乳腺癌根治术加放射治疗后上肢并发症的临床分析

目的了解乳腺癌根治手术加放射治疗患者上肢并发症的发病情况及其影响因素。方法对于接受根治或改良根治术后加放射治疗且放射治疗后已超过1年(中位数2.8年)的74例乳腺癌患者,从症状和体征两个方面进行了观测,并应用多因素回归分析相关的发病因素。结果患者上肢水肿的发生率在症状和体征检查中均约为50%,肩关节功能下降分别为49%和58%,患者年龄和全腋窝照射是发生上肢水肿与肩关节运动障碍的独立影响因素。结论上肢水肿和肩关节运动障碍是乳腺癌根治性手术加放射治疗后较常见的并发症,腋窝处理中减少正常组织的损伤以预防或降低其发生率,应该予以高度重视。     

超声介入治疗肩峰下撞击综合征疗效对比分析

目的 研究超声介入治疗肩峰下撞击综合征(SIS)患者的疗效及复发危险因素。 方法 回顾性分析92例SIS患者的临床资料,根据其超声表现进行分型,并分别采用超声引导肩峰下滑囊注射(单纯注射组)以及超声引导肩袖肌腱松解术联合肩峰下滑囊注射(联合治疗组),比较两组术后1周及1,3,6月的疗效差别。 结果两组患者术后1周及1,3,6月的VAS,CMS和OSS评分较术前均有不同程度改善,但术后6月均有复发病例,单纯注射组及联合治疗组的晚期复发率分别为34.9%及10.2%,两组差别有统计学意义(P<0.05)。 结论 对于SIS的患者,采用超声引导下介入治疗有确切的临床疗效; 但对于超声诊断为SIS 2型的患者,应采用超声引导肩袖肌腱松解术联合肩峰下滑囊注射,以降低晚期复发风险。     

肩关节注射治疗冻结肩的研究进展

冻结肩是导致肩关节疼痛及活动受限的常见疾病,肩关节注射是治疗冻结肩的最常用方法,包括糖皮质激素注射、液体扩张疗法、玻璃酸钠注射等。近年来肩关节注射治疗的研究较多,且有较多高质量随机对照研究,该文就糖皮质激素注射与其它治疗手段之间以及注射治疗的不同方式之间在疼痛缓解、活动度及功能改善等方面的疗效及安全性比较作一综述。     

Shoulder Disorders Related to Work Organization and Other Occupational Factors among Supermarket Cashiers

Abstract

The study was designed to examine, in 210 supermarket cashiers, the cross-sectional relationships between shoulder disorders according to location and chronicity of pain as well as personal and occupational factors and store and workstation characteristics. The factors associated with shoulder disorders differed for the right and left sides. Age and psychological disorders were significant risk factors. Among occupational factors, duration of employment, job control, wage dependence on efficiency, exposure to cold, movements and postures such as stooping, working with arms above shoulder level and holding heavy loads in position, and using a laser scanner were associated with shoulder disorders, especially on the left. These results confirm the multi factorial origin of shoulder disorders, and show the importance of psychosocial work factors, movements and postures, and the laser scanner as occupational risk factors, and the need to consider right and left shoulder disorders in cashiers separately.     

A Randomized,Double-Blind,Placebo-Controlled Trial of Oral Pregabalin for Relief of Shoulder Pain after Laparoscopic Gynecologic Surgery

Study ObjectiveTo investigate the efficacy of pregabalin for the relief of postoperative shoulder pain after laparoscopic gynecologic surgery.DesignProspective, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I).SettingTertiary referral center, university hospital.PatientsFifty-six women undergoing elective laparoscopic gynecologic surgery between June 2012 and March 2013.InterventionsWomen in the study group received 75 mg pregabalin 2 hours before surgery and then every 12 hours for 2 doses, and women in the control group received an identical capsule and the same dosage of placebo.Measurements and Main ResultsVisual analog scale (VAS) scores for shoulder pain and surgical pain at 24 and 48 hours after surgery were evaluated as primary outcome. Postoperative analgesics used and drug-related adverse events were also monitored. Patients in the pregabalin group had significantly lower postoperative VAS scores for shoulder pain at 24 hours, compared with the placebo group (median, 23.14 [range, 13.67–32.61] vs 37.22 [27.75–46.64]; p = .04), and required less analgesic (p = .01). There were no significant differences in VAS scores for surgical pain and adverse events between the 2 groups (p = .56).ConclusionsPerioperative administration of 75 mg pregabalin significantly reduced postoperative laparoscopic shoulder pain and amount of analgesic used.     

Kinematics of Chiropteran Shoulder Girdle in Flight

New data on the mechanisms of movements of the shoulder girdle and humerus of bats are described; potential mobility is compared to the movements actually used in flight. The study was performed on the basis of morphological and functional analysis of anatomical specimens of 15 species, high speed and high definition filming of two species and X‐ray survey of Rousettus aegyptiacus flight. Our observations indicate that any excursions of the shoulder girdle in bats have relatively small input in the wing amplitude. Shoulder girdle movements resemble kinematics of a crank mechanism: clavicle plays the role of crank, and scapula—the role of connecting rod. Previously described osseous “locking mechanisms” in shoulder joint of advanced bats do not affect the movements, actually used in flight. The wing beats in bats are performed predominantly by movements of humerus relative to shoulder girdle, although these movements occupy the caudal‐most sector of available shoulder mobility. Anat Rec, 296:382–394, 2013. © 2013 Wiley Periodicals, Inc.     

What would you do? Challenges in shoulder surgery

Dr. Evan Flatow moderates a panel of experts and discusses complex shoulder arthroplasty cases dealing with bone loss, malunions, arthroplasty revision, implant failure, and more. Panel includes Dr. Jon P. Warner, Dr. Gerald Williams, Dr. William Levine, Dr. William Seitz, and Dr. Evan Lederman.