BACKGROUND Based on the location and size of the fracture block,open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures.However,the treatment of ...BACKGROUND Based on the location and size of the fracture block,open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures.However,the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far.CASE SUMMARY A 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident.X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture.Three-dimensional(3D)computed tomography(CT)further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm×16.2 mm.The patient was diagnosed as the fracture of the lower part of the glenoid,also known as bony Bankart lesion without shoulder dislocation.After general anesthesia,the patient was surgically treated with the open reduction internal fixation through a novel axillary approach.3D CT and shoulder joint function were reexamined at 12 mo of followup,showing acceptable recovery.CONCLUSION This case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation.After a follow-up for more than 12 mo,3D CT and shoulder joint function examinations display a good recovery.展开更多
BACKGROUND The brisement manipulation is an effective treatment for refractory shoulder stiffness.Rotator cuff tears can sometimes exist in combination with adhesive capsulitis.Arthroscopic capsular release combined w...BACKGROUND The brisement manipulation is an effective treatment for refractory shoulder stiffness.Rotator cuff tears can sometimes exist in combination with adhesive capsulitis.Arthroscopic capsular release combined with rotator cuff repair has achieved good outcomes in published reports.CASE SUMMARY We report the case of a patient with right shoulder pain for more than 1 year that was suspected to have adhesive capsulitis and a rotator cuff tear that was treated with brisement manipulation and arthroscopic management.An iatrogenic glenoid fracture with shoulder instability occurred during the manipulation.Arthroscopic treatment for fracture fixation,capsular release,and rotator cuff repair was performed,and the functional results are reported.CONCLUSION Arthroscopic fixation for iatrogenic glenoid fracture and repairing coexisting rotator cuff tear can provide the stability needed for early rehabilitation.展开更多
BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed t...BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.展开更多
Reverse shoulder arthroplasty (RSA) is an effective treatment for rotator cuff tears. Despite its advantages, complications occur at a high rate. Complications requiring revision include a high rate of base plate fail...Reverse shoulder arthroplasty (RSA) is an effective treatment for rotator cuff tears. Despite its advantages, complications occur at a high rate. Complications requiring revision include a high rate of base plate failure, 38% of which are due to instability. The primary stability the base plate ensures is a crucial factor and, thus, is the subject of much debate in clinical studies and biomechanical research. This study is aimed to provide data that will contribute to the base plate’s pri-mary stability and glenoid longevity by clarifying the stresses at the scapular fossa and base plate interface associated with elevation after RSA. A 3D finite element model was created from the DICOM data for the scapulohumeral joint and SMR shoulder system. For loading conditions, 30 N was applied for each posi-tion with abduction angles of 0, 45, 90, and 135 degrees. A three-dimensional fi-nite element analysis was performed using the static implicit method with LS-DYNA. The von Mises stresses in the scapular fossa were found not to exceed the yield stress on the bone even after elevation to an abduction angle of 135 de-grees after RSA. It is rough to uniformly compare the yield stress and the von Mises stress, but it was inferred that the possibility of fracture is low unless a large external force is applied. A maximum von Mises stress showed 0 degrees of abduction, suggesting that the lowered position is in a more severe condition than the elevated position. If better improvement is desired, it may be necessary to devise ways to reduce the stress on the upper screw. .展开更多
Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial...Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial.The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.Methods:The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017.The glenoid bone defect was measured by three surgeons on‘self-confirmed’and‘designated’3-D en-face views,and repeated after an interval of 3 months.Measurements included the ratio of the defect area to the best-fit circle area,and the ratio of the defect width to the diameter of the best-fit circle.The inter-and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients(ICCs).The maximum absolute inter-and intra-observer differences and the cumulative percentages of cases with inter-and intraobserver differences greater than these respective levels were calculated.Results:Almost all linear defect values were bigger than the areal defect values.The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the‘self-confirmed’group and 0.549 and 0.431 in the‘designated’group.The inter-observer reliabilities for the linear defect were moderate or fair in the‘self-confirmed’group(ICC=0.446,0.374)and‘designated’group(ICC=0.402,0.327).The ICCs for intra-observer measurements were higher than those for inter-observer measurements.The respective maximum interand intra-observer absolute differences were 13.9%and 13.2%in the‘self-confirmed’group,and 15.8%and 9.8%in the‘designated’group.Conclusions:The areal measurement of the glenoid bone defect is more reliable than the linear measurement.The reliability of the glenoid defect areal measurement is moderate or worse,suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination.Subjective factors affecting the glenoid bone loss measurement should be minimized.展开更多
目的:探讨腋后路治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效。方法:回顾性分析2018年12月至2021年9月采用腋后路治疗的9例肩胛盂下部分骨折患者的资料,男3例,女6例;年龄50~78岁。所有患者骨折为闭合性骨折,依据肩胛盂骨折Ideberg分型:Ⅰa型6...目的:探讨腋后路治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效。方法:回顾性分析2018年12月至2021年9月采用腋后路治疗的9例肩胛盂下部分骨折患者的资料,男3例,女6例;年龄50~78岁。所有患者骨折为闭合性骨折,依据肩胛盂骨折Ideberg分型:Ⅰa型6例,Ⅱ型3例。分别于术后第6、12周及6、12个月摄肩关节正、侧位X线片,记录所有患者末次随访时的Constant-Murley肩关节评分,上肢功能障碍(disability of the arm,shoulder and hand,DASH)评分,骨折愈合情况以及其他并发症情况。结果:术后9例患者获得随访,时间6~15个月。末次随访时9例均获得骨性愈合,愈合时间3~6个月,末次随访时患者的Constant-Murley评分为55~96分;DASH评分为3.33~33.33分。结论:腋后路内固定治疗IdebergⅠa、Ⅱ型肩胛盂骨折有效解决了前方入路显露肩胛盂下部分骨折困难的问题,可避免肩胛下肌以及关节囊医源性损伤,临床效果满意,值得临床推广使用。展开更多
文摘BACKGROUND Based on the location and size of the fracture block,open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures.However,the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far.CASE SUMMARY A 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident.X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture.Three-dimensional(3D)computed tomography(CT)further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm×16.2 mm.The patient was diagnosed as the fracture of the lower part of the glenoid,also known as bony Bankart lesion without shoulder dislocation.After general anesthesia,the patient was surgically treated with the open reduction internal fixation through a novel axillary approach.3D CT and shoulder joint function were reexamined at 12 mo of followup,showing acceptable recovery.CONCLUSION This case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation.After a follow-up for more than 12 mo,3D CT and shoulder joint function examinations display a good recovery.
文摘BACKGROUND The brisement manipulation is an effective treatment for refractory shoulder stiffness.Rotator cuff tears can sometimes exist in combination with adhesive capsulitis.Arthroscopic capsular release combined with rotator cuff repair has achieved good outcomes in published reports.CASE SUMMARY We report the case of a patient with right shoulder pain for more than 1 year that was suspected to have adhesive capsulitis and a rotator cuff tear that was treated with brisement manipulation and arthroscopic management.An iatrogenic glenoid fracture with shoulder instability occurred during the manipulation.Arthroscopic treatment for fracture fixation,capsular release,and rotator cuff repair was performed,and the functional results are reported.CONCLUSION Arthroscopic fixation for iatrogenic glenoid fracture and repairing coexisting rotator cuff tear can provide the stability needed for early rehabilitation.
文摘BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.
文摘Reverse shoulder arthroplasty (RSA) is an effective treatment for rotator cuff tears. Despite its advantages, complications occur at a high rate. Complications requiring revision include a high rate of base plate failure, 38% of which are due to instability. The primary stability the base plate ensures is a crucial factor and, thus, is the subject of much debate in clinical studies and biomechanical research. This study is aimed to provide data that will contribute to the base plate’s pri-mary stability and glenoid longevity by clarifying the stresses at the scapular fossa and base plate interface associated with elevation after RSA. A 3D finite element model was created from the DICOM data for the scapulohumeral joint and SMR shoulder system. For loading conditions, 30 N was applied for each posi-tion with abduction angles of 0, 45, 90, and 135 degrees. A three-dimensional fi-nite element analysis was performed using the static implicit method with LS-DYNA. The von Mises stresses in the scapular fossa were found not to exceed the yield stress on the bone even after elevation to an abduction angle of 135 de-grees after RSA. It is rough to uniformly compare the yield stress and the von Mises stress, but it was inferred that the possibility of fracture is low unless a large external force is applied. A maximum von Mises stress showed 0 degrees of abduction, suggesting that the lowered position is in a more severe condition than the elevated position. If better improvement is desired, it may be necessary to devise ways to reduce the stress on the upper screw. .
文摘Background:The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability.However,the reliability of glenoid bone defect measurement is controversial.The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements.Methods:The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017.The glenoid bone defect was measured by three surgeons on‘self-confirmed’and‘designated’3-D en-face views,and repeated after an interval of 3 months.Measurements included the ratio of the defect area to the best-fit circle area,and the ratio of the defect width to the diameter of the best-fit circle.The inter-and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients(ICCs).The maximum absolute inter-and intra-observer differences and the cumulative percentages of cases with inter-and intraobserver differences greater than these respective levels were calculated.Results:Almost all linear defect values were bigger than the areal defect values.The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the‘self-confirmed’group and 0.549 and 0.431 in the‘designated’group.The inter-observer reliabilities for the linear defect were moderate or fair in the‘self-confirmed’group(ICC=0.446,0.374)and‘designated’group(ICC=0.402,0.327).The ICCs for intra-observer measurements were higher than those for inter-observer measurements.The respective maximum interand intra-observer absolute differences were 13.9%and 13.2%in the‘self-confirmed’group,and 15.8%and 9.8%in the‘designated’group.Conclusions:The areal measurement of the glenoid bone defect is more reliable than the linear measurement.The reliability of the glenoid defect areal measurement is moderate or worse,suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination.Subjective factors affecting the glenoid bone loss measurement should be minimized.
文摘目的:探讨腋后路治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效。方法:回顾性分析2018年12月至2021年9月采用腋后路治疗的9例肩胛盂下部分骨折患者的资料,男3例,女6例;年龄50~78岁。所有患者骨折为闭合性骨折,依据肩胛盂骨折Ideberg分型:Ⅰa型6例,Ⅱ型3例。分别于术后第6、12周及6、12个月摄肩关节正、侧位X线片,记录所有患者末次随访时的Constant-Murley肩关节评分,上肢功能障碍(disability of the arm,shoulder and hand,DASH)评分,骨折愈合情况以及其他并发症情况。结果:术后9例患者获得随访,时间6~15个月。末次随访时9例均获得骨性愈合,愈合时间3~6个月,末次随访时患者的Constant-Murley评分为55~96分;DASH评分为3.33~33.33分。结论:腋后路内固定治疗IdebergⅠa、Ⅱ型肩胛盂骨折有效解决了前方入路显露肩胛盂下部分骨折困难的问题,可避免肩胛下肌以及关节囊医源性损伤,临床效果满意,值得临床推广使用。
