奥洛他定治疗过敏性结膜炎的疗效及其对血清、泪液相关指标的影响

目的探讨奥洛他定治疗过敏性结膜炎的疗效及其对血清、泪液相关指标的影响。方法 90例过敏性结膜炎患者随机分为对照组(色甘酸钠滴眼液)和观察组(奥洛他定滴眼液),比较2组患者治疗前及治疗后各项症状体征评分、血清及泪液ECP、HA、LTB4及Ig E水平。结果治疗后,观察组的各项症状体征评分及血清、泪液ECP、HA、LTB4及Ig E水平均显著低于对照组(P0.05)。结论奥洛他定能有效改善过敏性结膜炎患者的症状体征及血清、泪液相关指标。     

Reverse shoulder arthroplasty for non-traumatic problems

Reverse shoulder arthroplasty (RSA) was developed by Grammont to address cuff tear arthropathy (CTA) in the elderly. RSA facilitates centring of the humeral head within the glenoid, such that deltoid function is maintained. CTA remains the main indication for RSA but observed improvements in postoperative outcomes have driven an expansion of indications. This review explores the broadening role of RSA, with emphasis on non-traumatic indications. In addition, the biomechanical principles, evolution of reverse polarity prostheses and complications are discussed.     

EFFECTS OF A DRY‐LAND STRENGTHENING PROGRAM IN COMPETITIVE ADOLESCENT SWIMMERS

Background

Shoulder pain is common in competitive young swimmers. A relationship between shoulder strength and shoulder soreness in competitive young swimmers may indicate need for strengthening.

Purpose

To determine if a shoulder exercise program will improve shoulder strength and decrease pain in competitive young swimmers.

Study Design

Randomized control

Methods

Participants (10 control, 11 experimental), randomly assigned to a control or experiment group, completed the 12 week program. Strength was measured prior to the study for shoulder flexion, abduction, external rotation, internal rotation, and extension on the dominant arm using handheld dynamometry. The experimental group was then assigned exercises to be performed three times per week. The control group was instructed not to perform the exercises. All participants were re‐tested at six and twelve weeks following initiation of the study.

Results

The changes in strength for each muscle group and pain were compared between groups using a mixed design two‐way ANOVA. The experimental group significantly increased external rotation strength compared to the control group. Shoulder soreness was not significantly different between groups.

Conclusion

Adolescents who perform shoulder strengthening significantly increased their external rotation strength compared to adolescents who only participated in a regular swimming regimen.     

肩袖滑囊侧部分撕裂的关节镜手术治疗

目的 探讨关节镜治疗肩袖滑囊侧部分撕裂的手术方法 和临床效果.方法 对2002年6月至2007年12月行关节镜手术的57例肩袖滑囊侧部分撕裂患者进行回顾性分析.男性34例,女性15例,年龄25～71岁,平均年龄49.7岁.左肩15例,右肩34例,涉及优势侧41例.根据Ellman分类标准,Ⅰ度7例,Ⅱ度6例,Ⅲ度36例.术前均拍摄肩关节正位和冈上肌出口位X线片,29例行B超检查,36例行MRI或磁共振血管造影检查.Ⅰ度及Ⅱ度患者行肩峰下间隙减压及肩袖清理术;Ⅲ度患者行肩峰下间隙减压及肩袖修复术.肩袖修复方式:3例直接行断端缝合,26例应用缝合锚钉行肩袖止点重建,7例联合应用断端缝合及缝合锚钉技术.分别在术前和最终随访时采用UCLA肩关节评分标准进行评价.手术前UCLA评分平均为(16.5±2.4)分.其中疼痛评分平均为(2.9±1.0)分,功能评分平均为(5.4±1.2)分,肩关节主动前屈评分平均为(4.3±1.1)分,前屈肌力评分平均为(4.0±0.4)分.结果 49例患者均获得随访,随访时间2～7年,平均48个月.手术后平均UCLA评分为(32.1±3.8)分.其中疼痛评分平均为(8.4±1.7)分,功能评分平均为(9.1±1.4)分,肩关节主动前屈评分平均(4.9±0.2)分,前屈肌力评分平均为(4.8±0.4),与术前比较差异均具有统计学意义(均为P=0.000).优16例,良31例,差2例.47例患者对手术效果表示满意.结论 关节镜手术是治疗肩袖滑囊侧部分撕裂的有效方法 .手术创伤小、恢复快.     

Effect of glenohumeral abduction angle on the mechanical interaction between the supraspinatus and infraspinatus tendons for the intact,partial‐thickness torn,and repaired supraspinatus tendon conditions

Rotator cuff tears are difficult to manage because of the structural and mechanical inhomogeneity of the supraspinatus tendon. Previously, we showed that with the arm at the side, the supraspinatus and infraspinatus tendons mechanically interact such that conditions that increase supraspinatus tendon strain, such as load or full‐thickness tears, also increase infraspinatus tendon strain. This suggests that the infraspinatus tendon may shield the supraspinatus tendon from further injury while becoming at increased risk of injury itself. In this study, the effect of glenohumeral abduction angle on the interaction between the two tendons was evaluated for supraspinatus tendon partial‐thickness tears and two repair techniques. Principal strains were quantified in both tendons for 0°, 30°, and 60° of glenohumeral abduction. Results showed that interaction between the two tendons is interrupted by an increase in abduction angle for all supraspinatus tendon conditions evaluated. Infraspinatus tendon strain was lower at 30° and 60° than at 0° abduction angle. In conclusion, interaction between the supraspinatus and infraspinatus tendons is interrupted with increase in abduction angle. Additionally, 30° abduction should be further evaluated for management of rotator cuff tears and repairs as it is the angle at which both supraspinatus and infraspinatus tendon strain is decreased. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:846–851, 2010     

半月板桶柄样撕裂的关节镜下修补：61例2~5年随访

背景：半月板的桶柄样撕裂如未经早期修补则要采取半月板切除,可导致膝关节退变的加速,但目前有关半月板的桶柄样撕裂关节镜下修补的长期、大样本报道较少。 目的：回顾性分析半月板桶柄样撕裂的关节镜下修补疗效。分析半月板桶柄样撕裂的术前诊断、修补技术、疗效评估及影响因素,探讨大型半月板撕裂理想的修复途径。 方法：于2002-05/2005-11在北京积水潭医院运动医学中心连续完成共90例关节镜下半月板桶柄样撕裂修补手术。对90例患者中的61例、63个半月板进行了2年以上的随访,平均随访期38个月(24~66个月)。半月板桶柄撕裂的修补手术适应证为：红-红区及红-白区损伤、具备可复位性、半月板组织无复合撕裂及明显变性。 结果与结论：在可随访的61例患者中,有51例(84%)的53个半月板经过二次手术探查。61例患者中53例(87%)无临床症状;4例(6%)部分临床症状;4例(6%)交锁复发。二次关节镜检查发现完全愈合的半月板有44个(83%);部分愈合者5个(9%),不愈合者4个(7%)。总体评估失效率为8%(5/63) ,成功率92%(包括完全愈合、部分愈合、无临床症状及部分临床症状者)。通过2~5年的随访结果表明对于发生在红-红区或红-白区的半月板桶柄样撕裂,采用多种缝合技术进行牢靠的修补缝合,并且与前十字韧带重建同期进行,修复效果较好。     

Management of obstetric anal sphincter injuries – a role for the colorectal surgeon

Aim To determine if surgical repair of third and fourth degree obstetric perineal tears by an experienced colorectal surgeon produces satisfactory functional results in the short and long term. Method Consecutive deliveries were studied prospectively over a 32‐month period. All patients with suspected third or fourth degree tears were referred to the colorectal team. Following confirmation of the injury, patients underwent surgical repair using a standard overlapped technique according to an established protocol. The patients were reviewed 2 months later. Long‐term continence was determined, by postal and telephone follow up, after a minimum of 3 years. Results Fifty‐nine sphincter injuries were identified and repaired by the colorectal team. Two months following repair 51 (86%) of patients had normal continence, four (7%) had urgency, and five (8%) had occasional incontinence of flatus. All patients with any degree of incontinence underwent endoanal ultrasound at which no sphincter defects were noted, and all improved symptomatically following pelvic floor physiotherapy. Long‐term follow up data was obtained in 45 women. Thirty‐nine (87%) had normal continence scores, 11 (24%) described urgency, but only three (7%) were often incontinent of liquid stool. Seven (15%) were occasionally incontinent of flatus. Conclusion Excellent short and long‐term functional results were obtained in the repair of third and fourth degree tears when performed by experienced colorectal surgeons. Since the protocol was established, obstetricians in North Cheshire have adopted the double overlapped technique, and now manage the majority of these injuries themselves.     

Factors related to successful outcome of conservative treatment for rotator cuff tears

Background

Much controversy exists as to the management of full-thickness tears of the rotator cuff. Not all patients with rotator cuff tears require surgical treatment. We have little information whether there are factors that are related to successful outcome of conservative treatment.

Aim

The purpose of this study was to determine the factors related to the successful outcome following conservative treatment.

Methods

This study included 123 shoulders in 118 patients with full-thickness tears of the rotator cuff diagnosed by high-resolution magnetic resonance imaging with a microscopy coil. All patients were treated conservatively for at least 3 months. Clinical symptoms improved in 65 shoulders in 62 patients by conservative treatment (conservative group), but remained unchanged or aggravated in 58 shoulders in 56 patients, who eventually underwent surgical repair (surgical group).

Results

The following parameters showed significant differences: 1) integrity of the intramuscular tendon of the supraspinatus (24.1% in the surgical group and 58.4% in the conservative group showed an intact intramuscular tendon); 2) supraspinatus muscle atrophy (occupancy ratio was 69.8% in the surgical group and 78.0% in the conservative group); 3) impingement sign (positive in 79.3% in the surgical group and 30.7% in the conservative group); and 4) external rotation angle (35.0 degrees in the surgical group and 52.2 degrees in the conservative group). The success rate of conservative treatment was 87% in the cases with at least three of these four factors.

Conclusion

These four factors are useful in selecting patients who will respond well to conservative treatment before initiating the treatment.