压力袖套辅助淋巴引流对乳腺癌术后患者上肢淋巴水肿的影响

目的:探讨压力袖套辅助淋巴引流对乳腺癌术后患者上肢淋巴水肿的影响。方法:选取68例乳腺癌根治术后上肢淋巴水肿的患者,随机分为压力衣辅助佩戴组(A组)和单纯淋巴引流组(B组)。B组接受为期11天,每天45min的淋巴引流手法治疗。A组在每天45min淋巴引流手法后予以患肢压力袖套佩戴。两组患者分别于第1次淋巴引流前(T0)、第1次淋巴引流后(T1)、第2次引流前(T2)、第3次引流前(T3)、第6次引流前(T4)、第11次引流前(T5),第11次引流24h后(T6),测量患者上肢的生物电阻抗(BIS),输出L-Dex比值。并在T1、T6时间测量两组患者的健患侧定点臂围,对采集到的数据进行组间及组内比较。结果:(1)L-Dex值:第1次治疗后,A、B两组均明显降低(P0.05);第2次治疗前均开始上升,A组上升幅度明显低于B组;A组持续降低(P0.05),B组出现波动;经过11天的治疗后,两组均有下降,但A组明显低于B组(P0.05)。(2)臂围:11次治疗后健患侧臂围差变化A组明显大于B组(P0.05)。结论:单纯淋巴引流手法及淋巴引流手法结合压力袖套治疗均能在一定程度上缓解乳腺癌术后患侧上肢淋巴水肿,而予淋巴引流手法治疗后联合压力袖套治疗,较单纯淋巴引流手法对淋巴水肿的治疗效果更明显。     

肱骨大结节上方的解剖分型及临床意义

目的 通过对肱骨大结节上面观的形态学分型,探讨其临床意义。 方法 将296例肩关节CT扫描图像根据大结节上面观形态进行分型,分别测量冈上肌、冈下肌和小圆肌肌腱在大结节上的止点长度,肩胛下肌肌腱在小结节上的止点长度,大结节最高点至肱骨头最高点的距离以及结节间沟的宽度和深度。 结果 肱骨大结节上面观形态可分为3型：弧形45.60%（135例）,平坦形44.26%（131例）,丘形10.14%（30例）。弧形的肱骨大结节,其冈上肌肌腱止点长度短于平坦形和丘形;丘形的肱骨大结节,其冈上肌肌腱在大结节上的止点长度、肩胛下肌肌腱在小结节上的止点长度、结节间沟的宽度和深度均短于弧形和平坦形;丘形的大结节最高点至肱骨头最高点的距离大于弧形和平坦形,差异均有统计学意义（P＜0.05）,其他解剖学形态差异无统计学意义（P>0.05）。 结论 不同分型的肱骨大结节上面观对临床肱骨大结节相关疾病诊治有一定的指导意义。     

气管导管套囊压力术中管理的研究进展

气管导管套囊在机械通气中,可起防止气道漏气,预防呼吸机相关性肺炎的作用。套囊压力管理是气管插管患者气道管理中的一个重要环节。深入了解气管导管套囊压力的影响因素及管理方法,能更好地为气管插管术后套囊相关并发症的防治提供参考。     

超声引导下PRP注射治疗肩袖损伤对局部炎症因子表达的影响

目的探讨超声引导下富血小板血浆(PRP)注射在部分肩袖损伤患者治疗中的安全性和有效性,及其对局部炎症因子表达的影响。方法选择2018年10月至2019年10月部分肩袖损伤患者84例,随机分为对照组和观察组,每组各42例。对照组采用超声引导注射玻璃酸钠,观察组注射等量自体PRP,1次/周,连续3周。比较两组治疗前,治疗结束后1、3和6个月疼痛视觉模拟量表(VAS)评分和上肢功能Fugl-Meyer量表(FMA)评分,治疗前及治疗结束后1周和1个月局部炎症因子白介素(I)-6、肿瘤坏死因子(TNF)-α、IL-10和转化生长因子(TGF)-β,随访6个月肩袖再撕裂率。结果观察组治疗结束后1、3、6个月VAS评分逐渐降低,上肢FMA评分逐渐升高,且同时间点观察组VAS评分比对照组降低,FMA评分比对照组升高,差异有统计学意义(P<0.05)。进一步发现,观察组治疗结束后1周和1个月局部IL-6和TNF-a水平明显低于对照组,而IL-10和TGF-β水平明显高于对照组(P<0.05)。随访观察组肩袖再撕裂率低于对照组(P<0.05)。结论超声引导下PRP注射治疗部分肩袖损伤有较好的安全性和有效性,能显著降低关节疼痛,改善关节功能,降低复发率,可能与抑制局部炎症反应,促进关节修复有关。     

Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs

Background:

Little is known about the bioabsorbable, anchor related postoperative changes in rotator cuff surgery, which has become more popular recently. The purpose of the present study was to use magnetic resonance imaging (MRI) to analyze the degradation of bioabsorbable anchors and to determine the incidences and characteristics of early postoperative reactions around the anchors and their mechanical failures.

Materials and Methods:

Postoperative MRIs of 200 patients who underwent arthroscopic rotator cuff repair were retrospectively analyzed. The tissue reactions around the bioanchors included fluid accumulations around the anchor, granulation tissue formation and changes in the condition of the surrounding osseous structure. The condition of the bioanchor itself was also examined, including whether the bioanchor failed mechanically. In the case of mechanical failure, the location of the failure was noted. Serial MRIs of 18 patients were available for analysis.

Results:

The total number of medial row bioanchors was 124, while that of the lateral row was 338. A low signal intensity rim suggestive of sclerosis surrounded all lateral row bioanchors. Ninety three lateral row bioanchors (27%) showed a rim with signal intensity similar to or less than that of surrounding bone, which was granulation tissue or foreign body reaction (FBR). Similar signal intensity was seen around nine medial row bioanchors (7%). Fluid accumulation was seen around 4 lateral row bioanchors (1%) and around 14 medial row bioanchors (11%). Five lateral row bioanchors showed the breakage, while there was none in the medial row bioanchors. There were nine cases with a cuff re-tear (4.5%). There was no evidence of affection of glenohumeral articular surfaces or of osteolysis around any bioanchor. In serial MRI, there was no change in appearance of the bioanchors, but the granulation tissue or FBR around four bioanchors and the fluid around one bioanchor showed a decrease in successive MRI.

Conclusion:

This study highlights the normal and adverse reactions to Bioabsorbable anchors that surgeons can expect to see on MRI after rotator cuff repairs.     

Effect of highly purified capsaicin on articular cartilage and rotator cuff tendon healing: An in vivo rabbit study

Highly purified capsaicin has emerged as a promising injectable compound capable of providing sustained pain relief following a single localized treatment during orthopedic surgical procedures. To further assess its reliability for clinical use, the potential effect of highly purified capsaicin on articular cartilage metabolism as well as tendon structure and function warrants clarification. In the current study, rabbits received unilateral supraspinatus transection and repair with a single 1 ml injection of capsaicin (R + C), PEG‐only placebo (R + P), or saline (R + S) into the glenohumeral joint (GHJ). An additional group received 1 ml capsaicin onto an intact rotator cuff (I + C). At 18 weeks post‐op, cartilage proteoglycan (PG) synthesis and content as well as cell viability were similar (p > 0.05) across treatment groups. Biomechanical testing revealed no differences (p > 0.05) among tendon repair treatment groups. Similarly, histologic features of both cartilage and repaired tendons showed minimal differences across groups. Hence, in this rabbit model, a single injection of highly purified capsaicin into the GHJ does not induce a deleterious response with regard to cartilage matrix metabolism and cell viability, or rotator cuff healing. These data provide further evidence supporting the use of injectable, highly purified capsaicin as a safe alternative for management of postoperative pain following GHJ surgery. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1854–1860, 2015.     

Complications of calcific tendinitis of the shoulder: a concise review

Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient.Level of evidence 5.