Therapeutic Effect of Single-row Technique and Nocompression Sputum in the Treatment of Post Small and Medium Rotator Cuff Injury under Shoulder Arthroscopy

Objective.To investigate the clinical effect of single-row fixation and non-conjunction compression in the treatment of post small and medium rotator cuff injuries under arthroscopy.Methods.Forty-five patients admitted to our department from June 2018 to May 2019 were enrolled in the study.32 patients in the single-row fixed-group and 13 patients in the non-conjunctival group were randomly assigned.The VAS,ASES,and UCLA scores of the two groups were compared before surgery,one month,three months,and six months after surgery[1].Results.The VAS,ASES,and UCLA scores were significantly higher in those two groups other than the preoperative group.The scores of the two groups were gradually improved from one month,three months,and six months respectively after surgery.At one month,the scores of those two groups were statistically significant(P<0.05),but there was no significant difference between the two groups at three months and six months(P>0.05).Conclusion.Under arthroscopy,the single-row fixation technique and the non-conjunction compression method were used to treat post small and medium rotator cuff injuries.The effect is very significant.In particular,the no-knot sputum method has a significant improvement in restoring postoperative pain,joint activity and joint strength.

Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair

AIM To compare the functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. METHODS Eighty-seven patients with rotator cuff tears following arthroscopic treatment were divided into traumatic and non-traumatic tear groups. Postoperative muscle strength and outcomes using the modified University of California, Los Angeles score were evaluated. Sex, age, affected limb and dominant limb were correlated between groups. Muscle strength of the repaired and unaffected shoulders was compared. Rotator cuff injury size was measured. RESULTS Of the 87 patients who underwent rotator cuff repairs, 35 had traumatic tears and 52 had non-traumatic tears. In patients with non-traumatic tears, the average age was 59 years, 74.5% were female, 96.1% were righthand dominant and 92.3% had their dominant shoulder affected. Patients with traumatic tears were 59.5 yearsold on average, 51.4% were female, 91.4% were righthand dominant and 88.5% had their dominant shoulder affected. No difference existed in the mean modified University of California, Los Angeles score between patients with traumatic tears(33.7) compared with those with non-traumatic tears(32.8). No strength differences were observed between groups: The strength difference between the non-affected and affected sides was 1.21 kg in the non-traumatic group and 1.39 kg in the traumatic group(P = 0.576), while the strength ratio between the non-affected/affected sides was 0.805 in the nontraumatic group and 0.729 in the traumatic group(P = 0.224). CONCLUSION The functional results of traumatic rotator cuff repairs are similar to non-traumatic tears. Both outcomes are satisfactory.

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.

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.

Knot impingement after arthroscopic rotator cuff repair mimicking infection:A case report

BACKGROUND Knot impingement as a complication after arthroscopic rotator cuff repair(ARCR)has been suggested as a cause of persistent pain with limited motion.We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion,which was confused with infection.CASE SUMMARY A 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room.Passive range of motion could not be evaluated due to the patient’s severe pain.The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder.An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder,and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging.Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils.The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed.Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials.The patient’s symptoms subsided immediately after the surgical procedure.CONCLUSION Although the incidence of knot impingement is rare,the possibility of knot impingement after ARCR should be a consideration.

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.

Clinical Decision Making in Open vs Arthroscopic Rotator Cuff Repair: Evidence for Preoperative Decision Making

Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help of the PubMed database. Of the articles searched through, three have been chosen to specifically address topics of interest concerning the factors affecting arthroscopic vs mini-open RCR surgical approaches. Discussion: As we continue to progress down the line of factors impacting a clinician’s decision making, we begin to see how postoperative management is unchanged. Tear severity lacks sufficient evidence to base a decision on, but financial, educational, and logistical factors are proven to play a significant role in this decision. Conclusion: As of right now it seems that mini-open RCR is the most cost and time efficient method, especially amongst non-fellowship trained surgeons or ones with lower volume of shoulder scopes. However, further studies should be done to examine cost and efficiency in Sport Medicine fellowship trained orthopedic surgeons to validate these findings.

肩关节镜下双排缝合桥技术治疗老年肩袖损伤46例

目的 探讨肩关节镜下双排缝合桥修复手术对老年肩袖损伤病人疼痛、手臂与肩部功能障碍(DASH)评分及再撕裂发生率的影响。方法 回顾性分析2018年8月至2020年2月阜阳市第二人民医院收治的89例老年肩袖损伤病人的临床资料,依照手术方法的不同划分成对照组(肩关节镜下单排铆钉固定)、治疗组(肩关节镜下双排缝合桥修复手术),分别为43例、46例。于术前、术后1年采用视觉模拟评分法(VAS)评定患肩疼痛度,采用手臂与肩部功能障碍(DASH)评分量表评定肩关节功能,测量患肩关节前屈、外展活动度,并统计两组1年内再撕裂发生率。通过logistic回归分析确定病人术后再撕裂发生的影响因素。结果 术后1年两组不同撕裂程度病人VAS、DASH评分及患肩关节前屈、外展活动度与同组术前相比均明显改善(均P<0.05),术后两组轻度撕裂病人上述指标改善情况比较差异无统计学意义(均P>0.05),而治疗组中、重度撕裂病人上述指标改善情况均明显较对照组优(均P<0.05);治疗组再撕裂发生率4.35%明显较对照组的23.26%低(P<0.05);年龄、手术方式是病人术后再撕裂发生的影响因素(均P<0.05)。结论 对老年肩袖损伤病人实施肩关节镜下双排缝合桥修复手术,可有效改善患肩疼痛及功能,显著降低再撕裂发生率。

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.

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.

关节镜下“Chinese way”治疗老年肩关节脱位合并巨大肩袖撕裂的临床疗效

目的 评估“Chinese way”技术行上关节囊重建在关节镜下治疗老年肩关节脱位合并巨大肩袖撕裂的临床效果。方法 回顾性分析2019年5月至2022年1月在苏州大学附属第二医院收治的老年肩关节脱位后合并巨大肩袖撕裂的患者资料,纳入36例,男16例,女20例,年龄52~73岁,平均(62.3±4.7)岁,术中行肱二头肌长头腱转位,加强肩袖缝合。统计分析术前、术后的疼痛、肩关节活动度及肩关节功能评分,通过MR评估肩袖再撕裂率。结果 所有患者均获得随访,随访时间为17.6±4.5个月。末次随访时肩关节前屈、外展、体侧外旋、体侧内旋活动度较术前均有显著增加(P<0.05);末次随访VAS评分、ASES评分、Constant-Murley评分、UCLA评分较术前均有明显改善(P<0.05);无肩关节再次脱位发生,MR依据Sugaya标准提示5例(13.9%)肩袖再撕裂,UCLA评分优9例,良23例,差4例,优良率为88.9%。结论 关节镜下处理老年肩关节脱位合并巨大肩袖损伤时,采用“Chinese way”技术重建上关节囊,加强缝合肩袖组织,可有效避免肩袖再撕裂,解除肩关节疼痛,恢复肩关节功能并防止再次脱位。

关节镜下肩袖缝线桥缝合术后疼痛的原因分析

目的探讨关节镜下肩袖缝线桥缝合术后患者疼痛的相关因素。方法收集112例接受关节镜下缝线桥缝合的单侧肩袖损伤患者资料,以电话随访的形式,通过数字评分法(NRS)调查患者术后3个月时疼痛情况;SPSS 23.0统计学软件录入数据并分析,采用单因素分析及多重线性回归分析,评价上述影响因素与术后疼痛的相关性。结果单因素分析结果显示,病程、吸烟史、患者术前美国加利福尼亚大学洛杉矶分校(UCLA)评分、Constant评分、NRS、肩袖撕裂大小、是否为全层撕裂和肌腱回缩程度8个因素可能与术后疼痛有关(P<0.05)。而患者的年龄、性别、身体质量指数(BMI)、饮酒史、是否合并糖尿病及高血压则与术后疼痛无关(P>0.05)。多重线性回归分析表明,与术后疼痛相关的因素有4个,其相关程度依次是术前NRS、术前UCLA评分、撕裂大小和吸烟史。结论影响关节镜下肩袖缝线桥缝合术术后疼痛的复杂且多样,进行术后疼痛的原因分析,可有效减轻患者术后的疼痛,有助于促进肩着节功能恢复。

糖尿病对关节镜下肩袖修复术后病人肩关节功能恢复影响的临床研究

目的探讨糖尿病对关节镜下肩袖修复术后病人肩关节功能恢复的影响。方法回顾性分析我科自2019年5月至2022年5月接受关节镜下肩袖修复术的62例肩袖损伤病人的临床资料和随访结果,其中糖尿病组30例,男18例,女12例,年龄为(62.10±11.87)岁;对照组32例,男18例,女14例,年龄为(63.78±12.98)岁。手术方式均为关节镜下缝线桥技术缝合肩袖。分别记录两组病人术前1周、术后3个月、6个月和12个月各时间点肩关节最大外展角度值,以及肩关节功能评分,包括疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国肩肘外科协会(American Shoulder Elbow Surgeon,ASES)评分、加州大学洛杉矶分校(University of California at Los Angeles,UCLA)肩关节评分以及Constant⁃Murley评分。据此对手术效果进行评估。结果62例病人均未出现伤口感染、术后僵硬、术后再撕裂等并发症。两组病人的肩关节最大外展角度值、VAS评分、ASES评分、UCLA评分以及Constant⁃Murley评分均在术后3个月、6个月和1年得到显著改善(P<0.05)。糖尿病组的肩关节最大外展角度值及各肩关节功能评分在术前1周、术后3个月及6个月时均劣于对照组(P<0.05),但在术后12个月时,糖尿病组与对照组比较,差异无统计学意义(P>0.05)。结论糖尿病对关节镜下肩袖修复术后的病人短期恢复会存在影响,但长期临床结果没有显著差异。围手术期血糖控制良好的糖尿病病人在关节镜下肩袖修复术后表现出与非糖尿病病人相当的临床和结构恢复。

关节镜联合小切口修复术治疗肩袖全层损伤的效果

目的观察关节镜联合小切口修复术治疗肩袖全层损伤的近期效果,并探讨关节镜联合小切口修复术的临床意义。方法选取2020年1月至2022年4月接受关节镜联合小切口修复术治疗的22例肩袖全层损伤患者为研究对象。比较术前、术后6个月随访时的疼痛视觉模拟评分法(VAS)评分、肩关节主动前屈角度、外旋角度及Constant-Murley、美国加州大学肩关节评分(UCLA)评分。结果术后6个月随访时,肩袖全层损伤患者的VAS评分低于术前,肩关节主动前屈角度、外旋角度大于术前(P<0.05)。术后6个月随访时,肩袖全层损伤患者的Constant-Murley、UCLA评分高于术前(P<0.05)。结论关节镜联合小切口修复术治疗肩袖全层损伤的效果显著,可明显降低肩关节疼痛,提高肩关节功能,有助于术后康复。

全肩关节镜和关节镜辅助小切口手术治疗肩袖损伤的对比研究

目的探讨应用全肩关节镜手术与关节镜辅助下小切口手术治疗肩袖损伤的疗效差异及对术后关节功能的影响。方法选取2020年1月~2022年12月收治的肩袖损伤并接受手术治疗的患者93例,随机分A组和B组,A组47例、B组46例。A组接受关节镜辅助下小切口手术,B组接受全肩关节镜手术。比较两组手术失血量、手术用时、住院用时、视觉模拟疼痛评分(VAS)、美国加州大学肩关节功能评分(UCLA)及整体疗效差异。结果术前两组VAS评分、UCLA评分比较,差异无统计学意义(P>0.05),术后1月、3月、6月B组各时间点VAS评分均低于A组(P<0.05),B组UCLA评分均高于A组(P<0.05);B组手术失血量、住院时间少于A组,手术用时高于A组(P<0.05);两组治疗总优良率比较,差异无统计学意义(P>0.05)。结论两种手术整体疗效相近;关节镜下小切口手术创伤性低,手术用时短;全肩关节镜手术失血量少、住院用时短,且术后疼痛与关节功能恢复效率更高。

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。

针对性康复护理对肩袖损伤行关节镜手术患者术后肩关节功能恢复及护理满意度的影响

目的 分析针对性康复护理对肩袖损伤行关节镜手术患者术后肩关节功能恢复及护理满意度的影响。方法 选取2020年6月至2023年6月于厦门大学附属中山医院接受关节镜手术治疗的肩袖损伤患者100例,根据随机数字表法分为两组,对照组(50例)采取常规护理方法,观察组(50例)在此基础上施以针对性康复护理干预,对比两组的肩关节功能(欧美肩关节评分系统C-M)、生活质量(SF-36)、并发症发生率及护理满意度。结果 术后5个月时,观察组的C-M评分、SF-36评分均较对照组高(P <0.05);观察组并发症发生率较对照组更低(4.00%vs. 16.00%,P <0.05);观察组护理满意度较对照组更高(98.00%vs. 82.00%,P <0.05)。结论 将针对性康复护理用于肩袖损伤行关节镜手术患者,能使其肩关节功能得到更好恢复,减少并发症发生,提高生活质量与护理满意度。

肩袖损伤术后康复护理的最佳证据总结

目的总结肩袖损伤术后康复护理的最佳证据,为临床实施相关干预提供参考。方法检索肩袖损伤术后康复护理相关文献,采用JBI循证卫生保健中心的文献评价标准和证据分级系统进行质量评价和证据级别评定。检索时限为2013年1月至2023年12月。结果最终纳入10篇文献,包括4篇指南、3篇专家共识、3篇系统评价。提取归纳肩袖损伤术后康复护理相关证据共34条,汇总9个主题,分别为康复目的、制定康复计划、康复原则、支具固定、运动时间及内容、运动频率,运动监督、疼痛控制、健康教育。结论总结的最佳证据可为临床医护人员实施肩袖损伤术后康复护理提供指引,在证据转化和应用过程中应结合临床情境,充分评估每条证据的适宜性和可行性。

体外冲击波结合关节松动术治疗肩袖部分损伤合并肩关节僵硬的短期疗效观察

目的探讨体外冲击波结合关节松动术治疗肩袖部分损伤的治疗效果。方法选取2020年1月至2021年1月在海军军医大学(第二军医大学)第一附属医院就诊的75例肩袖部分损伤合并肩关节僵硬患者作为研究对象,随机分为3组:冲击波组、关节松动术组和冲击波结合关节松动术组,每组25例。对冲击波组患者予体外冲击波及常规理疗(干扰电、短波等)和运动指导,对关节松动术组患者予关节松动术治疗及常规理疗和运动指导,对冲击波结合关节松动术组患者予冲击波结合关节松动术治疗及常规理疗和运动指导。治疗3周后比较3组患者的临床治疗效果。结果治疗3周后,3组患者视觉模拟量表(VAS)评分均降低,加利福尼亚大学洛杉矶分校(UCLA)肩关节评分均增加,各组与治疗前相比差异均有统计学意义(均P<0.01);冲击波结合关节松动术组患者VAS评分[(1.80±1.08)分]低于冲击波组[(3.08±1.44)分]和关节松动术组[(2.96±1.57)分],UCLA肩关节评分[(27.44±1.96)分]高于冲击波组[(24.76±2.24)分]和关节松动术组[(22.92±3.93)分],差异均有统计学意义(均P<0.05)。冲击波结合关节松动术组的总有效率[92.00%(23/25)]高于冲击波组[72.00%(18/25)]和关节松动术组[76.00%(19/25)],差异均有统计学意义(均P<0.05)。结论体外冲击波结合关节松动术治疗肩袖部分损伤相比单纯冲击波或关节松动术有更好的短期疗效。

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。