后路踝关节距下关节融合术治疗连枷足的远期疗效

本文报告采用改进的后路踝关节距下关节融合术治疗婴儿瘫后遗连枷足的远期疗效。15例采用本法治疗,平均随访10.5年的远期疗效满意,全部病例均于术后3月获得骨性融合,患足功能和外观良好。本文对治疗连枷足的各种方法进行了讨论。作者认为本法是治疗连枷足的一种安全简单和有效的方法。     

双Endobutton技术治疗Ⅲ型肩锁关节脱位的临床观察

目的回顾分析应用双Endobutton技术治疗TossyⅢ型肩锁关节脱位的初步临床疗效。方法对12例TossyⅢ型肩锁关节脱位患者采用双Endobutton技术重建喙锁韧带治疗,全部病例获得8～14个月随访,平均12个月。结果按Lazzcano疗效评价标准进行评价,优10例,良2例,无再脱位及其他并发症。结论应用双Endobutton技术治疗TossyⅢ型肩锁关节脱位近期疗效满意,远期疗效有待长期随访。     

改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位的临床观察

目的探讨改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位的初步临床疗效观察。方法回顾性分析2008年3月至2010年8月,采用改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位18例,术后1个月、3个月和1年分别进行门诊随访,并拍摄x线片,采用Constant评分评价术后肩关节功能。结果术后3个月肩关节功能采用Constant评分平均为93．5分,X线片显示无再发脱位和半脱位。结论改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位是一种有效的方法,手术创伤小,恢复快,并发症少,近期疗效满意,远期疗效有待长期随访。     

钢丝带固定治疗陈旧性重度肩锁关节脱位

陈旧性重度肩锁关节脱位的治疗方法较多，但疗效差异很大，多不能解剖复位，使肩关节功能减退。作者自１９８７年１１月～１９９１年２月，采用切开复位钢丝带固定治疗陈旧性重度肩锁关节脱位１４例，其中男１３例、女１例，年龄２５～３７岁。术后随访６～３８月，按优、良、中、差标准评定疗效。结果优１１例，占７８．６％；良３例，占２１．４％，无１例出现合并症。作者认为钢丝带提供了一种跨越关节而作用于关节面的应力，从而使肩锁关节面牢固、紧密接触，是手术成功的关键。该法适用于Ａｌｌｍａｎ分类法的Ⅱ°、Ⅲ°度肩锁关节脱位。而且操作简便、副损伤小、肩关节功能好、远期疗效更为满意。     

应用AO锁骨钩板联合韧带修复治疗完全性肩锁关节脱位

目的评价应用AO锁骨钩板联合韧带修复治疗完全性肩锁关节脱位的临床疗效。方法13例完全性肩锁关节脱位的病人采用AO锁骨钩板联合韧带修复治疗。全部病例获得随访，随访6．18个月，平均为12个月。结果按Karlsson标准进行评价，优良10例，满意2例，差1例。患者无感染，无金属内植物折断及松动，肩锁关节无再脱位。结论应用AO锁骨钩板联合韧带修复治疗完全性肩锁关节脱位，固定可靠，可以早期进行功能锻炼，疗效满意。     

颈麻下治疗老年粘连性肩周炎31例体会

颈麻下治疗老年粘连性肩周炎３１例体会李如华，邵宣肩周炎即肩关节周围炎，又称冻结肩。以老年人多见。治疗方法不少，但疗效往往不够满意。自１９９２年２月－１９９３年３月，我们采用颈麻下中西医结合治疗老年粘连性肩周炎３１例，疗效满意。报告如下：临床资料本组３...     

克氏针加丝线绳治疗肩锁关节脱位18例报告

克氏针加丝线绳治疗肩锁关节脱位１８例报告刘兆圣刘欣杨传华曹廷豹我院自１９９０年６月～１９９５年６月，采用克氏针加丝线绳治疗肩锁关节脱位１８例，随访６个月～２年，疗效满意，现报道如下：手术方法：采用局麻或颈丛麻醉，切口自肩峰与锁骨肩峰端开始，作弧形切口...     

AO锁骨钩钢板内固定结合喙锁韧带重建治疗Ⅲ度肩锁关节脱位

目的探讨治疗Ⅲ度肩锁关节脱位的治疗方法。方法临床治疗35例，均采用AO锁骨钩钢板内固定，其中25例直接修复断裂的喙锁韧带，10例喙锁韧带无法直接修复，采用喙肩韧带代替喙锁韧带。结果随访3～20个月，平均9个月。术后x片检查显示肩锁关节间隙复位满意。切口Ⅰ期愈合。术后15～20d，肩关节活动基本正常。患恢复工作和体力劳动时间为术后2～4个月，平均3个月。所有病例无内固定松动、断裂，无明显肌萎缩及再脱位。结论AO锁骨钩钢板内固定结合喙锁韧带、喙肩韧带重建治疗Ⅲ度肩锁关节脱位，固定牢靠，可早期活动肩关节，关节功能恢复快，疗效满意。     

锁骨钩钢板治疗锁骨肩峰端骨折及肩锁关节脱位

肩锁关节脱位约占肩部损伤的12％。轻度肩锁关节脱位一般采用保守治疗即可取得满意疗效，但对于重度肩锁关节脱位的患，多数学建议手术治疗，认为保守治疗效果差。1。2003年7月-2005年7月，我们采用锁骨钩钢板（cavicular hook plate，CHP）治疗锁骨肩峰端骨折及肩锁关节脱位23例，疗效满意。[第一段]     

涤纶毡片重建喙锁韧带治疗陈旧性肩锁关节脱位

涤纶毡片重建喙锁韧带治疗陈旧性肩锁关节脱位慕小瑜官众李洪杨杰山郭启发谭欣林赵希唐薛茂堂我们１９９１年１月～１９９７年５月采用涤纶毡型心脏补片（简称涤纶毡片）重建喙锁韧带，治疗陈旧性肩锁关节脱位１３例，疗效满意，现报告如下。１．临床资料：本组陈旧性肩关...     

Thermal Shrinkage for Shoulder Instability

Thermal capsular shrinkage was popular for the treatment of shoulder instability, despite a paucity of outcomes data in the literature defining the indications for this procedure or supporting its long-term efficacy. The purpose of this study was to perform a clinical evaluation of radiofrequency thermal capsular shrinkage for the treatment of shoulder instability, with a minimum 2-year follow-up. From 1999 to 2001, 101 consecutive patients with mild to moderate shoulder instability underwent shoulder stabilization surgery with thermal capsular shrinkage using a monopolar radiofrequency device. Follow-up included a subjective outcome questionnaire, discussion of pain, instability, and activity level. Mean follow-up was 3.3 years (range 2.0–4.7 years). The thermal capsular shrinkage procedure failed due to instability and/or pain in 31% of shoulders at a mean time of 39 months. In patients with unidirectional anterior instability and those with concomitant labral repair, the procedure proved effective. Patients with multidirectional instability had moderate success. In contrast, four of five patients with isolated posterior instability failed. Thermal capsular shrinkage has been advocated for the treatment of shoulder instability, particularly mild to moderate capsular laxity. The ease of the procedure makes it attractive. However, our retrospective review revealed an overall failure rate of 31% in 80 patients with 2-year minimum follow-up. This mid- to long-term cohort study adds to the literature lacking support for thermal capsulorrhaphy in general, particularly posterior instability.     

Arthroscopic Capsular Plication in the Treatment of Shoulder Pain in Competitive Swimmers

Shoulder pain is a common and difficult problem in competitive swimmers due to cumulative loads from repetitive overhead motion. Capsular laxity has been implicated as a potential etiology for shoulder pain in competitive swimmers. No study has examined the role of capsular plication in addressing recurrent shoulder pain in competitive swimmers. The purpose of this study is to retrospectively describe our series of competitive swimmers treated with arthroscopic capsular plication with a primary outcome of return to competitive swimming. Eighteen shoulders in 15 patients underwent arthroscopic capsular plication from 2003 to 2007. Patients were contacted at an average follow-up of 29 months (range, 8–42) and a swimming history, American Shoulder and Elbow (ASES) scores, and L''Insalata scores were obtained. At time of surgery, all patients demonstrated laxity under examination under anesthesia. All patients had a positive drive-through sign. Eighty percent (12/15) of patients returned to competitive swimming although only 20% (3/15) were able to return to their pre-injury training regimen volume. All patients subjectively reported improved pain after surgery. The average ASES score was 78 ± 16 (average, standard deviation). The average L''Insalata score was 82 ± 11. Although our results demonstrate that arthroscopic capsular plication has utility in the treatment of shoulder pain in swimmers who have failed non-operative treatment, the inability of some athletes to return to pre-injury training volume illustrates the difficult nature of shoulder pain in swimmers.Level of Evidence: Retrospective case series, Level IV     

Shoulder arthrodesis using a pelvic-reconstruction plate. A report of eleven cases

Eleven adults who had a flail shoulder due to brachial plexus palsy had arthrodesis of the shoulder using a single ten-hole pelvic-reconstruction plate. Both the glenohumeral and the acromiohumeral joints were fused with the shoulder in the position of 30 degrees of abduction, 30 degrees of flexion, and 30 degrees of internal rotation. No bone graft was used. The patients were immobilized in a spica cast for six weeks postoperatively. At an average follow-up of twenty-five months after the operation, the position of the arthrodesis had been maintained and solid fusion had occurred in each shoulder. No patient required removal of the plate. The pelvic-reconstruction plate is malleable and is more easily contoured in the operating room than a dynamic-compression plate. We recommend the use of a malleable pelvic-reconstruction plate when performing arthrodesis of the shoulder.     

Systematic Review and Meta-Analysis of Locked Posterior Dislocation of the Shoulder Treated with Shoulder Arthroplasty: Improved Outcomes for Total Shoulder Arthroplasty are Associated with Increased Age

Locked shoulder dislocations account for up to 5% of shoulder dislocations. These relatively rare injuries are characterized by dislocation of the humeral head from the scapular glenoid cavity with the humeral head incarcerated on the glenoid in a “locked” fashion. Diagnosis is often delayed because of the complexity of clinical presentation and subtle radiographic findings, resulting in locking of the humeral head out of the glenoid cavity with severe functional deficits. Most commonly, there are bony injuries to the glenoid and humeral head that engage and prevent closed reduction. Since few patients present with this injury, evidence-based treatment guidelines have not been established. The objective of this review is to assess postoperative outcomes following shoulder arthroplasty for locked posterior shoulder dislocations (LPSD) to guide best practices for treatment. This systematic review was conducted following PRISMA guidelines, searching the PubMed and Web of Science databases for original articles assessing outcomes following arthroplasty for locked posterior shoulder dislocations. Seven publications that evaluated 102 patients were included. Additionally, nine case studies were included, assessing 20 shoulder arthroplasties. Overall, the analysis demonstrated significant improvement in shoulder pain following total shoulder arthroplasty (TSA) (P = 0.0003). Older operative patient ages for TSA resulted in significantly improved modified Neer outcomes scores and patient satisfaction compared to younger patients (P = 0.047). A positive correlation was noted for the duration of dislocation and necessity for revision surgery following hemiarthroplasty (HSA) and TSA combined and TSA separately. The risk ratios assessing the incidence of postoperative complications (RR = 0.56, 95% CI = 0.28–1.11) and necessity for revision surgery (RR = 0.58, 95% CI = 0.24–1.39) were insignificant but noted outcomes favoring TSA. Data from the included studies show that both TSA and HSA are efficacious at treating locked posterior shoulder dislocation. Postoperative outcomes following TSA versus HSA are similar. TSA may be a more efficacious surgical treatment in elderly patients, with improved outcomes and patient satisfaction scores compared to younger patients. Early diagnosis and treatment of posterior locked dislocations may lead to reduced postoperative complications and revision surgery, signaling the importance of proper injury investigation and early treatment. The role of RSA in the management of locked posterior shoulder dislocation remains to be determined, as there is insufficient clinical outcome data currently in the literature.     

Shoulder fusion and free-functioning gracilis transplantation in patients with elbow and shoulder paralysis caused by poliomyelitis

Six children between 7-16 years of age presented with flail shoulder and elbow caused by poliomyelitis. Shoulder fusion was followed by free-functioning gracilis transplantation to replace the atrophied biceps muscle. The transplanted muscle was reinnervated by either the spinal accessory or phrenic nerve. Follow-up averaged 44 months (range, 56-23 months). All cases developed at least grade 3 power of elbow flexion and were able to place their hands to their mouths. Five out of 6 cases were able to flex their elbow against resistance. One case required tension readjustment, and elbow flexion contracture of 45 degrees developed in another case. On average, the transplanted gracilis started to contract 3 months after transplantation, and muscle power reached grade 2 at 5-6 months and grade 3 at 9-12 months. Muscles supplied by the spinal accessory nerve were earlier to contract and ultimately attained more power than those supplied by the phrenic nerve, probably because of easier rehabilitation. Shoulder fusion and free-functioning gracilis transplantation for biceps replacement provide a solution for restoration of function in children with flail shoulder and elbow, as caused by poliomyelitis. The procedure can be useful in other neuromuscular conditions, such as late-presenting Erb's palsy, especially when no other muscles are available for local transfer.     

Prognostic Factors in Arthroplasty in the Rheumatoid Shoulder

Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total shoulder arthroplasty and shoulder hemiarthroplasty in rheumatoid patients. Clinical Hospital for Special Surgery Shoulder score was determined at different time points over a mean period of 6.5 years in 66 rheumatoid patients with total shoulder arthroplasty and 75 rheumatoid patients with shoulder hemiarthroplasty. Moreover, radiographic analysis was performed to assess the progression of humeral head migration and glenoid loosening. Advanced age and erosions or cysts at the AC joint at time of surgery were associated with a lower postoperative Clinical Hospital for Special Surgery Shoulder score. In total shoulder arthroplasty, status of the rotator cuff and its repair at surgery were predictive of postoperative improvement. Progression of proximal migration during the period after surgery was associated with a lower clinical score over time. However, in hemiarthroplasty, no relation was observed between the progression of proximal or medial migration during follow-up and the clinical score over time. Status of the AC joint and age at the time of surgery should be taken into account when considering shoulder arthroplasty in rheumatoid patients. Total shoulder arthroplasty in combination with good cuff repair yields comparable clinical results as total shoulder arthroplasty when the cuff is intact.     

肩周恶性骨肿瘤保肢治疗的分析与探讨

目的分析探讨肩部周围恶性骨肿瘤保肢治疗方法和疗效。方法22例肩周部恶性骨肿瘤患者,其中肱骨上端15例,肩胛骨7例;软骨肉瘤9例,骨肉瘤10例,滑膜肉瘤3例。均行保肢治疗,化疗后行瘤段切除特制人工关节置换术15例,全肩胛骨切除、肱骨头悬吊术6例,肩胛骨部分切除术1例。术后定期辅助化疗。结果2例失访,20例平均随访40个月(3个月~6年)。1例复发;2例发生肺转移,其中1例死亡。根据Ennek ing肢体功能评价标准:优8例,良7例,可3例,差2例。结论对于肩部恶性骨肿瘤,在规范的辅助化疗下行合适的手术,可以达到彻底切除肿瘤并保存一定的肩部功能。     

Anterior Shoulder Dislocation

INTRODUCTION

Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management.

MATERIALS AND METHODS

We have discussed this condition with our colleagues and performed a Medline search (‘anterior shoulder dislocation’) of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint.

RESULTS

Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition.

CONCLUSIONS

Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae.     

High Rates of Occult Infection After Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty

Background

Existing hardware may contribute to increased risk of bacterial contamination and subsequent periprosthetic joint infection (PJI) in conversion shoulder arthroplasty performed for failed fracture fixation.

Questions/Purposes

This study examined the incidence of positive pre-operative aspiration and inflammatory marker data, along with correlation of pre-operative positive aspiration or inflammatory markers and subsequent infection following conversion shoulder arthroplasty for failed open reduction and internal fixation (ORIF) and the need for re-operation at 4.6-year follow-up.

Methods

Twenty-eight patients who underwent conversion to shoulder arthroplasty for any reason after fracture fixation were retrospectively reviewed in a single center. A pre-operative aspiration was done in 17 patients; all patients had intra-operative tissue sampling. All procedures were single-stage removal of hardware and performance of the arthroplasty. In cases of pre-operative positive bacterial growth, a single-stage procedure was performed according to the septic ENDO-Klinik protocol.

Results

In 4 of 17 pre-operative joint aspirations, bacterial growth was detected; one pre-operative negative aspiration demonstrated bacterial growth in intra-operative sampling. In three of them, the infection has been validated through intra-operatively results. Pre-operative aspiration showed a sensitivity of 75% and specificity of 92% (p < 0.005) for infection. No post-operative PJIs were observed. Six revisions were performed, most commonly for aseptic loosening (two cases) and conversion of hemiarthroplasty to a reverse design (two cases).

Conclusions

In conclusion, the risk of low-grade shoulder infection after fracture osteosynthesis may be higher than in hip and knee joints, based on limited study data. Adequate pre-operative testing is recommended to rule out occult shoulder infection in this setting.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-015-9450-z) contains supplementary material, which is available to authorized users.     

Symptomatic Glenoid Loosening Complicating Total Shoulder Arthroplasty

Glenoid component loosening is one of the most common causes of failed total shoulder arthroplasty. Previous reports indicate that it is desirable to reimplant the glenoid component during revision shoulder arthroplasty. The purpose of our study was to retrospectively evaluate the satisfaction of patients undergoing glenoid revision (reimplantation or resection) following total shoulder replacement specifically for symptomatic glenoid loosening. Twenty-eight shoulders that developed symptomatic glenoid loosening following primary total shoulder arthroplasty were included in the study. Patients were retrospectively evaluated at a minimum of 2 years postoperatively. Patients either underwent resection followed by reimplantation of the glenoid component (13) or resection of the component with or without bone grafting (15). Each patient was evaluated with the UCLA Shoulder Scale and the Constant–Murley Shoulder Assessment. There were seven excellent, 13 good, five fair and three poor results on the UCLA score. Functional outcome scores trended higher in the reimplantation group but were not statistically significant. Both groups reported equal pain relief and satisfaction. Five out of 15 patients underwent arthroscopic resection of the glenoid, and these patients scored as well on the UCLA and Constant scores as the reimplantation group. When symptomatic glenoid loosening is the indication for revision total shoulder replacement, patients tend to achieve good to excellent results. Though functional scores were slightly higher in the reimplantation group, satisfaction was equally high in both groups. Resection, when indicated, should be performed arthroscopically as this improved functional outcome in our series.