ObjectiveTo review the research progress of treatment for massive rotator cuff tears. MethodsThe domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized.ResultsThe treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. ConclusionSurgical treatment is the main choice for massive rotator cuff tears. Patients’ age and muscle condition should be taken into consideration to decide the surgical technique.
Objective To analyse the cl inical outcomes of the Z-osteotomy of the distal fibula to correct widened mortice of the ankle after fracture. Methods Between September 2009 and February 2011, 5 patients (5 feet) with widened ankle mortice after fracture underwent Z-osteotomy. There were 4 males and 1 female, aged from 23 to 58 years (mean, 38 years). At 3 months after operation of internal fixation when function exercises were done, patients got pains. The interval between trauma and operation ranged from 5 to 36 months (mean, 13.2 months). Lateral pressure test showed positive in2 cases and negative in 3 cases. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 50.2 ±17.3. Results Primary healing of incision was achieved in all cases. Five patients were followed up 9 to 24 months (mean, 15.6 months). Mild to moderate swelling of the affected limb and anterolateral skin numbness of the i psilateral dorsal foot occurred, and gradually improved. The cl inical exam and radiology showed bone union at 12-15 weeks (mean, 13.5 weeks). Postoperative range of motion of ankle had no significant improvement. AOFAS ankle-hindfoot scores were 76.8 ± 11.2 at 6 months after operation, and 85.4 ± 3.2 at last follow-up, showing significant differences when compared with preoperative score (P lt; 0.05). Conclusion Shortened fibula is the main cause of widened ankle mortice after fracture; Z-osteotomy can effectively reduce the width of the ankle mortice, increase the stabil ity of ankle joint, and decrease the complication rate.
ObjectiveTo review the research progress of indication and treatment of graft in shoulder superior capsular reconstruction (SCR) for rotator cuff tear (RCT).MethodsThe literature related to shoulder SCR in recent years was extensively reviewed, and the anatomy, biomechanics, surgical indications, and treatment of graft in SCR were summarized.ResultsSuperior capsule plays a role as a functional complex with rotator cuff, ligament, and whole capsule. SCR can effectively restore the superior stability of the shoulder. The indications of SCR include the irreparable massive RCT, massive RCT combined with pseudoparalysis shoulder, medium/large RCT with severe degenerative rotator cuff tissue, and dual-layer RCT. In order to achieve a better healing of tendon-bone in graft and decrease the rate of long-term graft retearing, it is essential to select an appropriate thickness graft, fix the graft in right intensity, and get a better capsular continuity.ConclusionThe technique of SCR advanced to SCR for reinforcement and it is indicated from substantial massive RCT to severe degeneration of rotator cuff tissue. Graft treatment is the key step for a successful SCR.
Objective To introduce a new theory of shoulder stability mechanism, rebalancing theory, and clinical application of this new theory for the shoulder instability and dysfunction of motion. Methods Through extensive review of the literature related to shoulder instability and dysfunction of the motion in recent years, combined with our clinical practice experience, the internal relation between passive stability mechanism and dynamic stability mechanism were summarized. Results Rebalancing theory of shoulder stability mechanism is addressed, namely, when the shoulder stability mechanism is destructive, the stability of the shoulder can be restored by the rebalance between dynamic stability mechanism and passive stability mechanism. When dynamic stability is out of balance, dynamic stability can be restored by rebalancing the different parts of dynamic stability mechanism or to strengthen the passive stability mechanism. When passive stability mechanism is out of balance, passive stability can be restored by rebalancing the soft tissue and bone of the shoulder. ConclusionRebalancing theory of shoulder stability mechanism could make a understanding the occurrence, development, and prognosis of shoulder instability and dysfunction from a comprehensive and dynamic view and guide the treatment effectively.
【Abstract】 Objective To study the shoulder anatomy characteristics of the Chinese people and to design a newkind of humeral prosthesis, which could real ize the adjustment in three-dimensional space and be adjusted repeatedly, based on Chinese humeral anatomy characteristics. Methods A double-gear structure as a rotating part was adopted to design the structure of this new kind humeral prosthesis. Results The humeral prosthesis could satisfy both the needs of Chinese individual shoulder characteristics and the Westerners’ demands. Conclusion A novel concept of shoulder prosthesis design with a b appl ication value in design and development of the new prosthesis is proposed.
Objective To investigate and analyze the three-dimensional anatomic structure of glenoid bone in some Chinese people so as to provide the accurate anatomic data to design the new prosthesis of glenoid bone for Chinese people. Methods A total of 90 volunteers with two healthy shoulders (52 males and 38 females, aging 19-60 years with an average of 39.6 years) were selected. Five parameters were measured by use of three-dimensional computed tomography, volumerendering technique (VRT) and multiplanar reformation (MPR), including the maximum antero-posterior width (MAPW),antero-posterior radius of curvature (APROC), maximum supero-inferior height (MSIH), supero-inferior radius of curvature(SIROC) and version angle (VA) of glenoid. All parameters were measured two times, and the average values were analysed by SPSS13.0. The level of significance was set at P lt; 0.05. Results The average MAPW was (2.51 ± 0.32) cm, the average APROC was (5.50 ± 1.21) cm, the average MSIH was (3.45 ± 0.29) cm, the average SIROC was (3.98 ± 0.55) cm, and the average VA was (— 0.03 ± 4.66)°. There were no significant differences (P gt; 0.05) in MAPW, APROC, MSIH, SIROC and VA between two sides. There were significant differences (P lt; 0.05) in MAPW, MSIH, SIROC and VA, and no significant difference (P gt; 0.05) in APROC between female and male. MAPW was correlated with APROC, MAPW was correlated with MSIH, APROC was correlated with SIROC, and the correlation coefficient was 0.298, 0.495 and 0.262, respectively. Conclusion There are no significant differences in MAPW, APROC, MSIH, SIROC and VA of glenoid between two sides. There are sexual significant differences in MAPW, MSIH, SIROC and VA. The data and its statistical results may serve as guidel ines for the design of the glenoid component.
ObjectiveTo evaluate the short-term effectiveness of arthroscopically capsular vertical mattress suturing for shoulder recurrent anterior dislocation combined with joint laxity.MethodsA retrospective analysis was performed on 6 shoulder recurrent anterior dislocation patients combined with joint laxity treated with arthroscopically capsular vertical mattress suturing between January 2017 and December 2018. There were 5 males and 1 female with an average age of 20.8 years (range, 19-24 years). The number of shoulder dislocation was 3-18 times, with an average of 9.5 times. The disease duration ranged from 2 to 60 months, with an average of 25.3 months. The preoperative Beighton score was 4-7, with an average of 5.8; the Instability Severity Index Score (ISIS) was 2-5, with an average of 3.5. There were 5 cases of simple Bankart injury and 1 case of bony Bankart injury. The range of motion of shoulder joint (including active flexion and lifting, external rotation, abduction and external rotation, and internal ratation) was recorded before operation and at last follow-up; Oxford shoulder instability score, Rowe shoulder instability score, and Simple Shoulder Test (SST) score were used to evaluate shoulder joint function before operation, at 6 months after operation, and at last follow-up, and complications were recorded.ResultsAll patients were followed up 16-28 months (mean, 19.3 months). During the follow-up, all patients had satisfactory motor function, and no re-dislocation and postoperative neurovascular complications occurred. At last follow-up, the activities of active external rotation and abduction and external rotation were significantly improved when compared with those before operation (P<0.05); the activities of active flexion and lifting and internal rotation were not limited before and after operation, and the difference was not significant (P>0.05). The Oxford shoulder instability score, Rowe shoulder instability score, and SST score at 6 months after operation and at last follow-up were significantly improved when compared with those before operation (P<0.05); there was no significant difference between at 6 months after operation and at last follow-up (P>0.05).ConclusionThe treatment of shoulder recurrent anterior dislocation combined with joint laxity by arthroscopically vertical matress suturing can achieve good short-term effectiveness.
Objective To investigate the method and effectiveness of coracoplasty with mini-incision for subcoracoid impingement syndrome. Methods Between May 2006 and September 2011, 4 patients with subcoracoid impingement syndrome were treated, including 3 cases of congenital dysplasia of the coracoid process and 1 case of anterior glenohumeral instability. There were 3 males and 1 female with an average age of 36 years (range, 20-56 years). The disease duration was 6-22 months (mean, 11.2 months). The patients had a history of chronic pain and click of the anterior should, which was aggravated in adduction, internal rotation, and flexion. The results of the coracoid impingement test were positive by Neer and Hawkins-Kennedy impingement sign. The axial CT in adduction position showed that the coracohumeral interval decreased and coracoid index increased. The 2 cm lateral coracoid incision was made and the 0.5-1.5 cm coracoid neck was revealed and cut by osteotomy. The coracoplasty was performed by amputating the conjoined tendon insertion of the short head of the biceps and the coracobrachialis muscle and suturing to proximal coracoid osteotomy surface. Shoulder was fixed with the external braces for 6 weeks. Results Healing of incision by first intention was observed in all cases without any complication. All the 4 patients were followed up from 8 months to 5 years. At last follow-up, pain and click disappeared. The mean visual analogue scale (VAS), University of California at Los Angeles (UCLA), Constant, and simple shoulder test (SST) scores were significantly improved from 7.75, 10.25, 65.50, and 9.75 at preoperation to 0.25, 34.25, 91.25, and 0.25 at last follow-up respectively. The axial CT in adduction position and MRI showed that long coracoid process was removed; the coracohumeral interval was increased to 13.38 mm from 4.16 mm at preoperation; and the coracoid index was decreased to 0.28 mm from 13.08 mm at preoperation. Conclusion Coracoplasty with mini-incision is an effective method to relieve clinical symptoms of subcoracoid impingement, which has less complications and faster recovery.
ObjectiveTo investigate the effectiveness of Tang’s arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome.MethodsBetween August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang’s arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups (P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement.ResultsMedian operation time of group A was 50.5 minutes ［95%CI (49.3, 54.6)］, which was significantly shorter than that of group B ［88.5 minutes, 95%CI (76.5, 92.8)］ (Z=?4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups (t=?0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). The median subjective satisfaction score of group A was 2.0 ［95%(1.4, 1.7)］, which was better than that of group B ［2.0, 95%(1.6, 2.2)］ (Z=?2.480, P=0.013).ConclusionArthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang’s approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.
ObjectiveTo investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions.MethodsBetween January 2012 and December 2016, 36 patients (36 feet) with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of 53.8 years (range, 18-76 years). There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection (inactive), 1 case of talar absence, 1 case of Charcot’s disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores.ResultsThe mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores (t=12.596, P=0.000; t=30.393, P=0.000).ConclusionIt is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.