Degradable magnesium alloy suture promotes fibrocartilaginous interface regeneration in a rat rotator cuff transosseous repair model

Despite transosseous rotator cuff tear repair using sutures is widely accepted for tendon-bone fixation,the fibrocartilaginous enthesis regeneration is still hardly achieved with the traditional sutures.In the present work,degradable magnesium(Mg)alloy wire was applied to suture supraspinatus tendon in a rat acute rotator cuff tear model with Vicryl Plus 4±0 absorbable suture as control.The shoulder joint humerus-supraspinatus tendon complex specimens were retrieved at 4,8,and 12 weeks after operation.The Mg alloy suture groups showed better biomechanical properties in terms of ultimate load to failure.Gross observation showed that hyperplastic response of the scar tissue at the tendon-bone interface is progressively alleviated over time in the both Mg alloy suture and Vicryl suture groups.In the histological analysis,for Mg alloy suture groups,chondrocytes appear to proliferate at 4 weeks postoperatively,and the tendon-bone interface showed an orderly structural transition zone at 8 weeks postoperatively.The collagenous fiber tended to be aligned and the tendon-bone interlocking structures apparently formed,where transitional structure from unmineralized fibrocartilage to mineralized fibrocartilage was closer to the native fibrocartilaginous enthesis.In vivo degradation of the magnesium alloy wire was completed within 12 weeks.The results indicated that Mg alloy wire was promising as degradable suture with the potential to promotes fibrocartilaginous interface regeneration in rotator cuff repair.

Application of multidisciplinary team-based integrated traditional Chinese medicine and Western medicine in rotator cuff injury patients undergoing arthroscopic surgery

BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.

Effect of sphygmomanometer cuff pressure on the differentiation of veins from arteries on ultrasound imaging:an observational cross-sectional study

BACKGROUND:Ultrasound guidance is commonly used for accessing difficult peripheral veins.For successful access,a tourniquet is required for venodilation.Tourniquets decrease the compressibility and increase the diameter of veins;they also obfuscate artery-vein differentiation on ultrasound.We aimed to establish the upper limit of sphygmomanometer cuff pressure that facilitates artery-vein differentiation during ultrasound-guided peripheral intravenous access.METHODS:We employed the sphygmomanometer cuff as a tourniquet for venodilation and tested it on seven participants at six different levels as follows:0 mmHg,DBP/2,DBP,(DBP+SBP)/2,SBP,and SBP+20 mmHg.We used an ultrasound probe attached to a pressure-measuring instrument to record cross-sectional images of the cubital artery and vein.During ultrasonography,compression was applied to the blood vessels through the skin.The following day,we measured the wrist pulse pressure and observed the oximeter pulse wave at six different tourniquet pressure levels.Repeated-measures analysis of variance(ANOVA)on ranks and Tukey’s post-hoc analysis were used for multiple comparisons.RESULTS:Arterial pulsation was maintained at tourniquet pressures between 0 mmHg and(DBP+SBP)/2.However,arterial pulsation decreased or disappeared when the tourniquet pressure reached or exceeded the SBP.Moreover,at this pressure level,the superior compressibility of veins compared to that of arteries was no longer observed.Compression of the artery to 75% and 50% of its original diameter increased arterial pulsation.CONCLUSION:Arterial pulsation and the superior compressibility are useful indicators for differentiating veins from arteries until the tourniquet pressure reaches(DBP+SBP)/2.However,these indicators are not reliable once the tourniquet pressure exceeds the SBP.

Effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries

BACKGROUND The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head,maintaining shoulder joint stability.AIM To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.METHODS We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023.Patients were grouped using the envelope method.RESULTS After treatment,the study group’s treatment effective rate was 94.90%(46/49 patients),significantly higher than that in the control group(79.17%,38/48 cases;P<0.05).Before treatment,there was no difference in Constant Murley Score(CMS)scores,shoulder mobility,or 36-Item Short Form Health Survey(SF-36)scale scores(P>0.05).Compared with those before treatment,the CMS scores(including pain,daily living ability,shoulder mobility,and muscle strength),all aspects of shoulder mobility(forward flexion,posterior extension,external rotation,internal rotation),and SF-36 scale scores(including physiological,psychological,emotional,physical,vitality,and health status)were higher in both groups after treatment and significantly higher in the study group(P<0.05).There was no difference in the occurrence of complications between the two treatment groups(P>0.05).CONCLUSION Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries,helps accelerate the recovery of shoulder function,improves the quality of life,and is highly safe.

多层螺旋CT上腔静脉三维成像技术在评估Cuff导管植入术后导管功能障碍中的应用价值

目的探讨多层螺旋CT上腔静脉三维成像技术在Cuff导管植入术后评估导管功能障碍中的应用价值。方法回顾性分析2019年5月至2021年8月海军第九七一医院因慢性肾衰竭行双腔带Cuff导管留置术,且术后出现导管功能障碍并接受CT上腔静脉三维成像(上腔静脉CTV)的20例患者的临床资料。上述患者中进行颈部血管彩超者13例、数字减影血管造影(DSA)检查者7例。将上腔静脉CTV结果、彩超结果、DSA检查结果进行比较分析。结果20例接受CT上腔静脉三维成像检查者中,CT图像清晰显示导管植入不同血管的位置,明确显示了导管尖端所在位置。呈现Cuff导管的情况分别为:周围血栓致功能障碍15例,导管滑脱2例,植管后皮下隧道疼痛2例,无明显症状1例。行颈部彩超检查的13例中,仅有1例显示头臂静脉上段血栓形成,5例显示颈部静脉管腔扩张或内径略小或仅有细小血流通过,余7例未显示。行DSA检查7例,均用于分析长期血液透析导管血流量减低及造瘘后肿胀手的原因、DSA引导下重新植管及长期血液透析导管纤维鞘去除术等诊疗应用。结论改良的上腔静脉CT三维成像技术空间分辨率高、可重复性强,能立体直观地显示血液透析患者Cuff导管植入血管位置、尖端所在位置、血管通路是否有血栓形成等情况。颈部血管彩超仅作为粗略评价之用;DSA为有创检查,更倾向用于临床治疗。上腔静脉CTV在敏感性、特异性及检查范围上都有较大优势,是评估Cuff导管植入术后导管功能障碍原因中优先选择的检查方法。

Optimizing Recovery Following Mihata Superior Capsular Reconstruction Surgery with Tensor Fascia Lata Auto Graft: A Comprehensive Rehabilitation Protocol

Objective: Superior Capsular Reconstruction (SCR) using a Tensor Fascia Lata (TFL) autograft is an evolving technique for treating irreparable rotator cuff tears. The Mihata technique, initially developed in Japan, has shown promising long-term results. However, a standardized post-operative rehabilitation protocol for this procedure in the USA is lacking. Purpose: This study aims to evaluate the outcomes of a comprehensive rehabilitation protocol following SCR with TFL autograft in a cohort of nine patients. Participants and Methods: A prospective observational study was conducted at Concentra Urgent Care, San Francisco. Nine patients, aged 55 - 65 years, underwent SCR with TFL autograft performed by a specialized orthopedic surgeon. Post-operative rehabilitation was managed using a structured protocol, divided into three phases focusing on passive exercises, progressive range of motion, and strengthening. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, forward flexion range of motion (FF-ROM), and Single Assessment Numeric Evaluation (SANE) scores over a six-month period. Results: Significant improvements were observed in pain reduction (mean VAS decrease of −3.67 points, p = 0.01), ROM (mean FF increase of 41.11 degrees, p = 0.014), and SANE scores (mean improvement of 42.11%, p = 0.009), indicating the efficacy of the rehabilitation protocol. Conclusion: The comprehensive rehabilitation protocol following SCR with TFL autograft significantly improved pain, range of motion, and shoulder function in patients, suggesting its potential utility in clinical practice.

Ultrasound of the Rotator Cuff in Non-Fractured Shoulder Trauma: 30 Cases at the Yalgado Ouedraogo University Hospital of Ouagadougou (Burkina Faso)

Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound lesions of the rotator cuff in cases of non-fracture shoulder trauma at the CHUYO in Ouagadougou. Methodology: This was a prospective descriptive cross-sectional study running from August 1 to November 30, 2017, in the medical imaging department of CHUYO. The study population consisted of patients received in the department for ultrasound in the context of non-fracture shoulder trauma. Results: We collected 20 cases (66.67%) of rotator cuff lesions out of 30 non-fracture shoulder injuries. The mean age of the patients was 27.6 years. Road traffic accidents accounted for 60% of injuries, sports accidents for 30%, and domestic accidents for 10%. Ultrasound lesions were mainly tendon ruptures (36.67%) and tendinitis (23.33%). Ruptures were non-transfixing in 90.90% of cases. The supraspinatus was the most affected (81.81%). Conclusion: Ultrasound can help diagnose rotator cuff injuries, particularly in non-fractured shoulder trauma.

不同浓度肝素封管液在带cuff的深静脉留置导管中的应用研究

目的观察采用不同浓度肝素液进行带cuff的深静脉留置导管封管对规律血液透析患者凝血功能、出血倾向、导管血栓形成等的影响,探讨合理的封管浓度。方法将60例带cuff的深静脉留置导管作为维持性血液透析血管通路的患者随机分为3组(n=20)。A组:纯肝素钠封管(6 250 U/mL);B组:中浓度肝素钠(4 088 U/mL)和生理盐水溶液;C组:低浓度肝素钠(3 125 U/mL)和生理盐水溶液。测定封管后24、h凝血指标,监测出血倾向、通路血栓形成、感染等情况。结果 A组在封管后2 h及4 h时凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)等凝血功能指标均较基础值显著延长(P<0.01)。B组患者封管2 h后仅PT、APTT显著超过基础值(P<0.05),且在4h后恢复至基础水平(P>0.05)。C组患者封管后PT、APTT和INR与基础值比较,差异均无统计学意义(P>0.05)。观察期1个月,C组患者出血事件发生率显著低于A、B组(P<0.05),3组间血栓发生率、感染率、导管拔出率均无显著差异。结论低浓度肝素钠溶液进行带cuff的深静脉留置导管封管不良反应较少,可用于大多数患者。有高凝倾向的患者更适合采用中浓度肝素液。

70%乙醇封管在血液透析带隧道带涤纶套导管中的应用

目的探讨70%乙醇封管对预防维持性血液透析带隧道带涤纶套(Cuff)导管患者导管相关性血流感染(catheter related blood stream infection,CRBSI)的有效性和安全性。方法本试验采用随机自身交叉对照方法。选择东南大学附属中大医院肾脏科维持性血液透析患者32例,首先将患者随机分为乙醇封管组(每周采用3.3mL 70%乙醇封管1次,再采用3.3mL标准肝素封管2次)和肝素封管组(每周采用3.3mL标准肝素封管3次),每组16例,22周后进行交叉互换。比较两组患者CRBSI、导管功能障碍和其他不良反应的发生率。结果 2例患者退出试验,2例死亡,共28例患者完成试验,每组各14例。乙醇封管组患者CRBSI的发生率为0.45/1 000导管日,低于肝素封管组患者(0.92/1 000导管日),但差异无统计学意义(P>0.05)。乙醇封管组患者导管功能障碍的发生率为0.90/1 000导管日,低于肝素封管组(2.06/1 000导管日),但差异无统计学意义(P>0.05)。两组患者的血常规、肝功能、凝血功能差异无统计学意义。乙醇封管组患者均未发生恶心、呕吐、头晕等不良反应。结论乙醇封管组维持性血液透析带隧道带Cuff导管患者的CRBSI发生率呈下降趋势,但与肝素封管组相比差异无统计学意义。

cuff管套入法建立大鼠同种异体睾丸移植模型

目的:探索应用cuff管套入法建立大鼠同种异体睾丸移植模型的新方法。方法:60只健康雄性近交系W istar大鼠分别作为供、受体,显微镜下(×10),连同左侧供睾的动、静脉一起截取与其相连的腹主动脉段和左髂总静脉段,以丝线结扎左髂总静脉段的远断端,其余3断端分别套上cuff管后袖套状翻转并以丝线环扎之,然后分别将外套cuff管的动、静脉嵌入切开的受鼠的腹主动脉内和左髂总静脉内后再环扎,端端吻合受、供体输精管,摘除受鼠双侧睾丸。结果:30只大鼠正式手术,27只长期存活直至处死,2只死于麻痹性肠梗阻伴感染,1只因术中大出血死亡。27只长期存活的受体中,4、4、5例于术后14 d、28 d、56 d探查植睾,血供情况良好,关腹存活至处死;余14只用于其他实验。受体左下肢术后无明显水肿、淤血和坏死。结论:应用cuff管技术建立的大鼠睾丸移植模型具有操作简便、成功率高、效果可靠等优点,可作为睾丸移植的研究模型。

血流量大小对带cuff中心静脉导管血液透析患者透析充分性的影响

目的观察血流量大小对带cuff中心静脉导管血液透析患者透析充分性的影响。方法将15例带cuff中心静脉导管维持血液透析患者的血流量设为200ml/min,透析12次后再设为250ml/min,透析12次后进入洗脱期,设为200ml/min透析24次,再设为300ml/min透析12次。每次透析4h,每周3次。观察每种血流量时的单室模型Kt/V(spKt/V)、尿素清除率(URR),观察试验前、后血红蛋白、红细胞压积、心功能的变化。结果随着血流量的增加,spKt/V和URR值越高,透析越充分。血流量分别为200ml/min、250ml/min、300ml/min时的spKt/V值分别为(1.44±0.04)、(1.58±0.05)、(1.85±0.20)(1.44比1.58,1.44比1.85,均P<0.05),URR值分别为(69.01%±3.88%)、972.23%±4.26%)、(76.06%±4.82%)(69.01%比72.23%,69.01%比76.06%,均P<0.05)。试验后的血红蛋白和血红细胞压积较试验前增加(107.60g/L比92.20g/L,31.65fl比28.53fl,均P<0.05)。试验前后的射血分数EF%、每搏输出量(SV)、心室舒张末期容积(EDV)、心室收缩末期容积(ESV)的差异均没有统计学意义(均P>0.05)。结论带cuff中心静脉导管血液透析患者随着血流量的增加,透析越来越充分,不会对心功能产生明显不良影响,且可以改善贫血状况。

带CUFF中心静脉导管作为血液透析通路的临床分析

目的 总结留置带CUFF中心静脉导管的经验,探讨如何防治带CUFF中心静脉导管的并发症。方法 分析1996年3月～2001年3月我院对20例患者留置带CUFF中心静脉导管25例次。其中,右侧颈内静脉留置导管8例次、左侧颈内静脉留置导管2例次、右侧锁骨下静脉留置导管12例次、左侧锁骨下静脉留置导管3例次。结果 主要并发症:导管位置不当4例次;感染的发生率为32％(8/25),平均1.3例次/1000天,治疗有效率为25％(2/8);血栓的发生率为24％(6/25),导管内血栓治疗的有效率为75％(3/4)。总的带管时间为201个月,从2～27个月,平均带管时间为8个月。结论 带CUFF中心静脉导管对于长期血液透析治疗而无血管通路或不能承受动静脉内瘘的患者是必不可少的,其并发症是可以防治的。

带cuff的中心静脉导管接头破损原因分析及护理对策

目的探讨带cuff的中心静脉导管接头破损的原因及护理对策。方法收集52例带cuff的中心静脉导管发生接头破损的相关资料,分析原因并提出护理对策,以处理和预防破损的再发生。结果接头破损的主要原因包括接头外侧螺纹口不清洁、接头过度拧接、接头对合不齐等;针对原因提出防范措施。更换52例破损接头,未发现有渗血、漏气等现象,未出现再次更换接头和感染的情况。结论接头破损原因与季节、护士操作不当有很大的关系。规范护理人员操作、选择合适的用物,可预防接头破损的发生。在严格无菌操作的前提下,更换接头的处理是可行的。

带Cuff中心静脉导管在维持性血液透析患者中的应用价值

血管通路是透析患者的“生命线”,对血液透析患者至关重要。自体动静脉内瘘有血栓形成率低、感染率低等优点,是目前血管通路建立的首选方案 [1] 。随着人口老龄化和糖尿病、高血压的发病率升高,老年肾脏病、糖尿病性肾病、高血压性肾病患者逐年增加,其中越来越多的患者因自身血管条件差而无法行自体动静脉造瘘手术,或因心功能不全而无法耐受内瘘,需要尝试其他的血管通路。

经皮下隧道双腔带Cuff导管在血液透析中的应用分析

目的寻求延长双腔带Cuff中心静脉留置导管使用时间和减少并发症发生的方法。方法回顾性分析30例经右颈内静脉留置双腔带Cuff中心静脉留置导管的病人的临床资料，分析其术后并发症发生情况、血液透析时血流量、感染、血栓形成、中心静脉狭窄的发生情况。结果带cuff的中心静脉留置导管术后并发症以隧道出血多见，经过压迫均愈合良好；有11例患者至今仍在使用，血流量在200-340ml／min，透析充分性良好；而拔除或重新置管的原因主要为感染和血栓形成，分别达40％和28％。结论双腔带cuff导管可作为一种有效的血透通路，尤其是多次建立自体动静脉内瘘失败或人造血管功能障碍等各种原因无法建立永久性血管通路时，如果通过严格的管理，其并发症的发生能进一步降低，将会有更长的使用寿命。

数字减影血管造影下血液透析长期导管改良的临床应用

目的:探讨在数字减影血管造影技术(DSA)可视下血液透析长期导管留置建立方法及效果。方法:选取68例因自身动静脉条件差无法行动静脉内瘘术,或原动静脉内瘘不能维持血液透析而施行长期导管置管术的患者,所有患者均系终末期肾衰竭需长期维持血液透析治疗。按手术方式的不同,将68例患者分为传统手术组(10例)和改良手术组(58例),传统手术组采用传统的颈内静脉长期导管置管术,应用Seldinger技术结合撕脱鞘进行置管;改良手术组采用改进的颈内静脉长期置管术,应用导引钢丝引导进行导管置入。观察两种置管术的难易程度及术中及术后出血等情况。结果:传统手术组的患者中,4例因隧道皮下组织收缩不能一次性将导管涤纶套放置在皮下所需位置,7例术中发生出血(>10 ml),6例术后48 h内发生明显穿刺点或隧道出口渗血。改良手术组全部一次性将导管涤纶套放置在所需的位置,仅2例出现明显穿刺点或隧道出口出血。结论:在DSA下行带涤纶套长期导管置管具有定位准确、操作安全及调管方便等优点,两种置管术中改良手术组采用的改进颈内静脉长期置管术出血量小,安全效果更好。

透视下留置永久性透析导管建立血透通路的临床研究

目的探讨透视下留置永久性透析导管建立血透通路的可行性及优势。方法回顾16例经颈内静脉留置双腔带Cuff的中心静脉导管患者的临床资料,分析其置管过程及术后并发症及导管使用情况。结果透视下留置永久性透析导管成功率100%,置管后隧道渗血1例,置管术后隧道出血2例,经过压迫均能止血,隧道口感染2例,无气胸、血胸、空气栓塞、静脉撕裂等严重并发症病例。所有导管透析充分性良好。结论术前彩超评估血管情况及体表定位,再加上透视下操作,使得留置永久性透析导管更安全和更具有科学根据。

颈内静脉隧道式Cuff血液透析导管移位的相关因素分析

目的探索维持性血液透析患者(Maintenance hemodialysis patient,MHP)使用颈内静脉隧道式Cuff血液透析导管发生移位的相关因素,为临床Cuff血液透析导管置入定位和护理提供参考意见。方法对我院使用颈内静脉隧道式Cuff血液透析导管的186例次MHP进行回顾性分析,收集患者的一般资料(年龄、性别、原发疾病等),生化指标(血肌酐、尿素氮、血清白蛋白等),人体测量指标(肱三头肌皮褶厚度、上臂肌围、肌肉组织质量等),根据置入导管是否有移位分为A组(移位组)和B组(未移位组),比较两组患者上述临床资料差异,进行Logistic回归分析。结果A组56例(30.1%),B组130例(69.9%)。Cuff血液透析导管移位单因素分析显示:两组患者的年龄、C-反应蛋白、血清白蛋白、蛋白质分解率、肱三头肌皮褶厚度、上臂肌围、肌肉组织质量和肌肉组织指数比较,差异均有统计学意义(P<0.05)。Logistic回归分析,患者年龄、C-反应蛋白是发生Cuff血液透析导管发生移位的危险因素(OR=1.062,OR=1.206,P均<0.05)。上臂肌围、肌肉组织质量是发生Cuff血液透析导管发生移位的保护因素(OR=0.976,OR=0.791,P均<0.05)。结论建议高龄、微炎状态、上臂肌围小、肌肉组织质量小的患者在放置颈内静脉隧道式Cuff血液透析导管时Cuff距离皮肤出口的距离适当增加或适当延长导管拆线时间。血液透析期间加强患者护理营养干预有助于降低Cuff血液导管移位风险。

带Cuff导管对血液透析患者微炎症状态及颈动脉硬化的影响

目的探讨经皮下隧道置入带cuff导管对血液透析患者微炎症状态和颈动脉内中膜厚度(IMT)的影响。方法入选患者为我院透析中心维持性血液透析患者54例,选择应用带cuff导管且血液透析两年以上患者24例为导管组,选择应用内瘘且血液透析两年以上患者30例为对照组。测定两组患者超敏C反应蛋白(hsCRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、三酰甘油(TG)、胆固醇(CHO)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血肌酐(Cr)、尿素氮(Bun)、清蛋白(Alb)、血磷(P)、血钙(Ca)、甲状旁腺素(PTH)、体重指数、彩色超声检查颈动脉IMT。用多元逐步回归法分析IMT与各指标间的相关关系。结果导管组hsCRP、IL-6、TNF-α、IMT、Cr、Alb与对照组差异有统计学意义(P<0.05)。回归分析显示IL-6、TNF-α、hsCRP与颈动脉IMT明显相关,以IL-6的影响最大。结论带cuff导管的血液透析患者存在明显的炎症状态,并且与颈动脉硬化明显相关。