肩关节镜下肩袖修复术治疗肩袖损伤的临床效果

目的探讨肩关节镜下肩袖修复术治疗肩袖损伤的临床效果。方法将我院2018年2月至2019年2月收治的52例肩袖损伤患者随机分为对照组(26例,开放式肩袖修复术)和观察组(26例,全肩关节镜下肩袖修复术)。比较两组的治疗效果。结果治疗后,两组的肩关节前屈、内旋、外旋活动度及Constant-Muley肩关节评分均增加,数字评估量表(NRS)评分均降低,且观察组显著优于对照组(P<0.05);观察组的治疗优良率显著高于对照组(P<0.05)。结论肩关节镜下肩袖修复术治疗肩袖损伤的临床效果显著,能够有效减轻患者疼痛,加快患者术后肩关节功能的恢复,值得临床推广应用。     

关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩疗效分析

目的探讨关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩的临床疗效,观察对患者关节活动范围及生活质量量表评分的影响。方法选取2014年2月至2018年2月河北省保定市第二中心医院收治肩袖损伤合并冻结肩患者84例。按照随机数字表法将患者分为观察组43例和对照组41例,观察组做关节镜下松解术结合肩袖修复术,对照组做关节镜下单纯肩袖修复术。采用采用视觉模拟评分(visual analogue scale/score,VAS)、Constant-Murley评分、美国加州大学肩关节评分系统(the university of California at Los Angeles shoulder rating scale,UCLA)和美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)、生活质量量表(quality of life,QOL)对患者肩关节功能、肩袖强度和生活质量进行对比分析。结果两组术后1、3、6个月VAS评分与术前比较,差异均有显著性(P<0.05)。观察组术后1、3、6个月VAS评分均低于对照组,差异有显著性(P<0.05)。两组Constant-Murley评分比较,术后较术前,肩关节外旋、前屈、外展、内旋均提高(P<0.05);术后1个月观察组前屈、外展、内旋显著小于对照组(P<0.05);术后3、6个月,外旋、前屈、外展、内旋差异均无显著性(P>0.05)。术后6个月两组UCLA、ASES评分均较术前明显改善,组内比较差异有显著性(P<0.05)。UCLA两组比较差异无显著性(P>0.05);手术前后两组ASES评分比较差异均无显著性(P>0.05);术后6个月两组患肢外旋、前屈、内旋的肌肉力量均较治疗前显著增加,差异有显著性(P<0.05)。术前QOL评分比较差异无显著性(P>0.05),治疗6个月后,观察组QOL评分显著高于对照组,差异有显著性(P<0.05)。结论与单纯关节镜下肩袖修复术相比,关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩,可以有效缓解疼痛,恢复肩关节功能活动,提高患者的生活质量。     

关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩疗效分析

目的探讨关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩的临床疗效,观察对患者关节活动范围及生活质量量表评分的影响。方法选取2014年2月至2018年2月河北省保定市第二中心医院收治肩袖损伤合并冻结肩患者84例。按照随机数字表法将患者分为观察组43例和对照组41例,观察组做关节镜下松解术结合肩袖修复术,对照组做关节镜下单纯肩袖修复术。采用采用视觉模拟评分(visual analogue scale/score,VAS)、Constant-Murley评分、美国加州大学肩关节评分系统(the university of California at Los Angeles shoulder rating scale,UCLA)和美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)、生活质量量表(quality of life,QOL)对患者肩关节功能、肩袖强度和生活质量进行对比分析。结果两组术后1、3、6个月VAS评分与术前比较,差异均有显著性(P<0.05)。观察组术后1、3、6个月VAS评分均低于对照组,差异有显著性(P<0.05)。两组Constant-Murley评分比较,术后较术前,肩关节外旋、前屈、外展、内旋均提高(P<0.05);术后1个月观察组前屈、外展、内旋显著小于对照组(P<0.05);术后3、6个月,外旋、前屈、外展、内旋差异均无显著性(P>0.05)。术后6个月两组UCLA、ASES评分均较术前明显改善,组内比较差异有显著性(P<0.05)。UCLA两组比较差异无显著性(P>0.05);手术前后两组ASES评分比较差异均无显著性(P>0.05);术后6个月两组患肢外旋、前屈、内旋的肌肉力量均较治疗前显著增加,差异有显著性(P<0.05)。术前QOL评分比较差异无显著性(P>0.05),治疗6个月后,观察组QOL评分显著高于对照组,差异有显著性(P<0.05)。结论与单纯关节镜下肩袖修复术相比,关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩,可以有效缓解疼痛,恢复肩关节功能活动,提高患者的生活质量。     

关节镜下肩袖修补术后的康复治疗

目的 研究关节镜下肩袖修补术后系统肩关节康复训练的方法.方法 自2002年3月～2006年12月,北京积水潭医院康复科收治86例行"关节镜下应用缝合锚进行肩袖修补术"的患者,随机分为强化组和普通组进行系统康复训练.使用美国肩肘医师协会评分(American Shoulder Elbow Scale, ASES)和 1990年美国医学会修订的<永久病损评定指南(GEPI)>进行肩关节定量评定.结果 两组患者在手术前ASES和GEPI评分均无显著性差异( P>0.05),术后1年两组患者ASES和GEPI评分分别与术前比较,有显著性改变( P<0.05).而且术后1年时强化组ASES评分高于普通组,GEPI(功能障碍指数)评分低于普通组( P<0.05).术后7周、12周和1年时肩关节的主动前屈上举和外旋活动范围(ROM),强化组均高于普通组( P<0.05).结论 关节镜下肩袖修补术后系统的、个性化的肩关节康复训练方法是恢复肩关节功能的有效方法.强化治疗效果更好.     

关节镜下肩袖修复术后早期及延迟康复治疗介入的疗效比较

目的:比较全关节镜下肩袖修复术后早期康复锻炼和延迟康复锻炼对肩关节功能和肩袖愈合情况的影响。方法:选取采用全关节镜下双排缝合桥技术修补中、大肩袖撕裂的患者共65例,随机将其分为治疗组33例和对照组32例,治疗组患者术后早期即进行肩关节的康复锻炼,对照组患者采用延迟的肩关节康复锻炼方案。2组患者均于术前、术后6个月、12个月采用简明肩关节功能测试(SST)、欧洲肩关节协会的Constant肩关节评分系统、视觉模拟评分(VAS)和关节活动范围进行肩关节功能评定,并在术后12个月行肩关节磁共振检查,观察肩袖愈合情况。结果:术前,2组患者SST评分、Constant评分、VAS评分、肩关节活动范围的组间差异均无显著性意义(P>0.05);术后6个月、术后12个月时2组患者的SST评分、Constant评分、VAS评分、肩关节前屈、外展外旋均显著优于组内术前评分(P<0.05),肩关节外旋差异无显著性意义(P>0.05);组间各时间点比较,差异均无显著性意义(P>0.05);术后12个月时2组患者的肩袖愈合情况比较,差异无显著性意义(P>0.05)。结论:全关节镜下双排缝合桥技术是一种治疗中、大肩袖撕裂安全有效的方法,术后1年内随访结果表明肩关节早期康复锻炼方案与延迟康复锻炼方案对肩关节功能和肩袖愈合影响类似,长期随访结果有待进一步研究。     

分阶段康复训练对肩袖损伤行肩关节镜修复术后患者生活质量改善的效果分析

目的 观察分阶段康复训练应用于肩袖损伤患者行肩关节镜修复术后对其生活质量的影响,为临床提供参考。方法 按照随机数字表法将2021年1月至2023年6月青岛阜外心血管病医院收治的60例肩袖损伤行肩关节镜修复术后患者分为对照组和试验组,各30例。给予对照组患者常规干预（包括抗感染、早期运动锻炼等）,在常规干预的基础上给予试验组患者分阶段康复训练干预。比较两组患者主动前屈角度和体侧外旋角度、加州大学肩关节评分系统（UCLA）评分优良率及简明健康状况调查问卷（SF-36）评分。结果 干预后,两组患者主动前屈角度和体侧外旋角度均大于干预前,且试验组均大于对照组（均P<0.05）。试验组患者UCLA评分整体优于对照组,且UCLA评分总优良率高于对照组（均P<0.05）。干预后,两组患者SF-36评分高于治疗前,且试验组高于对照组（P<0.05）。结论 分阶段康复训练干预可有效改善肩袖损伤患者行肩关节镜修复术后的主动前屈和体侧外旋角度,提高肩关节功能和生活质量。     

创伤性肩袖损伤患者术后不同时间开始康复训练效果观察

目的探讨创伤性肩袖损伤关节镜术后患者术后不同时间开始早期康复锻炼对肩关节功能恢复的影响,分析相关原因,为统一康复训练实施时间提供依据。方法将2006年9月-2008年11月收治的59例创伤性肩袖损伤关节镜术后患者按入院先后顺序随机分为观察组29例和对照组30例。两组患者术后均采用常规的抗炎、消肿、银杏叶针活血及短波、低频脉冲治疗;均于术后0—6周采用肩关节制动功能锻炼。观察组同时于术后第1天始按创伤性肩袖损伤术后康复计划进行肩关节康复训练,对照组按传统保守方法于术后第6周开始进行肩关节康复训练,均采用Constant—Murley肩关节评分标准评价患肩的功能状况。结果除术后第4周两组疼痛、日常生活活动差异无统计学意义（P〉0．05）外,术后第8周、第12周、第16周、第20周观察组疼痛、日常生活活动、肩关节活动度及肌力均优于对照组（P〈0．05或P〈0．01）。结论创伤性肩袖损伤患者关节镜术后,在无痛原则下,肩关节的功能锻炼越早进行效果越好。     

肩袖损伤关节镜修复术后的康复临床研究

目的:分析肩袖损伤关节镜修复术后系统康复的治疗效果。方法:应用关节镜下修补术治疗肩袖损伤的患者60例。选择术后能够坚持来我院进行系统锻炼的患者为康复组,仅进行出院或门诊指导的患者作为对照组,每组30例,根据国际认可康复流程进行指导。使用美国肩肘医师协会评分(ASES)、加州大学肩关节评分系统(UCLA)和视觉模拟评分(VAS)对患者术前和术后6个月时的肩关节功能进行评价,分别对两组患者术后7周、3个月和6个月时的主动前屈和体侧外旋角度进行测量。结果:两组患者ASES及UCLA评分术前无明显差异(P>0.05);术后6个月与术前相比有显著改变(P<0.05),且两项评分康复组均高于对照组(P<0.05);VAS评分术前无差异(P>0.05),术后较术前均有明显改善(P<0.05);术后7周、3个月和6个月时肩关节的主动活动度,康复组均高于对照组(P<0.05)。结论:关节镜下肩袖修补术可以有效治疗肩关节功能障碍,对术后患者进行系统和个体化的康复训练,可以有效恢复患者肩关节的功能,提高治疗效果。     

关节镜联合小切口修复术治疗肩袖全层损伤的效果

目的 观察关节镜联合小切口修复术治疗肩袖全层损伤的近期效果,并探讨关节镜联合小切口修复术的临床意义。方法 选取2020年1月至2022年4月接受关节镜联合小切口修复术治疗的22例肩袖全层损伤患者为研究对象。比较术前、术后6个月随访时的疼痛视觉模拟评分法（VAS）评分、肩关节主动前屈角度、外旋角度及Constant-Murley、美国加州大学肩关节评分（UCLA）评分。结果 术后6个月随访时,肩袖全层损伤患者的VAS评分低于术前,肩关节主动前屈角度、外旋角度大于术前（P<0.05）。术后6个月随访时,肩袖全层损伤患者的Constant-Murley、UCLA评分高于术前（P<0.05）。结论 关节镜联合小切口修复术治疗肩袖全层损伤的效果显著,可明显降低肩关节疼痛,提高肩关节功能,有助于术后康复。     

创伤性肩袖损伤患者术后不同时间开始康复训练效果观察

目的探讨创伤性肩袖损伤关节镜术后患者术后不同时间开始早期康复锻炼对肩关节功能恢复的影响,分析相关原因,为统一康复训练实施时间提供依据。方法将2006年9月—2008年11月收治的59例创伤性肩袖损伤关节镜术后患者按入院先后顺序随机分为观察组29例和对照组30例。两组患者术后均采用常规的抗炎、消肿、银杏叶针活血及短波、低频脉冲治疗;均于术后0～6周采用肩关节制动功能锻炼。观察组同时于术后第1天始按创伤性肩袖损伤术后康复计划进行肩关节康复训练,对照组按传统保守方法于术后第6周开始进行肩关节康复训练,均采用Constant-Murley肩关节评分标准评价患肩的功能状况。结果除术后第4周两组疼痛、日常生活活动差异无统计学意义(P>0.05)外,术后第8周、第12周、第16周、第20周观察组疼痛、日常生活活动、肩关节活动度及肌力均优于对照组(P<0.05或P<0.01)。结论创伤性肩袖损伤患者关节镜术后,在无痛原则下,肩关节的功能锻炼越早进行效果越好。     

Knot impingement after arthroscopic rotator cuff repair mimicking infection: A case report

BACKGROUNDKnot impingement as a complication after arthroscopic rotator cuff repair (ARCR) has been suggested as a cause of persistent pain with limited motion. We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion, which was confused with infection.CASE SUMMARYA 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room. Passive range of motion could not be evaluated due to the patient’s severe pain. The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder. An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder, and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging. Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils. The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed. Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials. The patient’s symptoms subsided immediately after the surgical procedure. CONCLUSIONAlthough the incidence of knot impingement is rare, the possibility of knot impingement after ARCR should be a consideration.     

关节镜下微创手术治疗运动性肩袖损伤50例康复护理

目的:探讨关节镜下微创手术治疗运动性肩袖损伤患者的康复护理方法.方法:对50例运动性肩袖损伤患者行关节镜下微创手术治疗,并给予个性化心理护理、疼痛护理及有计划的阶段性康复训练.结果:50例患者均未出现肩关节僵硬强直、创伤性骨性关节炎及神经损伤等并发症.随访3个月～1.5 年,根据美国UCLA肩关节评分标准评分优35例、良10例、可5例,优良率90%.患者自我满意度高.结论:关节镜下微创手术后早期阶段性康复训练能促进肩关节功能恢复,提高手术治疗的效果.     

The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation

Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation.

Objective

To investigate whether the lag signs were valid tools in diagnosing full-thickness tears of the rotator cuff.

Design

A same-subject, correlation, double-blinded design was used. The results of the external rotation lag sign, drop sign, and internal rotation lag sign were compared with the criterion standard of diagnostic ultrasound to establish their accuracy.

Setting

A regional orthopedic hospital.

Participants

Consecutive subjects (N=37), 21 women and 16 men, with shoulder pain referred to a consultant orthopedic surgeon specializing in shoulder conditions were recruited for this investigation.

Interventions

Not applicable.

Main Outcome Measures

Sensitivity, specificity, and positive and negative likelihood ratios of the lag signs when using ultrasound as the reference test.

Results

The specificities of the drop sign and internal rotation lag sign were 77% and 84%, respectively, which, together with low positive likelihood ratios 3.2 (95% confidence interval [CI], 1.5-6.7) and 6.2 (95% CI, 1.9-12.0), indicate that a positive result was poor at recognizing the presence of full-thickness tears. The drop sign had a sensitivity of 73% with a negative likelihood ratio of .34 (95% CI, 0.2-0.8), suggesting that a negative test was fair at ruling out the presence of full-thickness tears. The sensitivity of the internal rotation lag sign (100%) supported by the negative likelihood ratio of 0 (95% CI, 0.0-2.5) suggests that a negative test will effectively rule out the presence of full-thickness tears of the subscapularis. A positive external rotation lag sign is the clinical test most likely to indicate that full-thickness tears of the supraspinatus and infraspinatus are present (specificity, 94%). However, the external rotation lag sign did demonstrate a low sensitivity score of 46% and negative likelihood ratio of .57 (95% CI, 0.4-0.9), which means that a negative test will not rule out the presence of full-thickness tears.

Conclusions

The findings of this investigation suggest that a clinical diagnosis of a full-thickness tear of the rotator cuff cannot be conclusively reached using one or more of the lag signs.     

Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology

Anderson VB, Wee E. Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology.

Objectives

To assess the degree of impairment of shoulder proprioceptive acuity in individuals with chronic rotator cuff pathology (CRCP), and to examine the effect of impingement-related shoulder pain on acuity using a reliable laboratory technique.

Design

Case-control study.

Setting

University human movement laboratory.

Participants

A volunteer sample of individuals with CRCP (n=26) were recruited and screened, and compared with age-, sex-, and limb dominance–matched individuals (n=30) who acted as controls. Ten participants with CRCP underwent repeat assessment after 2 days to determine the intrarater reliability of proprioceptive measurement.

Interventions

Not applicable.

Main Outcome Measures

Each participant underwent assessment of joint position sense at 40° and 100° of scapular plane abduction using an active position-matching task. Movements were recorded with reflective skin markers and a multidimensional motion analysis system. Self-reported pain intensity associated with the procedure was recorded with a visual analog scale.

Results

Intraclass correlation coefficients (model 3,5) between repeat assessments ranged from .54 to .99. On average, those with CRCP demonstrated reduced acuity at 40° and 100° test angles. In comparison with the control group, proprioceptive acuity was significantly impaired (P<.01) at the 100° test angle, where the pain intensity was significantly greater (P<.01).

Conclusions

This study demonstrated impairment of shoulder joint position sense in CRCP. The degree of proprioceptive impairment was greatest at higher elevations in the setting of increased shoulder impingement and pain, which may serve to perpetuate the pathology. These findings provide a theoretic rationale for the continued implementation of proprioceptive rehabilitation programs in managing CRCP.     

Ultrasonography of the rotator cuff: Surgical correlation

Rotator cuff tears are a common orthopedic problem. The portions of the cuff most commonly torn are accessible to sonographic examination with appropriate positioning of the shoulder. This study was undertaken to correlate the sonographic appearance of the pathologic rotator cuff with findings at the time of surgical repair. Rotator cuff tears are readily seen with high-resolution real-time sonography. Sonography can demonstrate tears not demonstrated arthrographically. In the appropriate clinical setting arthrography may not be necessary if the sonogram demonstrates characteristic findings.     

急性创伤致肩袖撕裂的超声诊断

目的探讨肩袖撕裂的超声特征，评价超声检查肩袖撕裂的应用价值。方法对33例急性创伤后疑诊肩袖损伤者行超声检查，并与磁共振、肩关节造影或手术结果进行比较。结果肩袖撕裂的超声主要表现为：肩袖不显示，肩袖部分缺失，肩袖内局灶性异常回声，肩袖局部变薄。超声诊断的敏感性92％(22／24)，特异性82％(9／11)，准确性94％(31／33)。结论超声诊断肩袖撕裂有较高的应用价值，可作为急性肩部创伤而X线检查正常患者的首选检查方法。     

肩袖撕裂术后康复治疗中的高频超声评价分析

目的 探讨高频超声在肩袖撕裂术后康复治疗中的应用价值.方法 对临床疑诊肩袖损伤的87例患者进行超声检查,对肩袖部分及完全撕裂的54例患者进行手术治疗,术后患者中对照组27例(进行自主功能锻炼),康复组27例(进行正规的康复训练),两组患者于术后2周、4周、8周、12周和16周进行临床功能评分及超声评分,评价康复治疗效果,1年后进行临床疗效评定.结果 患者在肩袖撕裂术后不同时期的临床症状与超声表现相符.临床功能及超声评分术后2周、4周时两组间差异无统计学意义(P＞0.05),术后8周、12周、16周时康复组明显优于对照组(P＜0.05或P＜0.01).康复组1年后的疗效评定结果优于对照组(P＜0.01).结论 高频超声在肩袖撕裂术后的康复治疗中有较高的应用价值.     

The relationship of preoperative factors to patient-reported outcome in rotator cuff repair: a systematic review

Background: Understanding preoperatively available factors that predict valid, patient-reported outcomes following rotator cuff repair can assist clinicians and their patients in making an informed, shared-decision on rotator cuff repair, and assist in setting an evidence-based prognosis.

Objectives: To perform a systematic review of the preoperative factors related to patient-reported outcome following rotator cuff repair.

Methods: A systematic review of the literature was performed to identify studies analyzing the relationship of preoperative factors to valid, patient-reported outcome measures. To be included in the review, outcome had to be measured by at least one valid upper extremity or shoulder-specific patient-reported outcome.

Results: Twenty-three studies met the criteria for inclusion. Of these, 15 studies scored 3 or less on a 7-point scale of study quality indicating a paucity of strong trials investigating these prognostic factors. Prognostic factors reviewed included age, sex, worker’s compensation status, involvement of dominant arm, fatty infiltration of the cuff musculature, duration of symptoms, comorbidities, and smoking status. Increasing age predicted worse Disabilities of Arm, Shoulder and Hand Scores (DASH) but did not predict outcome of any other patient-reported outcome. A worker’s compensation claim predicted a negative impact on patient-reported outcome. Evidence for the remaining factors indicated they do not predict patient-reported outcome.

Conclusion: Six of the eight preoperative factors reviewed did not show a relationship with patient-reported outcome following rotator cuff repair. Evidence indicates a worker’s compensation claim negatively impacts patient-reported outcomes and increasing age resulted in a less favorable DASH score. However, age was not predictive of other patient-reported outcomes such as the Constant score or American Shoulder and Elbow Surgeons Shoulder Score. Overall quality of the included studies was low and future studies with stronger methodologies should be conducted.