Preoperative Shoulder Corticosteroid Injection Is Associated With Revision After Primary Rotator Cuff Repair

Rotator cuff surgery should be delayed in patients receiving frequent or recent shoulder steroid injections. That said, success rates after rotator cuff surgery are high, and injection is but one of a number of factors associated with retear after rotator cuff repair.     

Painful Shoulder After Surgery for Rotator Cuff Disease

Persistent shoulder pain after surgery for rotator cuff disease may be caused by conditions that are either extrinsic or intrinsic to the shoulder. Extrinsic causes of persistent shoulder pain include cervical radiculopathy, suprascapular neuropathy, abnormalities of scapular rotation (due to long-thoracic or spinal-accessory neuropathy), and adjacent or metastatic neoplasms. Causes of persistent pain that are intrinsic to the shoulder include both intra-articular conditions (e.g., glenohumeral osteoarthritis, adhesive capsulitis, recurrent anterior subluxation, and labral and bicipital tendon abnormalities) and extra-articular conditions (e.g., persistent subacromial impingement, persistent or recurrent rotator cuff defects, acromioclavicular arthropathy, and deltoid muscle deficiency). Successful management requires an accurate diagnosis, maximal rehabilitation, judicious use of surgical intervention, and a well-motivated patient. The results of revision surgery in patients with persistent subacromial impingement, with or without an intact cuff, are inferior to reported results after primary acromioplasty or rotator cuff repair.     

关节镜辅助小切口肩袖修复术治疗肩袖撕裂

目的 探讨关节镜辅助小切口修复术治疗肩袖撕裂的临床效果. 方法 1999年3月～2004年3月应用关节镜辅助小切口修复术治疗肩袖撕裂22例.13例行关节镜检查,小切口肩峰下间隙减压及肩袖修复术;9例行关节镜下肩峰下间隙减压及小切口肩袖修复术.采用UCLA肩评分标准进行评价. 结果 22例随访12～72个月,平均47个月,UCLA评分由术前（14.8±3.8）分升至术后（32.0±4.7）分（t=15.086,P=0.000）.优7例,良13例,可1例,差1例;20例满意. 结论 关节镜辅助小切口修复术是治疗肩袖撕裂的有效方法,操作简单,创伤小.     

The Effect of Hypercholesterolemia on Rotator Cuff Disease

Background  

The causes of rotator cuff tendon rupture are multifactorial and still unclear. Intrinsic and extrinsic factors have been implicated as predisposing risk factors for rotator cuff rupture. Previous studies have suggested a relationship between elevated serum lipid profiles and tendon ruptures, although not rotator cuff tears specifically.     

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Background  

Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA’s approval in 2004, the appropriateness in patients with rotator cuff disease is unclear.     

全关节镜与小切口修复肩袖损伤疗效的Meta分析

目的对全关节镜及小切口两种方法修复肩袖损伤的疗效进行Meta分析。方法计算机检索Ovid Medline和PubMed Medline(1966～2008.5),Embase(1980～2008.5),Cochrane Central Register of Controlled trials(2008)和中国生物医学文献数据库(1990～2008.5),搜集到所有的已发表的用于论证这些问题的对照研究,且采用RevMan 4.2.10进行Meta分析。结果共纳入10例对照研究,Meta分析显示这两组肩关节功能评分(SMD=-0.04,95%CI=-0.24～0.16,P=0.68)、患者满意度(OR=0.7,95%CI=0.35～1.40,P=0.32)、肩袖翻修率(OR=0.75,95%CI=0.40～1.41,P=0.37)、关节僵硬发生率(OR=0.48,95%CI=0.22～1.06,P=0.07)没有统计学意义。结论肩袖损伤全关节镜术后2年随访肩关节功能、病人满意度、肩袖翻修率及关节僵硬发生率等方面没有明显优势,但是它有较少的软组织损伤、极低的三角肌劈开风险、较少的早期切口疼痛及更快的功能恢复等潜在优势,可明显改善术后肩关节外展、外旋功能。而有趋势表明关节僵硬发生率与小切口相关,由于目前缺乏随机化对照试验证据,进一步比较仍须要大样本的多中心的随机化对照试验研究。     

肩峰撞击征合并肩袖损伤的关节镜下治疗

目的分析关节镜下肩峰减压成形术及肩袖修复的临床效果。方法自2005年初始,我院对11例肩峰撞击征并肩袖损伤行关节镜下肩峰减压成形术,部分行肩袖修复术,其中男5例,女6例,年龄21～57岁,平均40岁,8例无外伤史,3例有外伤史。患者均有肩关节疼痛、肌肉萎缩、活动受限、上举困难、疼痛反射弧阳性、撞击注射试验阳性,Neer征阳性;5例有患侧卧位痛。X线提示肱骨大结节骨赘9例和肩峰骨刺2例,A—H间隙距离变小,小于1．0cm8例、小于0．5cm3例。MRI扫描均示肩袖结构T1为强信号,如关节积液T2相强信号。关节镜检查可见肩袖大撕裂（30～50mm）4例,中撕裂（10～30mm）5例,小撕裂（小于10mm）2例。行关节镜下肩峰下减压成形术,其中8例行缝合锚钉肩袖修复术。分别在术前及最终随访时采用美国肩肘外科医师（American Shoulder and Elbow Surgeons,ASES）和Constant—Murley评分进行功能评估。结果术后随访22．5个月（13～34个月）。患者手术前平均ASES评分为62．4分（47～76分）,VAS评分平均为5．8分（3～8分）,Constant—Murley评分为66．7分（42～79分）,平均外展35．5°（30°～50°）,平均外旋为28．4°（0°～45°）;终末随访时平均ASES评分为94．6分（79～100分）,其中VAS评分为0．6分（0～2分）,Constant—Murley评分为93．6分（77～100分）,肩关节外展160°（80°～180°）,平均外旋30．2°（20°～55°）。8例患者冈上、下肌萎缩恢复,ASES评分优良率为81．8％,Constant—Murley评分优良率为90．9％。术后各项评分均存在显著性差异（ASES：P〈0．001,t一12．324;VAS：P〈0．001,t=14．765;外展：P〈0．001,t=15．236;外旋：P〈0．01,t=7．967;Constant—Murley：P〈0.001,t=16．647）。结论a）肩峰撞击征、肩袖损伤是关节镜手术的适应证;b）对肩袖单纯修复是不够的,必须同时解决撞击因素;c）不宜将肩峰切除过多,以免发生骨折;d）尽管镜下手术技术难度较大,但镜下视野广、创伤小、术后及早进行功能锻炼,功能可以得到很好恢复,故镜下进行肩袖损伤、肩峰成形等手术应值得提倡。