肩肘外科手术后并发上消化道出血的临床分析

目的分析肩肘外科手术后并发上消化道出血的临床特点,并分析其危险因素。 方法回顾性分析2007年1月至2015年12月于北京大学人民医院行肩肘外科手术治疗后并发上消化道出血患者的临床资料,总结其临床特点,分析引起上消化道出血的危险因素。 结果肩肘外科术后发生上消化道出血共33例,发生率为3.36%（33/983）;单因素分析显示高龄、性别、手术时间长、吸烟史、饮酒史、消化性溃疡或出血史、应用抗凝药物或抗血小板药物等因素与肩肘外科手术患者术后发生上消化道出血明显相关（P <0.05）;非条件多因素Logistic分析结果显示高龄、性别、手术时间长、消化性溃疡或出血史、应用抗凝药物或抗血小板药物是肩肘外科手术患者术后发生上消化道出血的独立危险因素（P <0.05）。 结论肩肘外科手术患者术后发生上消化道出血较为少见,高龄、性别、手术时间长、消化性溃疡或出血史、应用抗凝药物或抗血小板药物是肩肘外科手术患者术后发生上消化道出血的独立危险因素。     

Arthroscopic synovectomy of rheumatoid shoulder and elbow

Surgical Principles Radical arthroscopic synovectomy of rheumatoid shoulder and elbow. Revised Version from: Operat. Orthop. Traumatol. 4 (1992), 112–129 (German Edition).     

Medium term outcomes of primary and revision Coonrad-Morrey total elbow replacement

Background:

Total elbow replacement (TER) is indicated in inflammatory arthritis, osteoarthritis and fractures that are not amenable to reconstruction. There is no series in literature, to the best of our knowledge, regarding the results of revision of the Souter-Strathclyde prosthesis (SSP) to the Coonrad-Morrey prosthesis (CMP). The aim of this study is to present the medium term results of primary CMP total elbow replacement and revision of the SSP to CMP.

Materials and Methods:

50 primary CMPs (Group I) and 11 revision CMPs (Group II) were included in the study. Demographic, operative, followup and radiological data were analysed. The indication for revision of the primary implant was peri-prosthetic fracture in six cases, aseptic loosening in four cases and instability in one case.

Results:

The mean age in Group I was 67.28 ± 12.45 years and in Group II was 57.09 ± 11.25 years. The mean period of followup was 8.08 ± 2.95 years and 7.46 ± 2.39. There was a significant improvement in range of motion and pain in both groups. The complications seen were nerve palsy, infection, fractures and heterotopic ossification. The 5-year survival rate in Group I was 94%. The results were good in 36 elbows, fair in 8 elbows and poor in 5 elbows. In Group II, the results were good in 8 elbows, fair in 2 elbows and poor in 1 elbow. The complications seen were nerve palsy, fractures and heterotopic ossification.

Discussion:

Primary CMP TER provides a functionally useful range of movement of 100° which is enough to perform most activities of daily living. It also produces a pain free and stable joint. Similar results are achieved after revision of the SSP to CMP. The unique toggle-hinge mechanism of articulation provides inherent stability and good survivorship.

Conclusion:

Semiconstrained prostheses like CMP provide good functional results and survivorship and are the implant of choice in both primary and revision total elbow replacements.     

Adult fractures and dislocations of the shoulder and elbow

Fractures and dislocations of the shoulder girdle, humerus and elbow are common occurrences that will be encountered daily in any orthopaedic practice. The aim of this article is to provide an overview of the most common fractures and dislocations of the shoulder and elbow that the reader would come across in Accident and Emergency. The article also covers the treatment options for each injury with an emphasis on the senior authors' preferred method of fixation. Most fractures around the shoulder girdle, including clavicle fractures, proximal humeral fractures and humeral shaft fractures, have traditionally been treated conservatively. There is still a role for conservative management, however, shoulder surgeons are becoming more aggressive regarding fracture fixation. This is because the initial fixation with modern prostheses is easier and carries less morbidity than dealing with an un-united or a malunited fracture.     

Adult fractures and dislocations of the shoulder and elbow

Fractures and dislocations of the shoulder girdle, humerus and elbow are common occurrences that will be dealt with daily in any orthopaedic practice. The aim of this article is to provide an overview of the most common fractures and dislocations of the shoulder and elbow that the junior trauma surgeon will encounter. The article also covers the treatment options for each injury with an emphasis on the senior author's preferred method of fixation. Most fractures around the shoulder girdle, including clavicle fractures, proximal humeral fractures and humeral shaft fractures, have traditionally been treated conservatively. There is still a role for conservative management; however, shoulder surgeons are becoming more aggressive regarding fracture fixation. This is because the initial fixation with modern prostheses is easier and carries less morbidity than dealing with an un-united or a mal-united fracture.     

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).     

Total elbow arthroplasty is moving forward: Review on past,present and future

The elbow joint is a complex joint, which, when impaired in function, leads to severe disability. In some cases however, an arthroplasty might be an appropriate treatment. In the past four decades, large steps havebeen taken to optimize this treatment in order to achieve better post-operative outcomes. To understand these progresses and to discover aspects for upcoming improvements, we present a review on the past developments, the present state of affairs and future developments which may improve patient care further.     

右肩肘关节同时发生骨折脱位1例

<正>患者,女,25岁。因"车祸致右肩右肘关节肿痛活动障碍2h"收治入院。患者乘汽车时被另一辆汽车侧方撞击,右手掌撑在仪表盘上致右肩关节和右肘关节剧烈疼痛,活动困难,右腕右手无疼痛、无麻木、能活动,无手指发冷感。当时无颈部疼痛,活动正常,左上肢无疼痛、麻木,活动正常。受伤后即被送