To compare the diagnostic value of four signs for superior labrum anterior and posterior (SLAP) lesions of the shoulder.Methods The physical examination was performed randomly on 81 cases with abnormalities of the sho...To compare the diagnostic value of four signs for superior labrum anterior and posterior (SLAP) lesions of the shoulder.Methods The physical examination was performed randomly on 81 cases with abnormalities of the shoulder.There were four tests,including Kibler anterior sliding test,Liu crank test,O’Brien active compression test and Kim biceps load test Ⅱ.The arthroscopic examination were also performed.The result of the arthroscopic examination was considered as a golden standard,so that we could estimate the diagnosis value of the four tests according to the method of evaluation of diagnosis test on clinical epidemiology,their sensitivity,specificity,positive and negative predictive value,accuracy.Results There were 21 cases diagnosed as SLAP lesions by arthroscopy.The diagnosis value of Kim biceps load test Ⅱ was the highest among the four tests,in which 19 of true positive,59 of true negative,1 of false positive,only 2 of false negative cases;while the sensitivity was 90.48%,specificity was 98.33%,positive predictive value was 95.00%,negative predictive value was 96.72%,and accuracy was 96.30%.However the sensitivity,specificity,positive predicitive value,negative predictive vale and accuracy of Kibler anterior sliding test were 76.19%,96.67%,88.89%,92.06%,91.33%;and those of Liu crank test were 85.71%,93.33%,81.82%,94.92%,91.35%;those of O’Brien active compression test were 80.95%,91.66%,77.27%,93.22%,88.89%.Conclusion Kim Biceps load test Ⅱ may be the best for clinical diagnosis of SLAP lesions of the shoulder.9 refs,4 figs,2 tabs.展开更多
After the improvement in arthroscopic shoulder surgery,superior labrum anterior to posterior(SLAP)tears are increasingly recognized and treated in persons with excessive overhead activities like throwers.Several poten...After the improvement in arthroscopic shoulder surgery,superior labrum anterior to posterior(SLAP)tears are increasingly recognized and treated in persons with excessive overhead activities like throwers.Several potential mechanisms for the pathophysiology of superior labral tears have been proposed.The diagnosis of this condition can be possible by history,physical examination and magnetic resonance imaging combination.The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention.The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis,but young and active patients like throwers will need an arthroscopic repair.The results of arthroscopic repair in older patients are not encouraging.The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management.展开更多
Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first c...Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type Ⅱ needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported.展开更多
目的观察关节镜下对V型从前到后上盂唇损伤(superior labral anterior to posterior,SLAP)的复发性肩关节前脱位修复的临床疗效。方法收集我单位2008年3月-2010年12月V型SLAP损伤患者16例,选取同期单纯Bankart损伤病例16例作为对照组。...目的观察关节镜下对V型从前到后上盂唇损伤(superior labral anterior to posterior,SLAP)的复发性肩关节前脱位修复的临床疗效。方法收集我单位2008年3月-2010年12月V型SLAP损伤患者16例,选取同期单纯Bankart损伤病例16例作为对照组。在关节镜下采用可吸收带线锚钉修复盂唇。采用视觉模拟评分(visual analogue scale,VAS)评价疼痛,美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分系统和Rowe肩关节评分系统评价关节功能。结果两组患者术后VAS评分、ASES评分和Rowe评分均优于术前(P<0.05),没有脱位复发。两组患者术后结果的差异无统计学意义(P>0.05)。结论对V型SLAP损伤的复发性肩关节前脱位,采用可吸收带线锚钉进行修复可获得良好的临床效果。展开更多
The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provid...The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.展开更多
[目的]比较肱二头肌长头腱切断固定术和上盂唇锚钉缝合修复术治疗II型SLAP损伤的临床疗效。[方法]回顾性分析本院2018年1月—2021年6月收治的31例II型SLAP损伤患者的临床资料,根据医患沟通结果,16例采用肱二头肌长头腱切断固定术治疗(...[目的]比较肱二头肌长头腱切断固定术和上盂唇锚钉缝合修复术治疗II型SLAP损伤的临床疗效。[方法]回顾性分析本院2018年1月—2021年6月收治的31例II型SLAP损伤患者的临床资料,根据医患沟通结果,16例采用肱二头肌长头腱切断固定术治疗(腱固定组),15例采用带线锚钉缝合修复术(修复组),比较两组围手术期及随访结果。[结果]两组均顺利完成手术,两组手术时间、切口长度、术中失血量、主动活动时间、切口愈合和住院时间比较的差异均无统计学意义(P>0.05)。两组均获得至少1年的随访。两组完全负重活动时间的差异无统计学意义(P>0.05)。术后随时间推移,两组VAS、ASES、QuickDASH和Constant-Murley评分均显著改善(P<0.05)。术后3个月,腱固定组的VAS评分[(2.5±0.5) vs (3.7±1.0), P<0.001]显著优于修复组。末次随访,腱固定组的ASES [(93.7±1.8) vs (90.3±3.3), P=0.002]、QuickDASH [(8.9±1.9) vs (11.0±1.6), P=0.002]和Constant-Murley评分[(93.8±1.5) vs (91.1±3.1), P=0.006]均显著优于修复组,但两组VAS评分的差异已无统计学意义(P>0.05)。[结论]肱二头肌长头腱切断固定术和上盂唇的带线锚钉缝合修复术在治疗II型SLAP损伤上均有良好的效果,相比之下,肱二头肌长头腱切断固定术在患者术后半年的体验及疗效,较修复术更优。展开更多
文摘To compare the diagnostic value of four signs for superior labrum anterior and posterior (SLAP) lesions of the shoulder.Methods The physical examination was performed randomly on 81 cases with abnormalities of the shoulder.There were four tests,including Kibler anterior sliding test,Liu crank test,O’Brien active compression test and Kim biceps load test Ⅱ.The arthroscopic examination were also performed.The result of the arthroscopic examination was considered as a golden standard,so that we could estimate the diagnosis value of the four tests according to the method of evaluation of diagnosis test on clinical epidemiology,their sensitivity,specificity,positive and negative predictive value,accuracy.Results There were 21 cases diagnosed as SLAP lesions by arthroscopy.The diagnosis value of Kim biceps load test Ⅱ was the highest among the four tests,in which 19 of true positive,59 of true negative,1 of false positive,only 2 of false negative cases;while the sensitivity was 90.48%,specificity was 98.33%,positive predictive value was 95.00%,negative predictive value was 96.72%,and accuracy was 96.30%.However the sensitivity,specificity,positive predicitive value,negative predictive vale and accuracy of Kibler anterior sliding test were 76.19%,96.67%,88.89%,92.06%,91.33%;and those of Liu crank test were 85.71%,93.33%,81.82%,94.92%,91.35%;those of O’Brien active compression test were 80.95%,91.66%,77.27%,93.22%,88.89%.Conclusion Kim Biceps load test Ⅱ may be the best for clinical diagnosis of SLAP lesions of the shoulder.9 refs,4 figs,2 tabs.
文摘After the improvement in arthroscopic shoulder surgery,superior labrum anterior to posterior(SLAP)tears are increasingly recognized and treated in persons with excessive overhead activities like throwers.Several potential mechanisms for the pathophysiology of superior labral tears have been proposed.The diagnosis of this condition can be possible by history,physical examination and magnetic resonance imaging combination.The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention.The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis,but young and active patients like throwers will need an arthroscopic repair.The results of arthroscopic repair in older patients are not encouraging.The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management.
文摘Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type Ⅱ needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported.
文摘The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.
文摘[目的]比较肱二头肌长头腱切断固定术和上盂唇锚钉缝合修复术治疗II型SLAP损伤的临床疗效。[方法]回顾性分析本院2018年1月—2021年6月收治的31例II型SLAP损伤患者的临床资料,根据医患沟通结果,16例采用肱二头肌长头腱切断固定术治疗(腱固定组),15例采用带线锚钉缝合修复术(修复组),比较两组围手术期及随访结果。[结果]两组均顺利完成手术,两组手术时间、切口长度、术中失血量、主动活动时间、切口愈合和住院时间比较的差异均无统计学意义(P>0.05)。两组均获得至少1年的随访。两组完全负重活动时间的差异无统计学意义(P>0.05)。术后随时间推移,两组VAS、ASES、QuickDASH和Constant-Murley评分均显著改善(P<0.05)。术后3个月,腱固定组的VAS评分[(2.5±0.5) vs (3.7±1.0), P<0.001]显著优于修复组。末次随访,腱固定组的ASES [(93.7±1.8) vs (90.3±3.3), P=0.002]、QuickDASH [(8.9±1.9) vs (11.0±1.6), P=0.002]和Constant-Murley评分[(93.8±1.5) vs (91.1±3.1), P=0.006]均显著优于修复组,但两组VAS评分的差异已无统计学意义(P>0.05)。[结论]肱二头肌长头腱切断固定术和上盂唇的带线锚钉缝合修复术在治疗II型SLAP损伤上均有良好的效果,相比之下,肱二头肌长头腱切断固定术在患者术后半年的体验及疗效,较修复术更优。
文摘目的总结肩关节不稳与上盂唇自前向后(superior labrum anterior posterior,SLAP)损伤的联系。方法通过查阅国内外相关研究文献,分析肩关节不稳与SLAP损伤的特点,归纳并探讨两者在发病机制、临床症状及生物力学上的关联。结果肩关节不稳和SLAP损伤既可同时存在,也可单独发生。SLAP损伤由于破坏了上盂唇的完整性和肱二头肌长头腱(long head of biceps tendon,LHBT)止点,可引起肱骨头相对关节盂过度移位,导致肩关节不稳。而慢性反复性或急性高能量创伤导致的肩关节不稳也会加重SLAP损伤,造成原有损伤范围扩大及撕裂程度加重。结论 SLAP损伤会破坏肩关节稳定机制,肩关节不稳会引起上盂唇和LHBT撕裂,两者间存在一定联系。然而,现有研究结果仅能证明肩关节不稳和SLAP损伤之间具有互相诱发和促进发展的关系,而非互为充分必要条件,因此两者间具体因果关系还需进一步深入研究。
