Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales

Evaluation of upper extremity function after reconstructive surgery is increasingly important both to predict outcome and for the control of cost-effectiveness. Three validated, self-administered shoulder questionnaires were applied prospectively in 23 otherwise healthy patients with rotator cuff deficiency and correlated to the Constant-Murley Shoulder Score and a visual analogue scale for satisfaction. Seven women and 16 men with combined tears of supraspinatus and infraspinatus (mean age 55.3 ± 10.5 years, r/l: 14/9, follow-up 57.8 ± 15.7 weeks) were gathered prospectively and evaluated pre- and postoperatively with the American Shoulder and Elbow Surgeons (ASES) Shoulder Index, the Simple Shoulder Test (SST) and the Disabilities of the Arm, Shoulder and Hand Module (DASH questionnaire). Additionally, a visual analogue scale for satisfaction was employed. All four scores and the visual analogue scale revealed improvement at a statistically significant level (P < 0.01) after surgery. All questionnaires showed a significant correlation with the Constant-Murley Shoulder Score (ASES: r = 0.871, P < 0.01; DASH: r = –0.758, P < 0.01, SST: r = 0.494, P < 0.05, Pearson’s correlation coefficient). Taken together, all questionnaires were easy to apply, and reliable evaluation of shoulder function was possible with significant correlation to the Constant-Murley Shoulder Score postoperatively. The SST was easy to apply, and compound outcome analysis was possible with the ASES Shoulder Index and DASH questionnaire. The DASH scale was the most complex evaluation instrument. The Constant-Murley Shoulder Score comprises a physical examination, which is advantageous but restricts the application to the office. For postoperative assessment without the patient having to return to the clinic, the ASES Shoulder Index is preferred because of its good correlation to the Constant-Murley Shoulder Score (r = 0.871) and the visual analogue scale for satisfaction (r = 0.762). Received: 4 October 1999     

Scoring systems for the functional assessment of the shoulder

A number of instruments have been developed to measure the quality of life in patients with various conditions of the shoulder. Older instruments appear to have been developed at a time when little information was available on the appropriate methodology for instrument development. Much progress has been made in this area, and currently an appropriate instrument exists for each of the main conditions of the shoulder. Investigators planning clinical trials should select modern instruments that have been developed with appropriate patient input for item generation and reduction, and established validity and reliability. Among the other factors discussed in this review, responsiveness of an instrument is an important consideration as it can serve to minimize the sample size for a proposed study. The shoulder instruments reviewed include the Rating Sheet for Bankart Repair (Rowe), ASES Shoulder Evaluation Form, UCLA Shoulder Score, The Constant Score, Disabilities of the Arm, Shoulder and Hand (DASH), the Shoulder Rating Questionnaire, the Simple Shoulder Test (SST), the Western Ontario Osteoarthritis of the Shoulder Index (WOOS), the Western Ontario Rotator Cuff Index (WORC), the Western Ontario Shoulder Instability Index (WOSI), Rotator Cuff Quality of Life (RC-QOL), and the Oxford Shoulder Scores (OSS).     

应用肱骨近端锁定钢板治疗肱骨近端骨折的临床结果分析

目的探讨应用肱骨近端锁定钢板（LPHP）治疗肱骨近端骨折的临床效果和适应证选择。方法2004年9月至2006年3月收治的84例肱骨近端骨折患者中75例患者获得随访,平均随访时间17个月（12—30个月）。新鲜骨折60例,陈旧骨折15例,均行切开复位LPHP内固定。应用美国肩肘外科医师评分（ASES）、Constant-Muxley评分、UCLA评分系统以及简易肩关节测验（SST）问卷评估治疗结果,观察肩关节活动范围,肌力、疼痛情况,并对比新鲜骨折与陈旧骨折的治疗效果。结果75例患者肩关节活动范围平均为前屈上举（147．3±17．7）°,外旋（30．5±16．2）°,内旋达Tq水平。ASES平均为86．7±12．7;Constant-Murley评分为87．4±10．5;UCLA评分系统为30．1±4．2,总体优良率为89．3％。与新鲜骨折相比,陈旧骨折患者前屈上举的范围和ASES评分存在明显差异（均为P〈0．05）。在9例出现晚期并发症的患者中ASES、UCLA、Constant-Murley评分与无并发症的患者相比均存在明显差异（P〈0．05）。结论正确选择手术指征和掌握操作技术,应用肱骨近端锁定钢板治疗存在明显移位的肱骨近端骨折可以获得较为满意的临床结果。     

Patients' preoperative expectations predict the outcome of rotator cuff repair

BACKGROUND: We are not aware of any previous studies of the relationship between patients' expectations regarding rotator cuff repair and the actual outcome. We hypothesized that preoperative expectations are predictive of the outcome of rotator cuff repair. METHODS: One hundred and twenty-five patients who underwent unilateral primary repair of a chronic rotator cuff tear were included in the study. All operations were performed by a single surgeon. Each patient prospectively completed the Simple Shoulder Test (SST); the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; three visual analogue scales for shoulder pain, shoulder function, and quality of life; and the Short Form-36 (SF-36) preoperatively and at one year (mean and standard deviation, 54.1 +/- 7.6 weeks) postoperatively. Preoperative expectations were quantified with use of six questions from the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire. RESULTS: Greater preoperative expectations correlated with better postoperative performance on the SST, DASH, each visual analogue scale, and the SF-36 (p values ranging from <0.0001 to 0.03) as well as with greater improvement from the baseline scores on the DASH and SF-36 (p values ranging from <0.0001 to 0.018). A rigorous multivariate analysis controlling for age, gender, smoking, Workers' Compensation status, symptom duration, number of previous operations, number of comorbidities, tear size, and repair technique confirmed that greater expectations were a significant independent predictor of both better performance at one year and greater improvement on the SST, the DASH, each visual analogue scale, and the SF-36 (p values ranging from <0.001 to 0.042). CONCLUSIONS: Patients' preoperative expectations regarding rotator cuff repair are associated with their actual self-assessed outcome. Variations in patient expectations may help to explain divergent results in published series as well as among various patient populations.     

Measuring shoulder injury function: common scales and checklists

The increasing shift towards patient-centred healthcare has lead to an emergence of patient-reported outcome instruments to quantify functional outcomes in orthopaedic patients. Unfortunately, selecting an instrument for use in a shoulder trauma population is often problematic because most shoulder instruments were initially designed for use with chronic shoulder pathology patients. To ensure an instrument is valid, reliable, and sensitive to clinical changes, it is important to obtain psychometric evidence of its use in the target population.Four commonly used shoulder outcome instruments are reviewed in this paper: American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); Constant-Murley shoulder score (CMS); Disabilities of Arm, Shoulder, and Hand (DASH); Oxford Shoulder Score (OSS). Each instrument was reviewed for floor or ceiling effects, validity, reliability, responsiveness, and interpretability. Additionally, evidence of each instrument's psychometric properties was sought in shoulder fracture populations.Based on the current literature, each instrument has limited amounts of evidence to support their use in shoulder trauma populations. Overall, psychometric evaluations in isolated shoulder fracture populations remain scarce, and clinicians must remember that an instrument's properties are defined for the population tested and not the instrument. Therefore, caution must always be exercised when using an instrument that has not been fully evaluated in trauma populations.     

Reliability by surgical status of self-reported outcomes in patients who have shoulder pathologies

STUDY DESIGN: A test-retest design was used to evaluate the reliability of the self-report sections of 4 shoulder pain and disability scales. OBJECTIVE: The objective of the study was to compare interitem consistency and test-retest reliability by surgical status (postoperative versus nonoperative) and to evaluate the effect of surgical status in the prediction of retest scores. BACKGROUND: Patients and healthcare providers evaluate shoulder status based on self-evaluations of pain and disability. Shoulder outcome measures have been developed that include self-reports, but the properties of these measures have not been assessed by surgical status. METHODS AND MEASURES: A questionnaire containing self-report sections of 4 shoulder scales was administered to study participants twice with 1 week between administrations. The outcome measures examined were the: (1) University of California at Los Angeles (UCLA) Shoulder Score; (2) Constant-Murley Scale (CMS); (3) American Shoulder and Elbow Society (ASES) Shoulder Index; and (4) Shoulder Pain and Disability Index (SPADI). Intraclass correlation coefficients (ICC) were calculated to estimate the test-retest reliability of each of the scales and subscales. The interitem consistencies of the multi-item subscales were assessed using Cronbach's alpha. The effect of surgical status on shoulder outcome scale reliability was evaluated using a general linear models approach. RESULTS: The interitem consistency estimates for the multi-item scales were high with both operative and nonoperative participants (0.88 to 0.96). With the exception of the satisfaction subscale of the UCLA Shoulder Score for the nonsurgical group, the estimated intraclass coefficients ranged from 0.51 to 0.91. The prediction of UCLA-satisfaction and ASES-disability, pain, and total retest scores was improved with the addition of surgical status into a regression model. CONCLUSIONS: The examined scales exhibited good internal consistency across surgical status. The postsurgical sample's reproducibility estimates tended to be higher than those of the nonsurgical sample. Reliability of shoulder outcome scales can be affected by patient surgical status.     

The Munich Shoulder Questionnaire (MSQ): development and validation of an effective patientreported tool for outcome measurement and patient safety in shoulder surgery

ABSTRACT: BACKGROUND: Outcome measurement in shoulder surgery is essential to evaluate the patient safety and treatment efficiency. Currently this is jeopardized by the fact that most patient-reported selfassessment instruments are not comparable. Hence, the aim was to develop a reliable selfassessment questionnaire which allows an easy follow-up of patients. The questionnaire also allows the calculation of 3 well established scoring systems, i.e. the Shoulder Pain and Disability Index (SPADI), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand (DASH) Score. The subjective and objective items of these three systems were condensed into a single 30-questions form and validated against the original questionnaires. METHODS: A representative collective of patients of our shoulder clinic was asked to fill in the newly designed self-assessment Munich Shoulder Questionnaire (MSQ). At the same time, the established questionnaires for self-assessment of CONSTANT, SPADI and DASH scores were handed out. The obtained results were compared by linear regression analysis. RESULTS: Fifty one patients completed all questionnaires. The correlation coefficients of the results were r = 0.91 for the SPADI, r = -0.93 for the DASH and r = 0.94 for the CMS scoring system, respectively. CONCLUSIONS: We developed an instrument which allows a quantitative self-assessment of shoulder function. It provides compatible data sets for the three most popular shoulder function scoring systems by one single, short 30-item. This instrument can be used by shoulder surgeons to effectively monitor the outcome, safety and quality of their treatment and also compare the results to published data in the literature.     

Lessons learned during the cross-cultural adaptation of the American Shoulder and Elbow Surgeons shoulder form into German

Cross-cultural adaptation and testing of reliability and validity were performed by use of a sample of 118 patients after shoulder arthroplasty. They completed a questionnaire booklet containing the American Shoulder and Elbow Surgeons (ASES) questionnaire, Shoulder Pain and Disability Index (SPADI), Short Form 36, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and 1 week later, they completed the ASES questionnaire again. The cross-cultural adaptation procedure revealed no major problems. The intraclass correlation coefficients (ICCs) for the subscales for pain and function and for the total score were very high (>0.84); the ICC for the subscale instability was unacceptably low. Function of the contralateral side was consistently better for all items (P < .01). Reliability for both function scales was similar (ICC >0). The ASES scores showed moderate correlation of 0.57 to 0.67 with the various scales of the SF-36 and higher correlation with the DASH (0.84) and SPADI (0.92). The German ASES showed good reliability and validity and can be used for shoulder-specific patient self-assessment in comparison to the contralateral (unaffected) side and provides additional information to objective parameters. The instability domain does not provide any additional clinical information.     

应用肱骨近端锁定型髓内针治疗肱骨近端骨折的临床疗效分析

目的探讨应用肱骨近端髓内针治疗肱骨近端两部分外科颈骨折的疗效。方法回顾性分析22例应用锁定型肱骨近端髓内针治疗两部分外科颈新鲜骨折患者的临床资料,患者平均年龄57岁。最终随访时拍摄肩关节X线片以评价愈合情况,并应用可视模拟评分法（VAS）评分,美国肩肘外科医师评分（ASES）,Constant-Murley评分,UCLA评分以及简易肩关节测验（SST）问卷评估。结果所有患者均获随访,平均随访时间为13个月,22例患者骨折均在术后8周内初步愈合。随访过程中未出现感染、肱骨头坏死以及任何与内固定物有关的并发症。术后患肢主动前屈上举平均为147．8°,主动体侧外旋平均为45．5°,主动内旋平均达T10水平。术后患者疼痛VAS评分平均为1．5。平均ASES评分为81．2,Constant-Murley评分为85．4,UCLA评分为29．9,SST评分为9．5。18例患者的肩关节功能评估为优或良,4例患者肩关节功能评估为差。结论闭合复位、锁定型肱骨近端髓内针固定术是治疗肱骨近端两部分外科颈骨折的一种有效的手术方式。     

中老年人肩关节脱位合并肩袖损伤诊治

目的探讨中老年人肩关节前脱位合并肩袖损伤等多种损伤的诊治方法及疗效。 方法回顾性分析2016年6月至2020年8月长海医院收治的中老年(年龄>40岁)肩关节脱位合并肩袖损伤等多种损伤患者15例。经肩关节镜下手术治疗,术后指导关节功能锻炼,应用美国肩肘医师协会评分(ASES评分)、视觉模拟评分(VAS评分)及Constant评分对患者进行功能评估,结果分析采用配对t检验。 结果14例患者获随访,1例患者因其他原因导致的瘫痪而被排除,平均随访时间(15±4)个月。ASES评分、VAS评分、Constant评分术前为(33.0±11.8)、(5.1±1.4)、(37.4±8.8),末次随访时为(88.7±6.4)、(0.9±0.7)、(82.3±8.2),差异有统计学意义(t＝17.341、12.902、13.270,均为P<0.001)。 结论中老年人肩关节脱位常合并肩袖损伤、Bankart损伤或骨性Bankart损伤、Hill-sachs损伤等多种损伤,诊断明确后建议及时手术全面修复,重建肩关节稳定性,缓解疼痛及恢复肩关节功能。     

Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results

Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4–36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.     

The Penn shoulder score: reliability and validity

STUDY DESIGN: Psychometric evaluation of a cross-sectional survey. OBJECTIVES: The purpose of this study was to examine the psychometric properties of reliability and validity of the Penn Shoulder Score (PSS). BACKGROUND: Shoulder outcome measures are used to assess patient self-report levels of pain, satisfaction, and function. The PSS is a 100-point shoulder-specific self-report questionnaire consisting of 3 subscales of pain, satisfaction, and function. This scale has been utilized in the literature. However, the measurement properties of reliability and validity, including responsiveness, of the PSS subscales and overall scale need to be established. METHODS AND MEASURES: Patients (n = 40) with shoulder disorders undergoing a course of outpatient physical therapy completed the PSS at initial visit and again within 72 hours to assess test-retest reliability. The Constant Shoulder Score (CSS) and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were also completed at the initial visit and compared to the PSS to assess convergent construct validity. A separate cohort of patients (n = 109) completed the PSS at initial visit and 4 weeks later. These scores were used to assess internal consistency and responsiveness. RESULTS: Reliability analysis revealed a test-retest ICC2,1 of 0.94 (95% CI, 0.89-0.97). Internal consistency analysis revealed a Cronbach alpha of 0.93. The standard error of measurement (SEM) was +/- 8.5 scale points (based on a 90% CI) and the minimal detectable change (MDC) was +/- 12.1 scale points (based on a 90% CI). The minimal clinically important difference (MCID) for improvement was 11.4 points. Pearson product moment correlation coefficients between the PSS and the CSS and ASES were 0.85 and 0.87, respectively. Responsiveness analysis revealed an effect size of 1.01 and a standardized response mean of 1.27. CONCLUSIONS: This study has demonstrated that the PSS is a reliable and valid measure for reporting outcome of patients with various shoulder disorders.     

Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair

BACKGROUND: In a previous study, we found that medical comorbidities have a negative effect on preoperative pain, function, and general health status in patients with a chronic rotator cuff tear. In this study, we evaluated the relationship between medical comorbidities and the postoperative outcome of rotator cuff repair. METHODS: One hundred and twenty-five patients were evaluated on the basis of a history (including medical comorbidities) and use of outcome tools preoperatively and at one year after rotator cuff repair. Outcome was evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire, the Simple Shoulder Test (SST), visual analog scales (pain, function, and quality of life), and the Short Form-36 (SF-36). RESULTS: The mean number of medical comorbidities was 1.91 (range, zero to six). At one year after rotator cuff repair, there were no significant correlations between comorbidities and pain, shoulder function, or quality of life as determined with the SST, DASH, and visual analog scales (p > 0.05). A greater number of comorbidities was associated with a worse postoperative general health status (SF-36 role emotional [p = 0.045], SF-36 bodily pain [p = 0.032], SF-36 general health [p = 0.001], and SF-36 vitality [p = 0.033]). Nevertheless, a greater number of comorbidities was associated with greater improvement, compared with the preoperative status, in the pain score on the visual analog scale (p = 0.009), function as assessed with the visual analog scale (p = 0.022) and the DASH (p = 0.044), and quality of life as assessed with the visual analog scale (p = 0.041). CONCLUSIONS: Patients with more medical comorbidities have a worse general health status after rotator cuff repair. Interestingly, it also appears that these patients have greater improvement in overall shoulder pain, function, and quality-of-life scores compared with preoperative scores. Therefore, despite a negative effect of comorbidities on outcomes, patients with more comorbidities have greater improvement after the repair, to the point where postoperative shoulder function and pain are not significantly influenced by medical comorbidities. Consequently, a higher number of medical comorbidities should not be considered a negative factor in determining whether a patient should undergo rotator cuff repair.     

Inlay hemiarthroplasty of the humeral head for nontraumatic osteonecrosis

BackgroundOsteonecrosis of the humeral head often occurs in younger individuals and presents a difficult clinical situation. The purpose of this study was to evaluate the patient reported outcomes in patients undergoing inlay hemiarthroplasty for nontraumatic osteonecrosis of the humeral head. We hypothesized that patients would achieve a meaningful clinical improvement.MethodsA retrospective review of prospectively collected data on 9 patients undergoing inlay hemiarthroplasty for humeral head osteonecrosis was conducted. The American Shoulder and Elbow Surgeons Shoulder score (ASES), Simple Shoulder Test (SST), visual analog scale for pain (VAS), and range of motion measurements were collected preoperatively and at final follow-up. Radiographs were evaluated for any evidence of component loosening or glenoid wear. The primary outcome was achievement of substantial clinical benefit (SCB) for ASES.ResultsPostoperatively at a mean of 7.2 years the ASES improved from 35 to 73 (p = 0.011), the SST improved from 2 to 6 (p = 0.038), and the VAS for pain decreased from 7 to 3 (p = 0.009). Forward elevation increased from 96° to 138° (p = 0.012) and external rotation increased from 13° to 63° (p = 0.007). SCB for ASES was seen in 7 out of the 9 patients (78%). Asymptomatic mild or moderate glenoid wear was seen in 4/9 (44%) of patients. One patient (11%) developed symptomatic glenoid wear necessitating conversion to total shoulder arthroplasty.ConclusionInlay hemiarthroplasty offers a viable solution to osteonecrosis of the humeral head.Level of Evidence: Level IV; Treatment Study     

关节镜下治疗肩袖损伤合并肱二头肌长头腱病变的临床随访研究

目的 评估经皮关节内肌腱固定技术在关节镜下肩袖损伤重建患者中,治疗合并肱二头肌长头腱损伤的临床效果.方法 2006年3月-2008年3月,对30例肩袖损伤合并肱二头肌长头腱损伤的患者,采用经皮关节内肌腱固定技术进行肌腱固定治疗.按照肩关节ASKS评分、Constant-Murley评分和YAS疼痛评分,并对肱二头肌肌力、外观进行评估.结果 术后随访时间平均为23个月(12～37个月).30例肩关节ASKS评分术前平均为43.8分,术后平均为94.7分;Constant-Murley评分术前平均为52.8分,术后平均为94.1分;VAS疼痛评分术前平均为5.5分,术后平均为0.6分;三种评分术前和术后差异均有统计学意义(P<0.01).术后均未出现Popeye畸形和二头肌痉挛症状,屈肘肌力测量患侧与健侧基本相同,差异无统计学意义.29例对手术效果满意.结论 经皮关节内肌腱固定技术是治疗肱二头肌长头腱损伤的有效方法,术后肩关节功能和疼痛改善明显,可以较好地维持肱二头肌的肌力并且避免肱二头肌出现肌腹膨隆畸形.     

钙化性肩袖肌腱炎的针刺封闭治疗

目的　探讨和分析应用闭合针刺封闭疗法治疗钙化性肩袖肌腱炎的疗效。　方法对 17例应用针刺封闭疗法治疗钙化性肩袖肌腱炎的患者进行随访 ,平均随访时间 9 3个月。治疗时采用 18或 16号粗针头对钙化灶进行反复穿刺 ,针刺封闭后第 4、6、8周以及随后每隔 4周随访患者 ,记录症状缓解情况并进行相同体位的X线片投照 ,应用ASES评分、Constant Murley评分、UCLA评分以及简易肩关节测验 (SST)问卷评估对比治疗前后的治疗结果。　结果　 17例中 15例在 1～ 3次针刺封闭注射后钙化灶消失 ,平均消失时间为 9 4周 (4～ 2 0周 )。治疗前ASES评分平均为 4 7 7(34～ 5 9) ,肩关节活动度平均为前屈上举 90°(70°～ 10 0°) ,外旋 15°(0°～ 30°) ,内旋L3～ 4 (L1～臀部 ) ;Constant Murley评分平均为 4 4 6 (34～ 5 4 ) ;UCLA评分平均为 11 6 (8～ 15 ) ;SST问卷这回答“是”的问题平均为 3 4个 (2～ 5个 )。经针刺封闭治疗后ASES评分平均为 87 1(72～ 91) ,肩关节活动度平均为前屈上举 14 3 5°(12 0°～ 16 0°) ,外旋 4 0°(30°～ 5 0°) ,内旋T8～T9水平 ;Constant Murley评分平均为 87 8(6 4～ 94 ) ;UCLA评分平均为 2 9 5 (19～ 33) ;SST问卷这回答“是”的问题平均为 9 1个(6～ 12个 )。治疗前后存在显著     

一期手术治疗肩袖损伤合并肩关节僵硬的疗效分析

目的:探讨肩袖损伤合并肩关节僵硬一期手术治疗的疗效。方法:回顾性分析2017年1月至2019年11月应用关节镜下手术修补冈上肌损伤合并肩关节僵硬患者20例（僵硬组）的临床资料,男9例,女11例;年龄（62.2±8.7）岁（范围：45~80岁）;病史（5.2±4.3）个月（范围：1~12个月）。以同期应用关节镜下手术修补...     

Short-term results after reversed shoulder arthroplasty (Delta III) in patients with rheumatoid arthritis and irreparable rotator cuff tear

The purpose of this study was to describe the outcome after reversed Delta III shoulder prosthesis in patients with rheumatoid arthritis (RA) and irreparable rotator cuff tear. Fifteen patients (17 joints) were prospectively analysed using the Constant-Murley score (CS). Comprehensive outcome measure was carried out by means of four widely used questionnaires as well as clinical and radiographic examinations at an average of 24.3 months postoperatively. The CS improved significantly from 19 to 59.5 points. The mental (MSC) and physical (PCS) component summary score of the Short Form 36 (SF-36) reached 108% and 77%, respectively, while the DASH (Disabilities of the Arm, Shoulder, and Hand) was 58% of a comparative norm population. Remaining deficits were documented by SPADI (Shoulder Pain and Disability; 54.4 points) and ASES (clinical and patient-orientated American Shoulder and Elbow Surgeons; 84.3 and 61.3 points, respectively). No radiological signs of loosening were found, but scapular notching occurred in four cases. Reversed arthroplasty provides a substantial improvement of shoulder function in patients with RA. The high incidence of notching is of concern.     

锁定钢板与半肩关节置换治疗中老年复杂肱骨近端骨折的Meta分析

目的通过Meta分析探讨锁定钢板(LP)及半肩关节置换(HA)治疗肱骨近端骨折(PHFs)术后并发症及疗效的差异。 方法计算机检索Pubmed、Cochrane图书馆、EMBASE、ScienceDirect、中国知网、万方、维普等数据库。搜集有关LP/HA治疗PHFs的各种对照研究,纳入标准：随机或非随机对照试验;行LP和HA治疗;年龄≥ 45岁;随访时间>3个月;可提取到可靠的数据。排除标准：病例数少于10例;其他治疗方式;病例报告,综述,动物实验以及系统评价;多种原因不能耐受手术;病理性骨折或者肱骨近端陈旧性骨折;既往有肩关节外伤及手术病史。研究共纳入27项研究2 082例患者,对纳入的文献选择总并发症、常见并发症(肩关节不稳、关节僵硬、肩峰下撞击症)、术后功能评分(Constant-Murley肩关节评分系统、美国肩肘外科医师协会评分)作为Meta分析的评价指标,采用STATA 14.0分析,对于合并SMD 或者OR ,P <0.05差异有统计学意义。 结果结果表明两组总并发症[OR ＝1.73,95%CI(1.35,2.21),P <0.01]、肩峰下撞击症[OR ＝0.25,95%CI(0.11,0.55),P<0.01]以HA组较低;上肢肌力评分[SMD＝1.857,95%CI(0.803,2.912),P<0.01]、肩关节活动度评分[SMD＝2.542,95%CI(1.273,3.811),P<0.01]以LP组较优。两组CMS、ASES评分差异无统计学意义(P >0.05)。 结论HA术后并发症的发生率低于LP,两者均能获得相近的肩关节功能恢复。