肱骨头缺如肩关节置换1例

1 病例资料 患者,女,36岁,因左肩关节间歇性疼痛8年,加重并肿胀1个月,于2009年10月24日就诊.患者8年前无明显诱因出现左肩部疼痛不适,起初为间歇性钝痛,稍事休息及口服止痛药后疼痛缓解,后发展到劳累后疼痛加重并出现左肩关节肿胀,偶尔肿胀波及到左上臂,有时可触及包块,挤压后消失.     

高龄肩关节前脱位合并肱骨解剖颈骨折的治疗

目的探讨肩关节前脱位合并肱骨解剖颈骨折的治疗方法和疗效。方法 20例肩关节前脱位合并肱骨解剖颈骨折患者中,手法复位成功外展架固定3例,切开复位内固定15例,人工肱骨头置换术2例。结果20例均获随访,时间7～22个月。手法复位成功外展架固定3例均有不同程度的关节功能障碍;切开复位锁定解剖钢板固定、术后外展架固定15例中,12例肩关节功能恢复正常,3例肩关节功能轻度受限;2例肱骨头置换术者肩关节功能基本正常。结论肩关节前脱位合并肱骨解剖颈骨折,若无手术禁忌,宜采用切开复位锁定解剖钢板内固定、术后外展架固定,肩关节功能恢复良好。     

关节镜和开放治疗复发性肩关节前方不稳的Meta分析

目的系统评价关节镜下和开放手术治疗青壮年复发性肩关节前方不稳定的疗效。方法计算机检索Cochrane图书馆(2011年第6期)、MEDLINE(1966年至2011年6月)、EMBase(1966年至2011年6月)、中国生物医学文献数据库(1979年1月至2011年6月)、PubMed(1966年6月至2011年6月)、万方数据库和维普数据库,手工检索中文骨科期刊的相关文献。收集所有关节镜与开放手术比较治疗青壮年患者(18～55岁)复发性肩关节前方不稳的随机对照试验,筛选出符合纳入标准的文献,对其进行严格的质量评价后应用RevMan5.0软件进行Meta分析。结果共纳入5个随机对照试验,包含278例患者。Meta分析结果显示,术后肩关节Rowe评分(WMD=4.43,95%CI2.27～6.59),关节镜手术治疗组优于开放手术治疗组。但二者在术后肩关节不稳复发(RR=1.31,95%CI0.51～3.34)、术后神经损伤(RR=0.51,95%CI0.11～2.32)、术后再手术(RR=0.49,95%CI0.11～2.27)、术后恢复伤前功能(RR=0.96,95%CI0.80～1.15)等方面比较均无统计学意义。结论与传统开放手术相比,关节镜手术治疗青壮年复发性肩关节前向不稳,术后肩关节Rowe评分具有优势,但术后并发症等方面二者间无明显差异。     

Spontaneous dislocation of posterior chamber intraocular lenses (PC IOLs) in patients with retinitis pigmentosa – Case series

PurposeTo report the outcomes of intraocular lens (IOL) dislocation management in 6 cases with Retinitis Pigmentosa (RP).SettingPrivate practice, Los Angeles, USA.DesignRetrospective interventional case series.MethodsThe medical reports of six eyes of four RP patients with capsule bag fixated posterior chamber IOL dislocation were retrospectively reviewed. Pre-operative data included demographics, systemic or ocular disorders, history of trauma, previous intraocular surgery and pre-operative visual acuity. Outcome measures included the type of surgery, surgical complications, elevation of intraocular pressure (IOP), ocular inflammation, cystoid macular edema (CME) and IOL dislocation at 3 months or greater post-operatively.ResultsThe medical records of six eyes of four patients operated on between December 2009 and May 2011 were evaluated. In four cases, dislocated PC IOL implants were sutured to the sclera. In two eyes of one patient anterior chamber IOLs (AC IOLs) were implanted after PC IOLs were explanted. One eye developed CME during the follow-up period. Despite modest tilt in one case and modest decentration in another, stability and centration of the IOLs was excellent during the follow-up period. No eyes had intraocular inflammation requiring long term medical treatment, new onset glaucoma or retinal detachment. Mean follow-up time was 6.9 months (range 3-20).ConclusionsCataract surgeons should be aware of the increased risk for decentration and malposition of PC IOLs in patients with RP. Satisfactory results can be achieved by fixation of the PC IOL or AC IOL implantation.     

Bilateral spontaneous dislocation of posterior chamber intraocular lens in a patient with gyrate atrophy

We report a patient with gyrate atrophy, a rare metabolic disease, who had bilateral late spontaneous posterior dislocation of in-the-bag posterior chamber intraocular lens (PCIOL). He underwent pars plana vitrectomy, PCIOL retrieval and anterior chamber intraocular lens implantation in both eyes. This report may imply that patients with gyrate atrophy are at risk for spontaneous dislocation of intraocular lenses.     

外伤性眼球脱位病例报告及文献复习

目的 探讨外伤性眼球脱位的预防及急诊处理的有效措施.方法 从发病年龄、时间、职业、病因、并发症、手术方法、治疗结果及脱位类别进行分析.结果 眼球脱位多见于中青年男性,好发于工人、农民及学生等,以车祸多见,大多损伤较重,常伴有严重的并发症,致眼球或视力丧失.处理方法以手法复位为主,治疗结果与就诊时间早晚、脱位(程度全脱位或半脱位)以及患者年龄等有关.结论 加强安全教育、增强自我保护意识是预防眼球脱位的关键,一旦发生眼球脱位应及时就诊,原则上尽最大努力挽救患者的眼球或视力.     

Acromioclavicular joint dislocations

Acromioclavicular (AC) dislocation is a common injury especially among sportsmen. There is still a lack of consensus on whether to conserve or operate type III AC joint dislocations. Even among surgeons inclined to operate AC joint dislocations there is no unanimity on which surgical technique. There are a plethora of choices between mechanical fixation or synthetic materials or biologic anatomic reconstructions. Even among surgeons, there is a choice between open repairs and the latest—arthroscopic reconstructions. This review of AC joint dislocations intends to analyze the available surgical options, a critical analysis of existing literature, actual technique of anatomic repair, and also accompanying complications.     

Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts,indications, and recent advances

Latissimus dorsi tendon transfer is a method for surgical treatment of massive irreparable posterosuperior cuff tears. It partially restores active anteflexion, external rotation, and function of the shoulder but does not significantly increase strength of the shoulder. It is contraindicated in case of pseudoparalytic shoulder; associated irreparable subscapularis tear, deltoid palsy, and in case of associated osteoarthritis, as an isolated procedure. Results are inferior when performed as a secondary procedure compared with a primary procedure. However, latissimus dorsi tendon transfer is an attractive solution to improve shoulder mobility and function of young and non osteoarthritic patients whose previous surgical treatment of massive postero-superior irreparable rotator cuff tear failed. As a primary procedure, latissimus dorsi tendon transfer competes with debridement, biceps tenotomy, and partial cuff repair. In association with reverse shoulder arthroplasty, it restores active external rotation in osteoarthritic patients with active external rotation deficit. New arthroscopic assisted techniques might improve results in the future.     

IS THERE A RELATION BETWEEN SHOULDER DYSFUNCTION AND CORE INSTABILITY?

Background:

Overhead athletes often suffer injury to the glenohumeral joint secondary to inherent instability. However, little is known about the relationship between core stability and shoulder dysfunction among athletes.

Purpose:

The purpose of this study was to analyze the difference between healthy athletes and those with shoulder dysfunction in regard to core stability measures. Secondary purpose was to explore the relationship between measures of core stability and measures of shoulder dysfunction.

Methods:

Participants consisted of NCAA Division III overhead athletes (28 males, 33 females) with a mean age of 19.3 ± (1.1) years, mean weight of 173.6 ± (36.9) pounds, mean height of 67.8 ± (3.5) inches. Functional questionnaires (the Kerlan‐Jobe Orthopaedic Clinical Scale [KJOC] and the QuickDASH sports module) as well as Single‐Leg Stance Balance Test (SLBT), Double Straight Leg Lowering Test (DLL), Sorensen Test, and Modified Side Plank Test were completed in a randomized order with consistent raters.

Results:

MANOVA was significant at (p = .038) for the comparison between the experimental group and the control group for the values of Right SLBT. The experimental group had significantly less balance than the control group with means of 10.14 ± (5.76) seconds and 18.98 ± (15.22) seconds respectively. Additionally, a positive correlation was found between the DLL and the KJOC at (r = .394, p > .05) and a negative correlation was found between the Right SLBT and the Quick DASH sports module (QD) at (r = –.271, p > .05).

Discussion and Conclusion:

Balance deficiency was found in athletes with shoulder dysfunction. According to this study, greater shoulder dysfunction is correlated with greater balance and stability deficiency. Therapists and trainers should consider incorporating balance training as an integral component of core stability into rehabilitation of athletes with shoulder dysfunction.

Level of Evidence:

3b