Differences in the Length and Thickness of the Coracoacromial Ligament between Normal Shoulders and Shoulders with Rotator Cuff Tears

Although the relationship between the material properties of the coracoacromial ligament and rotator cuff tears has been clarified, it is difficult to evaluate these properties in the clinical setting. The purpose of this study was to clarify the relationship between rotator cuff tears and the length and thickness of the coracoacromial ligament in living shoulders, in order to assess the potential use of these parameters as clinical indicators of the possible risk or progression of rotator cuff tears. Thirty-five volunteers (46 shoulders, mean age: 52 years) were enrolled. The presence or absence of rotator cuff tears and the length and thickness of the coracoacromial ligament were evaluated by ultrasonography. Longitudinal images of the coracoacromial ligaments with the acromion and coracoid process as landmarks were obtained, and the lengths of the ligaments were measured using acoustic shadows as the index. On the same screens, the thicknesses at the center of the ligaments were measured. Ligaments in shoulders with a rotator cuff tear were significantly shorter than ligaments in shoulders without a rotator cuff tear (25.9 ± 2.5 mm vs. 28.6 ± 1.7 mm, respectively;P < 0.0001). There was no significant difference in the thicknesses of the ligaments. The length and thickness of the coracoacromial ligament of living shoulders were easily evaluated with ultrasonography in the present study, and the coracoacromial ligament was found to be significantly shorter in shoulders with a rotator cuff tear. The risk and progression of rotator cuff tears can be evaluated clinically by measuring the length of the coracoacromial ligament.

Role of shoulder gradient in the pathogenesis of rotator cuff tears

BACKGROUND Shoulder gradient has been associated with shoulder pathologies such as shoulder impingement syndrome.AIM To investigate if there is an association between shoulder gradient and incidence of rotator cuff tear(RCT).METHODS A total of 61 patients with a confirmed diagnosis of RCT were included in this retrospective study.The anteroposterior radiograph of the shoulder was used to measure shoulder gradient in adduction and neutral rotation positions.The pain level was assessed with the visual analog scale for pain.RESULTS The mean age of the patients was 55.7±12.3 years.The mean visual analog scale of the patients was 4.1±1.2.The mean shoulder gradient was 14.11 ±2.65 for the affected shoulder and 15.8 ±2.2 for the unaffected shoulders.This difference was not statistically significant(P=0.41).A difference of 1.15 ±1.82 was found between the injured and non-injured shoulder.No significant association was found between the gradient difference of the shoulder and demographic and clinical characteristics of the patients.CONCLUSION Shoulder gradient is not associated with the pathology of RCT.Yet,future studies with more standardization and a larger sample size are needed to investigate the role of shoulder gradient in RCT pathogenesis further.

Comparison with Surgical Findings for the Accuracy of Routine MRI in Rotator Cuff Tears

Objective: To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears(FTT) by comparing its findings with surgical findings as the gold standard and to improve the previous MRI accuracy in diagnosing rotator cuff tears (RCT) considering more variables. Methods: In 45 months, 804 patients underwent MRI shoulder joint. Among them, only 95 cases had undergone both MRI imaging and surgery accordingly. The patient records were evaluated retrospectively if MRI and surgery were performed within 40 days of MRI. MRI findings were categorized into PTT, FTT and no tears which were further divided into different types according to four main nominal data as variables viz. site, size, shape and muscle involvement in RCT and were correlated with surgical findings for statistical calculation by using Kappa coefficient and McNemar Bowker test. Results: 81 patients (86 RCTs) underwent surgery within 40 days. On the basis of site as variable, MRI correctly depicted 100% of full thickness tears(FTT), 85% of bursal partial thickness tears(PTT), 80.4% of articular partial thickness tears(PTT). The consistency in diagnosis of RCT between MRI and surgery was moderate (Kappa coefficient 0.645). Overall sensitivity, specificity and accuracy of MRI for diagnosing PTT was 87.3%, 53.3% and 81.3%;and that for FTT was 100%, 98.7% and 98.8% respectively. Likewise on the basis of size, shape and muscles involved, the consistency between MRI and surgery was poor for size and shape and moderate for muscles involved;and the difference in diagnosing RCT by MRI and surgery was significant for shape (P = 0.002) only, but not significant for size (P = 0.16) and for muscles involved (P = 0.206) respectively. The agreement between MRI and surgery in diagnosing calcific tendinitis and shoulder joint hematoma with Kappa coefficient is (0.577) and (0.556) respectively. Conclusion: MRI has better accuracy for detecting FTT and has high sensitivity and positive predictive value in diagnosing both PTT and FTT. Combining more others variables in addition to RCT, MRI offers a great value in diagnosing RCT.

Reporting rotator cuff tears on magnetic resonance arthrography using the Snyder's arthroscopic classification

AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.

Outcomes after arthroscopic repair of rotator cuff tears in the setting of mild to moderate glenohumeral osteoarthritis

BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated for both pathologies,however,outcomes data is limited when examining rotator cuff repair(RCR) in the setting of glenohumeral arthritis(GHOA).Thus,this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017.Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity.Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis.Patients included had a minimum two year follow-up.Rate of conversion to total shoulder arthroplasty,complication rates following initial surgery,and patient-reported outcome measures were collected.RESULTS A total of 142 patients were included.The number of patients that required total shoulder arthroplasty within two years after index surgery was low.2/71(2.8%) patients with GHOA,and 1/71(1.4%) without GHOA.Following rotator cuff repair,both groups showed favorable patientreported outcomes.CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study

BACKGROUND Arthroscopic procedures are commonly performed for rotator cuff pathology.Repair of rotator cuff tears is a commonly performed procedure.The intraoperative evaluation of the tear size and pattern contributes to the choice and completion of the technique and the prognosis of the repair.AIM To compare the arthroscopic and open measurements with the real dimensions of three different patterns of simulated rotator cuff tears of known size using a plastic shoulder model.METHODS We created three sizes and patterns of simulated supraspinatus tears on a plastic shoulder model(small and large U-shaped,oval-shaped).Six orthopaedic surgeons with three levels of experience measured the dimensions of the tears arthroscopically,using a 5 mm probe,repeating the procedure three times,and then using a ruler(open technique).Arthroscopic,open and computerized measurements were compared.RESULTS A constant underestimation of specific dimensions of the tears was found when measured with an arthroscope,compared to both the open and computerized measurements(mean differences up to-7.5±5.8 mm,P<0.001).No differences were observed between the open and computerized measurements(mean difference-0.4±1.6 mm).The accuracy of arthroscopic and open measurements was 90.5%and 98.5%,respectively.When comparing between levels of experience,senior residents reported smaller tear dimensions when compared both to staff surgeons and fellows.CONCLUSION This study suggests that arthroscopic measurements of full-thickness rotator cuff tears constantly underestimate the dimensions of the tears.Development of more precise arthroscopic techniques or tools for the evaluation of the size and type of rotator cuff tears are necessary.

Effects of different positions on rehabilitation after rotator cuff repair under shoulder arthroscopy

Objective Shoulder arthroscopic rotator cuff tear repair is currently the main treatment for full-thickness rotator cuff tears,and postoperative rehabilitation training is essential.However,pain and limitation of activity during the rehabilitation process will lead to poor results.Hence,identifying rehabilitation approaches is crucial.This study aimed to compare patient's rehabilitation outcomes and experience between rehabilitation in the supine position and in the standing position.Methods This prospective study included patients diagnosed with full-thickness rotator cuff tears who underwent shoulder arthroscopic double-row rivet repair at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from March 2019 to September 2021.The patients were randomly assigned to the standing rehabilitation exercise group(group A)and the supine rehabilitation exercise group(group B).All patients were followed up for 6 months to record and compare the visual analog scale(VAS)scores,shoulder range of motion,and rehabilitation compliance.Results Altogether,86 patients participated in the study,of whom 79 patients completed the 6-month follow-up.Groups A and B had 39 and 40 patients,respectively.Before operation,the VAS score,forward flexion and extension angle,and abduction angle were comparable between groups A and B.After operation,the patients in groups A and B all experienced a significant improvement in the VAS score,forward flexion and extension angle,and abduction angle(p<0.05).In addition,patients in group B had better VAS score(4.58±0.87 vs.5.21±1.13,p=0.0068;2.15±0.66 vs.2.51±0.51,p=0.0078;0.78±0.86 vs.1.33±0.81,p=0.0015),forward flexion and extension angle(109.30±2.87°vs.102.33±3.74°,p=0.0001;109.53±3.39°vs.104.18±2.76°,p=0.0001;125.22±6.05°vs.117.59±2.27°,p=0.0001),and abduction angle(91.78±2.77°vs.82.92±2.12°,p=0.0001;91.62±2.78°vs.82.82±1.45°,p=0.0001;109.48±3.37°vs.100.10±2.94°,p=0.0001)at 2 wk,6 wk and 6 m postoperatively.Conclusion After 6 months of follow-up,the patients who performed rehabilitation exercises in the supine position achieved better rehabilitation outcomes than those who performed rehabilitation exercises while standing.

Predictors of clinical outcomes after non-operative management of symptomatic full-thickness rotator cuff tears

BACKGROUND Previous studies have shown that non-surgical management can be an effective treatment strategy for many patients with rotator cuff tears.Despite the prevalence of rotator cuff disease,few studies have examined the patient and tear related factors that predict outcomes of nonsurgical management in this cohort of patients.AIM To identify factors that are associated with changes in patient reported outcomes over time in individuals with full-thickness rotator cuff tears treated without surgery.METHODS A cohort of 59 patients who underwent non-surgical management of full thickness rotator cuff tears with a minimum of 1-year follow-up were identified from our institutional registry.Patient demographics,comorbidities and tear characteristics were collected at initial presentation.Outcome measures were collected at baseline and at each clinical follow-up,which included Western Ontario Rotator Cuff(WORC)index,American Shoulder and Elbow Surgeons score,Visual Analog Scale for pain and Single Assessment Numerical Evaluation.Multi-and univariate regression analyses were used to determine the impact of each patient and tear related variable on final WORC scores and change in WORC scores throughout the study.RESULTS In this non-surgical cohort,all patient-reported outcome measures significantly improved compared to baseline at 1 and 2-year follow-up.There was no significant difference in outcomes between 1 and 2 years.The average improvement surpassed the published minimal clinically important differences values for WORC,American Shoulder and Elbow Surgeons,Visual Analog Scale pain and Single Assessment Numerical Evaluation scores.Regression analysis identified female gender(β=-19.88,P=0.003),smoking(β=-29.98,P=0.014)and significant subscapularis fatty infiltration(β=-15.35,P=0.024)as predictors of less favorable WORC scores at 1 year,and female gender(β=-19.09,P=0.015)alone as a predictor of lower WORC scores at 2 years.Patients with symptom duration greater than 1 year at presentation reported less improvement in WORC scores at 1-year follow-up(β=-14.63,P=0.052)and patients with traumatic tears reported greater improvements in WORC scores at 2-year follow-up(β=17.37,P=0.031).CONCLUSION Patients with full thickness rotator cuff tears can achieve and maintain clinically meaningful benefit from non-surgical management through 2-year follow-up.Female patients,smokers,and those with significant subscapularis fatty infiltration tend to have lower overall WORC scores at 1-year follow-up,and females also have lower WORC scores at 2-year follow-up.Patients presenting with symptoms greater than 1 year had less clinical improvement at 1-year follow-up,and those with traumatic tears had greater clinical improvement at 2-year follow-up.

Factors affecting healing after arthroscopic rotator cuff repair

Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymalstem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.

Usefulness of computed tomography based three-dimensional reconstructions to assess the critical shoulder angle

BACKGROUND The critical shoulder angle(CSA)is a radiographic measurement that provides an assessment of both glenoid inclination and acromial length.Higher values may correlate with the presence of rotator cuff tears.However,it is difficult to obtain a high-quality true anteroposterior(AP)radiograph of the shoulder,with any excess scapular version or flexion/extension resulting in deviation from the true CSA value.Three-dimensional(3D)bony reconstructions of computed tomography(CT)shoulder scans may be able to be rotated to obtain a similar view to that of true AP radiographs.AIM To compare CSA measurements performed on 3D bony CT reconstructions,with those on corresponding true AP radiographs.METHODS CT shoulder scans were matched with true AP radiographs that were classified as either Suter-Henninger type A or C quality.3D bony reconstructions were segmented from the CT scans,and rotated to replicate an ideal true AP view.Two observers performed CSA measurements using both CT and radiographic images.Measurements were repeated after a one week interval.Reliability was assessed using intraclass correlation coefficients(ICCs)and Bland-Altman plots[bias,limits of agreement(LOA)].RESULTS Twenty CT shoulder scans were matched.The mean CSA values were 32.55°(±4.26°)with radiographs and 29.82°(±3.49°)with the CT-based method[mean difference 2.73°(±2.86°);P<0.001;bias+2.73°;LOA-2.17°to+7.63°].There was a strong correlation between the two methods(r=0.748;P<0.001).Intra-observer reliability was similar,but the best intra-observer values were achieved by the most experienced observer using the CT-based method[ICC:0.983(0.958-0.993);bias+0.03°,LOA-1.28°to+1.34°].Inter-observer reliability was better with the CT-based method[ICC:0.897(0.758-0.958),bias+0.24°,LOA-2.93°to+3.41°].CONCLUSION The described CT-based method may be a suitable alternative for critical shoulder angle measurement,as it overcomes the difficulty in obtaining a true AP radiographic view.

Application of Tranexamic Acid in Shoulder Arthroscopic Surgery:A Randomised Controlled Trial

Objective To explore the optimal administration route of tranexamic acid(TXA)in shoulder arthroscopic surgery.Methods Patients undergoing arthroscopic rotator cuff repair were randomly divided into four groups:control group(without TXA treatment),intravenous group(TXA was intravenously administered 10 minutes before surgery),irrigation group(TXA was added to the irrigation fluid during subacromial decompression and acromioplasty),and intravenous plus irrigation group(TXA was applied both intravenously and via intra-articular irrigation).The primary outcome was visual clarity assessed with visual analog scale(VAS)score,and the secondary outcomes included irrigation fluid consumption and time to subacromial decompression and acromioplasty procedure.Results There were 134 patients enrolled in the study,including 33 in the control group,35 in the intravenous group,32 in the irrigation group,and 34 in the intravenous plus irrigation group.The median and interquartile range of VAS scores for the intravenous,irrigation,and intravenous plus irrigation groups were 2.70(2.50,2.86)(Z=-3.677,P=0.002),2.67(2.50,2.77)(Z=-3.058,P<0.001),and 2.91(2.75,3.00)(Z=-6.634,P<0.001),respectively,significantly higher than that of the control group[2.44(2.37,2.53)].Moreover,the control group consumed more irrigation fluid than the intravenous group,irrigation group,and intravenous plus irrigation group(all P<0.05).The intravenous plus irrigation group consumed less irrigation fluid than either the intravenous group or the irrigation group(both P<0.001).There was no difference in subacromial decompression and acromioplasty operative time among the four groups.Conclusion TXA applied both topically and systematically can improve intraoperative visual clarity,and the combined application is more effective.

A Case of Septic Arthritis of the Shoulder Joint That Developed after Suprascapular Nerve Block

Septic arthritis of the shoulder is uncommon in the immunocompetent patient with no previous risk factors for joint infection. We treated an immunocompetent patient who developed septic arthritis of the shoulder after suprascapular nerve block for pain due to rotator cuff tear. An 80-year-old man with no underlying disease visited a nearby orthopedics clinic with complaint of left shoulder joint pain. Left suprascapular nerve block was performed, but the pain gradually aggravated. On the day after the block, he had a fever of 39&deg;C and came to our department. On examination, enlargement and tenderness were present at the injection site. Cellulitis at the site was suspected. He was admitted and administration of a cephem anti-biotic was started. Pain subsequently decreased. Magnetic resonance imaging (MRI) performed 4 days after hospitalization showed massive effusion close to the injection site. The effusion spread into the joint cavity through the tear site of the supraspinatus. Septic arthritis of the shoulder was strongly suspected, open irrigation and debridement were performed 11 days after hospitalization. After surgery, pain immediately improved. In our case the extra-articular infection caused by suprascapular nerve block considered to spread into the shoulder joint cavity through the site of rotator cuff tear, although there have been no reports of such cases. This case suggests the possibility that patients with rotator cuff tear may easily develop septic arthritis because extra-articular infection may spread into the joint cavity through the site of tear.

麻醉下手法松解联合关节镜技术治疗冻结肩合并肩袖损伤的临床疗效

目的探讨麻醉下手法松解联合关节镜技术治疗冻结肩合并肩袖损伤的临床疗效。方法回顾性分析2017年1月—2021年12月本院收治的25例冻结肩合并肩袖损伤的患者资料,接受麻醉下手法松解后行关节镜下关节囊松解术联合肩袖修补术治疗。术后3个月、6个月、12个月及末次随访时评估患者的肩关节疼痛、功能评分以及活动度。主要观察指标:疼痛视觉模拟评分(visual analogue scale,VAS)、Constant-Murley评分、美国肩肘协会评分(American Shoulder and Elbow Surgeon,ASES)和肩关节的活动度。结果所有患者均接受至少1年的随访,末次随访时,患者肩关节疼痛、功能评分和活动度均较术前明显改善,差异有统计学意义(P<0.01)。结论麻醉下手法松解联合关节镜技术治疗冻结肩合并肩袖损伤能使患者获得快速康复以及持久良好的活动度。

肩关节脱位伴肩袖巨大撕裂镜下修复1例

患者,女,70岁,主因“右肩伤后疼痛伴活动受限2个月”于2022年9月13日入院。患者2个月前不慎自行摔伤致右肩关节脱位,至医院急诊就诊,经X线检查后诊断:右肩关节脱位(图1a)。手法复位后颈腕吊带悬吊固定。1个月后右肩肿痛明显伴活动受限,经查体及MRI(图1b-1c),诊断为右肩袖巨大撕裂(冈上肌腱、冈下肌腱、肩胛下肌撕裂),右肱二头肌长头腱脱位,右肩骨关节炎,遂由门诊收入院进一步诊治。专科情况:右肩局部肤色、皮温、感觉均正常,锁骨走行正常。关节主动活动度:外展,左170°,右60°;中立位内收,左40°,右0°;前屈,左180°,右100°;后伸,左30°,右20°;0°外旋,左50°,右20°;被动活动与主动活动无明显差别(图1d)。右肩Neer征阳性、Neer加强试验阳性、外展抗阻力试验阳性、0°内外旋抗阻力试验阳性、Hawkins征阳性、O'Brien试验阳性、熊抱试验阳性、肱二头肌抗阻力试验阳性、Speed试验阳性、落臂试验阴性、外旋迟滞试验阴性、内旋迟滞试验阳性、双上肢感觉正常对称,上肢肌力、肌张力未见明显异常,颈椎无明显压痛,生理曲度正常,压颈试验阴性。

肩关节镜围手术期不停用阿司匹林对手术难度及术后临床疗效的影响

目的 探讨肩关节镜手术围手术期不停用阿司匹林对手术过程中操作难度和术后临床疗效的影响。方法 回顾性选取2019年8月至2022年8月在首都医科大学附属北京友谊医院骨科接受肩关节镜手术的177例患者作为研究对象。根据是否停用阿司匹林分为观察组(n=37)和对照组(n=140)。观察组患者围手术期不停用阿司匹林,对照组的患者既往不服用阿司匹林。比较两组患者的手术时间、麻醉时间、失血量、术前及术后6个月的Constant评分,视觉模拟评分法(VAS)评分、心脑血管并发症、非心脑血管并发症。结果 两组患者均顺利完成手术并获得6个月的随访资料。两组患者的手术时间、麻醉时间、失血量、术前及术后6个月Constant评分、VAS评分比较,差异均无统计学意义(P>0.05)。观察组患者术后6个月内未出现心脑血管并发症,对照组发生1例急性脑梗死。观察组患者术后出现2例肩关节僵硬,未出现伤口感染;对照组出现13例肩关节僵硬,1例伤口感染。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论 肩关节镜围手术期若不停用阿司匹林,不会增加手术时间、麻醉时间、失血量和并发症发生率,不增加手术难度和影响术后恢复效果。

肩峰形态在退行性肩袖撕裂诊断中的研究进展

退行性肩袖撕裂是引起肩关节疼痛的常见病因,随着现代社会老龄化的日趋严重,退行性肩袖撕裂的发病率日益上升。许多研究证实肩峰形态与退行性肩袖撕裂的发生有一定的相关性。临界肩角(CSA)、肩峰指数(AI)可以反映肩峰形态的个体解剖学差异。回顾相关文献,发现CSA、AI可在一定程度上预测退行性肩袖撕裂的发生,但在预测退行性肩袖撕裂的诊断价值及预测方法上仍需进一步研究。

肩袖撕裂修复术后并发肩部僵硬因素的研究进展

肩袖撕裂是日常工作和体育活动中常见的一种肩部损伤。关节镜修复是目前治疗肩袖撕裂最广泛使用的方法,术后预后良好。但仍有一系列术后并发症影响治疗效果和患者满意度,如术后疼痛、感染、再次撕裂、肩部僵硬等。本文对肩袖撕裂关节镜修复术后肩关节僵硬的发生和影响因素进行了综述,以期为预防术后肩部僵硬,探究术后肩部僵硬的机制提供参考。

冻结肩合并肩袖损伤患者肩关节镜术后主动康复训练介入时间研究

目的探讨冻结肩合并肩袖损伤(RCI)患者术后肩关节主动康复训练最佳时间。方法回顾性分析2019年1月—2022年1月中国康复研究中心北京博爱医院骨科收治冻结肩合并RCI患者90例,男性44例,女性46例;年龄45~63岁,平均54.6岁。按患者术后肩关节主动康复训练时间分为术后4周组(27例)、术后5周组(31例)及术后6周组(32例)。比较三组患者术前及康复后肩关节功能、肩关节活动度、肩关节疼痛程度、焦虑、抑郁程度。结果三组患者入院时Constant-Murley肩关节功能评价量表(CMS)各维度评分、加州大学肩关节功能评分(UCLA)系统量表评分比较差异均无统计学意义(P>0.05),但三组患者出院后3、6、12个月CMS各维度评分差异均有统计学意义(P<0.05),其中术后4周组评分最高,其次是术后5周,评分最低为术后6周组。三组患者出院后UCLA量表评分均呈显著升高趋势(P<0.05)。术后4周组出院后3、6、12个月的UCLA量表评分分别为(16.9±2.0)分、(25.4±2.3)分、(30.6±2.5)分均显著高于术后5周组[(13.9±1.7)分、(20.9±1.9)分、(24.6±2.2)分,P<0.05)]和术后6周组[(12.6±1.6)分、(16.8±1.8)分、(22.4±2.1)分,P<0.05)]。三组出院后3、6、12个月UCLA量表各方向肩关节活动度均较入院时显著增加(P<0.05),术后4周组最高,其次为术后5周组,术后6周组评分最低。三组患者出院后VAS、SAS和SDS评分均呈显著降低趋势(P<0.05)。术后4周组患者出院3、6、12个月VAS、SAS和SDS评分均显著低于术后5周组和术后6周组,术后5周组显著低于术后6周组(P<0.05)。三组患者在康复锻炼以及出院后12个月内均未发生再断裂或内固定失效。

肩关节复合体模型构建及该领域有限元研究与进展

背景:肩关节作为人体上肢的一个非负重关节,被认为是灵活性与稳定性的完美折中。肩关节传统实验力学研究受限于体内结构的复杂性及测量技术、伦理问题等,存在一定的局限性。将有限元分析方法应用于肩关节领域研究,对肩关节疾病探讨、手术方式决策等方面提供了有价值的参考结论。目的:综述肩关节领域的有限元研究现状,对后续研究前景提出展望。方法:使用计算机在PubMed、Web of Science及中国知网、万方数据库已发表的文献中,检索使用有限元分析方法研究肩关节复合体相关疾患的相关文献。中文检索词:“肩关节、有限元分析、肩袖损伤、盂唇、肩关节置换”,英文检索词:“FE、should joint、glenohumeral joint、rotator cuff tears、glenoid labrum、shoulder arthroplasty”。检索时限重点在2010年1月至2023年1月,对部分重要文献另加以追踪并检索、阅读。结果与结论:①随着模型数据的网络公开化及相关模型数据库的建立,现如今的有限元研究越来越具备规范化、数据可复制性。②经广泛验证的肩关节有限元模型,深化了对肩关节领域的理解,从而实现更高效的临床决策。③随着计算机技术及软件开发等方面的不断发展,未来的有限元研究必然成为临床科研工作不可或缺的实用工具。

三线锚钉结合改良Mason-Allen技术在肩袖中大型撕裂修复中的应用

目的观察三线锚钉结合改良Mason-Allen缝合技术在关节镜肩袖中大型撕裂修复手术中的治疗效果。方法回顾性分析收治的48例患者(使用改良Mason-Allen技术修复中大型肩袖撕裂)的临床资料。依据使用的锚钉将患者分为对照组(双线锚钉,n=23)和观察组(三线锚钉,n=25)。记录2组患者年龄、性别、手术时间、术中使用锚钉数量和术后并发症发生情况。比较2组术前及术后(末次随访)的美国肩肘外科医师(ASES)评分、Constant-Murley肩功能评分和视觉模拟评分法(VAS)评分。随访期间,采用磁共振成像(MRI)评估肩袖有无再撕裂。结果末次随访时,2组肩关节VAS评分低于术前,Constant-Murley肩功能评分及ASES评分高于术前,差异有统计学意义(P<0.05)。对照组使用锚钉数量多于观察组,差异有统计学意义(P<0.05)。结论三线锚钉结合改良Mason-Allen技术修复中大型肩袖撕裂的临床效果较好,与传统双线锚钉一致,但锚钉用量更少。