The main quality management innovation is the transition from the current methodological process of a single-step defect evaluation to a two-step evaluation. A two-step defect check of the strip’s surface involves checking for defects during the hot-rolling process first, and double-checking it during the process of pickling. These defects are detected in a well-established process of camera imaging in the production process. The recorded image is then processed mathematically to find the degree of defect correlation in those processes. The two-step evaluation enables a more detailed focus on a particular defect and its position on the strip. Decisions concerning further processing are based on defect evaluation, for instance, whether a rework is necessary to maximize the product utilization and minimize the eventual negative impact of the defect on production equipment. A crucial aspect is also the reduced probability of failures in the manufacturing process.