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.     

锚钉技术治疗糖尿病与非糖尿病患者腱性锤状指畸形的疗效分析

目的探讨应用锚钉技术治疗糖尿病与非糖尿病患者腱性锤状指畸形的疗效,评估锚钉技术在治疗糖尿病患者腱性锤状指畸形的临床可行性。 方法前瞻性收集石家庄市第二医院和唐山市第二医院的腱性锤状指畸形糖尿病（试验组）与非糖尿病（对照组）患者各30例,试验组男性15例,女性12例,平均年龄（44.54±4.55）岁,对照组男性13例,女性13例,平均年龄（43.63±4.37）岁,均应用锚钉技术治疗。术后比较两组患者伤口愈合时间;2、3,4个月的患指屈伸运动功能;肌腱愈合情况;并发症发生情况。 结果试验组30例,其中3例失去随访;对照组30例,其中4例失去随访。伤口愈合时间：试验组平均（14.0±1.0）d;对照组平均（13.0±1.1）d,两组比较差异无统计学意义（t=0.087,P>0.05）。末次随访时MP、PIP,DIP屈伸活动度分别为试验组：（89.7±2.4）°、（84.2±5.4）°,（76.3±5.2）°;对照组：（89.0±3.2）°、（84.0±5.3）°,（75.3±5.2）°,两组比较差异分别无统计学意义[（t=1.325,P>0.05）、（t=1.079,P>0.05）,（t=1.553,P>0.05）]。手运动功能TAM分级：试验组优23例,良3例,可1例;对照组优22例,良2例,可2例,两组比较差异无统计学意义（χ²=0.343,P>0.05）。肌腱彩超提示,两组患者均腱骨愈合良好。两组患者术后均无明显并发症发生,可从事正常工作及生活。 结论锚钉技术可有效防止伸肌腱粘连,使患指获得良好的屈伸运动功能,术后并发症少,同样可以用于糖尿病患者腱性锤状指畸形的治疗。     

Tight Rope联合锚钉固定与单纯Tight Rope固定治疗重度肩锁关节脱位的效果比较

目的 比较Tight Rope联合锚钉固定与单纯Tight Rope固定治疗重度肩锁关节脱位的临床效果。方法 回顾性研究。纳入2017年4月—2020年12月南京医科大学附属逸夫医院骨科收治的45例重度肩锁关节脱位患者临床资料,其中男30例、女15例,年龄25~61（47.8±10.5）岁。按照Rockwood分型：Ⅳ型31例,Ⅴ型14例。根据患者手术方法不同分为2组,采用Tight Rope联合锚钉固定治疗25例为Tight Rope+锚钉组,其中男17例、女8例,年龄25~60（48.1±9.9）岁;采用单纯Tight Rope固定治疗20例为Tight Rope组,其中男14例、女6例,年龄27~61（47.4±10.8）岁。比较2组患者临床基线资料、手术切口长度、手术时间、住院时间,以及术后伤口感染、关节活动受限、内固定松动等并发症发生情况。术后3个月,采用疼痛视觉模拟评分法（VAS）评价患肢疼痛程度,应用Constant-Murley评分（CMS） 、美国加州大学洛杉矶分校（UCLA）肩关节评分系统评价肩关节功能;同时拍摄肩关节正位及改良Alexander位X线片,评定锁骨的垂直稳定程度和水平稳定程度。结果 2组患者年龄、性别、受伤部位、受伤原因、受伤至手术时间等基线资料比较差异均无统计学意义（P值均>0.05）。2组患者均顺利完成手术,术中无相关并发症发生。2组手术切口长度、手术时间、住院时间差异均无统计学意义（P值均>0.05）。Tight Rope+锚钉组1例患者术后出现切口愈合不良,予相应处理后愈合良好。45例患者术后均获随访,随访时间6~26个月。随访期间2组患者均无关节活动受限、内固定松动等并发症发生。术后3个月,Tight Rope+锚钉组患肢疼痛VAS评分低于Tight Rope组,CMS评分、UCLA评分均高于Tight Rope组,差异均有统计学意义（t=2.96、14.16、18.26,P值均<0.01）。术后3个月影像学评估锁骨的垂直稳定程度,Tight Rope+锚钉组优20例、良5例,优良率为100.0％（25/25）,Tight Rope组优10例、良8例、差2例,优良率为90.0％（18/20）,差异无统计学意义（χ²=2.62,P=0.106）;锁骨的水平稳定程度,Tight Rope+锚钉组优20例、良5例,优良率100.0％（25/25）,Tight Rope组优5例、良10例、差5例,优良率75.0％（15/20）,Tight Rope+锚钉组优良率高于Tight Rope组,差异有统计学意义（χ²=7.03,P=0.008）。结论 Tight Rope固定联合锚钉固定治疗重度肩锁关节脱位效果可靠,可有效减少术后的疼痛,提高锁骨的水平稳定程度和肩关节功能。     

The improved oval forceps suture-guiding method for minimally invasive Achilles tendon repair

ObjectiveTo discuss the effect and advantage of the improved oval forceps suture-guiding method combined with anchor nail in the treatment of acute Achilles tendon rupture.MethodsA retrospective research was performed on 35 cases of acute Achilles tendon rupture treated with the improved oval forceps suture-guiding method from January 2013 to October 2016. Instead of the Achillon device, we perform the Achillon technique with the use of simple oval forceps, combined with absorbable anchor nail, percutaneously to repair the acute Achilles tendon rupture.ResultsAll patients were followed up for at least 12 months (range, 12–19 months), and all the patients underwent successful repair of their acute Achilles tendon rupture using the improved oval forceps suture-guiding method without any major intra- or postoperative complications. All the patients returned to work with pre-injury levels of activity at a mean of 12.51 ± 0.76 weeks. Mean AOFAS ankle-hindfoot scores improved from 63.95 (range, 51–78) preoperatively to 98.59 (range, 91–100) at last follow-up. This was statistically significant difference (P < 0.001). Mean Achilles Tendon Total Rupture Score (ATRS) at final follow-up was 94.87 (range, 90–100).ConclusionThe improved oval forceps suture-guiding method could make the advantage of minimally invasive repair with less complications, reduced surgical time and similar functional outcomes compared with the traditional open surgery. In addition, our new technique could save the cost of surgery with the compare of the Achillon device. At the same time for the cases which the remote broken tendon ends were within 2 cm from the calcaneal nodules, because of the less tendon tissue was left in the remote side, traditional percutaneous methods are incapable to ensure the reconstruction strength. By using the anchor nail, the improved technique has better repair capacity and expands the operation indication of oval forceps method.     

颈椎间孔内口锚链韧带的形态和分布特征

目的 通过解剖学观察,揭示颈椎间孔内口区锚链韧带的形态及其分布特征,探讨其与神经根型颈椎病神经卡压之间的关系。 方法 12具成人脊柱颈段防腐标本,正中矢状切开,从脊神经根袖根部切断根袖,在外科显微镜下解剖观察C3/4～C7/T1椎间孔内口处神经根袖周围的锚链韧带,记录韧带的形态、分布、起止点及走行。 结果 120个椎间孔内口脊神经根袖周围共发现560条锚链韧带,所有韧带均呈放射状连于神经根袖与椎间孔内口周围骨膜壁,两端附着紧密,不易分离。各椎间孔内口韧带的数目均≥4个。锚链韧带形态主要包括带形和索形两种。带形韧带258条,宽度（4.5±2.6）mm（4.1~5.2 mm）,索形韧带302条,直径（2.5±1.8）mm（1.2~3.8 mm）。C3/4、C7/T1椎间孔内口区韧带较为松散纤细,数量较少;C4/5~C6/7椎间孔内韧带较为坚韧而粗壮,数量较多。 结论 颈椎椎间孔内口区神经根周围存在锚链韧带,将神经根锚定于周围椎间孔骨膜壁,极大限制了神经根自由移动范围,可能与突出椎间盘一起导致神经根卡压,是神经根型颈椎病的潜在解剖学因素。     

Self-drilling anchor screws for dural tenting sutures: technical note

Background

Dural tenting sutures are difficult to place in the case of keyhole surgery and other craniotomies exposing the temporal base and sphenoid ridge because of difficulty in making small drill holes along the bone edge.

Methods

The technical difficulty is solved by using a self-drilling anchor screw. A 4-mm self-drilling titanium screw is fixed loosely to either the cortical surface or the cancellous bone of the bone edge to anchor dural tenting sutures.

Results

The present technique allowed easy placement of dural tenting sutures and efficient epidural hemostasis under the bone edge in more than 100 craniotomies.

Conclusions

The anchor screw technique allows easy placement of dural tenting sutures along the bone edge in the craniotomy with a limited exposure.     

Revision using modified transglenoid reconstruction in recurred glenohumeral instability combined with anchor-induced arthropathy

A 25-year-old man presented with a history of pain and crepitus in the right shoulder; he had been previously treated with arthroscopic anterior stabilization using four metallic suture anchors for recurrent traumatic anterior instability 1 year earlier. In this report, we present a patient with recurrent glenohumeral instability combined with anchor-induced arthropathy who was managed with modified arthroscopic transglenoid reconstruction following arthroscopic suture anchor retrieval.     

Twinfix锚钉改良单开门颈椎管扩大成形术治疗多节段脊髓型颈椎病的早期临床疗效

目的评价Twinfix锚钉改良单开门颈椎管扩大成形术治疗多节段脊髓型颈椎病的早期临床疗效。方法选择2008年3月～2011年3月四川省眉山市人民医院采用Twinfix锚钉改良单开门颈椎管扩大成形术治疗多节段脊髓型颈椎病28例（改良组）,与同期传统单开门手术治疗的31例（传统组）进行疗效分析比较,记录日本骨科协会（JOA）评分（17分法）、颈椎总活动度（ROM）及轴性症状。结果术后随访12～36个月,改良组平均24.3个月,传统组平均24.5个月。改良组术前JOA评分（8.13±0.47）分,术后（15.09±0.53）分,改善（6.95±0.68）分,传统组术前JOA评分（8.09±0.53）分,术后（14.94±0.47）分,改善（6.84±0.49）分,两组间改善比较差异无统计学意义（P〉0.05）。改良组手术前后ROM减少（5.42±1.89）度,传统组手术前后ROM减少（8.67±2.39）度,组间差异有统计学意义（P〈0.05）。改良组术后发生轴性症状8例,传统组术后发生轴性症状20例,组间差异有统计学意义（P〈0.05）。结论 Twinfix锚钉改良单开门颈椎管扩大成形术是治疗多节段脊髓型颈椎病的一种简便安全的方法,能较大程度保留颈椎活动度,能有效减少术后轴性症状的发生,早期疗效较满意。     

Comparison of two arthroscopic repair techniques for small-medium supraspinatus tendon tear: 1 triple-loaded vs 2 double-loaded metallic sutures anchors

IntroductionSurgical repair of the rotator cuff is based on the use of anchors whose ideal numbers and configurations continue to be controversial. We compared the clinical-functional results arising from the arthroscopic repair of shoulders, with small-medium lesions of the supraspinatus tendon, among patients using one anchor with three sutures, or two anchors with two sutures.MethodsIn this retrospective study patient were resolved into 2 groups. Clinical and functional results were assessed based on Constant Score and instrumental isometric examination.ResultsPatients in Group 1 experienced shoulder repair using a single anchor with three sutures (n = 21, mean age = 56 years, range = 51–65). In Group 2, patients received two anchors with two sutures each (n = 24, mean age = 59 years, range = 24–75). The mean follow-up time was 15 months. The mean values of the operated shoulders’ Constant Score were 88.05 and 88.25 respectively. Examination of isometric test results in operated shoulders, healthy shoulders and the two different rotator cuff repair techniques did not reveal any statistically significant differences.ConclusionIn the arthroscopic repair of small-medium supraspinatus tendon tears, the short to mid-term clinical and functional outcomes arising from use of 1 triple-loaded or 2 double-loaded metallic sutures anchors are comparable.