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Discovery Elbow System arthroplasty polyethylene bearing exchange: outcomes and experience. Discovery 肘关节置换系统聚乙烯轴承交换:结果和经验。
Pub Date : 2024-03-01 Epub Date: 2024-01-26 DOI: 10.5397/cise.2023.00668
Daniel L J Morris, Katherine Walstow, Lisa Pitt, Marie Morgan, Amol A Tambe, D I Clark, Timothy Cresswell, Marius P Espag

Background: The Discovery Elbow System (DES) utilizes a polyethylene bearing within the ulnar component. An exchange bearing requires preoperative freezing and implantation within 2 minutes of freezer removal to allow insertion. We report our outcomes and experience using this technique.

Methods: This was an analysis of a two-surgeon consecutive series of DES bearing exchange. Inclusion criteria included patients in which exchange was attempted with a minimum 1-year follow-up. Clinical and radiographic review was performed 1, 2, 3, 5, 8 and 10 years postoperative. Outcome measures included range of movement, Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), complications and requirement for revision surgery.

Results: Eleven DESs in 10 patients were included. Indications were bearing wear encountered during humeral component revision (n=5); bearing failure (n=4); and infection treated with debridement, antibiotics and implant retention (DAIR; n=2). Bearing exchange was conducted on the first attempt in 10 cases. One case required a second attempt. One patient developed infection postoperatively managed with two-stage revision. Mean follow-up of the bearing exchange DES was 3 years. No further surgery was required, with no infection recurrence in DAIR cases. Mean elbow flexion-extension and pronosupination arcs were 107° (±22°) and 140° (±26°). Mean OES was 36/48 (±12) and MEPS was 83/100 (±19).

Conclusions: Our results support the use of DES bearing exchange in cases of bearing wear with well-fixed stems or acute infection. This series provides surgeons managing DES arthroplasty with management principles, successful and reproducible surgical techniques and expected clinical outcomes in performing DES polyethylene bearing exchange. Level of evidence: IV.

背景:发现者肘关节系统(DES)在尺侧组件内使用聚乙烯轴承。交换支座需要术前冷冻,并在取出冷冻装置后 2 分钟内植入,以便插入。我们报告了使用这种技术的结果和经验:这是一项由两名外科医生连续进行的DES轴承交换系列分析。纳入标准包括至少随访1年并尝试过置换的患者。术后1年、2年、3年、5年、8年和10年进行临床和放射学复查。结果指标包括活动范围、牛津肘评分(OES)、梅奥肘关节表现评分(MEPS)、并发症和翻修手术要求:结果:纳入了10名患者的11个DES。结果:纳入了10名患者的11个DES,适应症包括肱骨组件翻修过程中遇到的轴承磨损(5例);轴承故障(4例);以及通过清创、抗生素和植入物保留(DAIR;2例)治疗的感染。10例患者在第一次尝试时进行了轴承交换。1例需要第二次尝试。一名患者术后发生感染,经两期翻修处理。轴承交换 DES 的平均随访时间为 3 年。无需进一步手术,DAIR病例无感染复发。平均肘关节屈伸弧度为107°(±22°),前屈弧度为140°(±26°)。平均OES为36/48(±12),MEPS为83/100(±19):我们的研究结果支持在轴承磨损、柄固定良好或急性感染的病例中使用DES轴承交换。该系列研究为管理DES关节置换术的外科医生提供了管理原则、成功且可重复的手术技巧以及进行DES聚乙烯轴承交换时的预期临床结果。证据级别:IV级。
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引用次数: 0
Blood flow velocity in the anterior humeral circumflex artery and tear size can predict synovitis severity in patients with rotator cuff tears. 肱骨前环状动脉的血流速度和撕裂大小可预测肩袖撕裂患者滑膜炎的严重程度。
Pub Date : 2024-03-01 Epub Date: 2024-01-24 DOI: 10.5397/cise.2023.00752
Takahiro Machida, Takahiko Hirooka, Akihisa Watanabe, Hinako Katayama, Yuki Matsukubo

Background: Rotator cuff tears are often associated with synovitis, but the ability of noninvasive ultrasonography to predict the severity of synovitis remains unclear. We investigated whether ultrasound parameters, namely peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, reflect synovitis severity.

Methods: A total of 54 patients undergoing arthroscopic rotator cuff repair were selected. Doppler ultrasound was used to measure peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, and these values were compared with the intraoperative synovitis score in univariate and multivariate analyses.

Results: Univariate analyses revealed that tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the glenohumeral joint were associated with synovitis in the glenohumeral joint (P=0.02, P<0.001, P=0.02, respectively). In the subacromial space, tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the subacromial space were associated with synovitis severity (P=0.02, P<0.001, P=0.02, respectively). Multivariate analyses indicated that tear size and peak systolic velocity in the anterior humeral circumflex artery were independently associated with synovitis scores in both the glenohumeral joint and the subacromial space (all P<0.05).

Conclusions: These findings demonstrate that tear size and peak systolic velocity in the anterior humeral circumflex artery, which can both be measured noninvasively, are useful indicators of synovitis severity. Level of evidence: IV.

背景:肩袖撕裂常伴有滑膜炎,但无创超声波检查预测滑膜炎严重程度的能力仍不明确。我们研究了超声参数,即肱骨前环状动脉的收缩峰值速度和盂肱关节及肩峰下间隙的多普勒活动是否能反映滑膜炎的严重程度:方法:共选取了 54 名接受关节镜肩袖修复术的患者。使用多普勒超声测量肱骨前环状动脉的收缩速度峰值以及盂肱关节和肩峰下间隙的多普勒活动度,并将这些数值与术中滑膜炎评分进行单变量和多变量分析比较:单变量分析显示,撕裂大小、肱骨前环动脉收缩速度峰值和盂肱关节多普勒活动度与盂肱关节滑膜炎相关(P=0.02,PC结论:这些研究结果表明,肱骨前环动脉的撕裂大小和收缩速度峰值都可以无创测量,是滑膜炎严重程度的有用指标。
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引用次数: 0
Cubital tunnel syndrome associated with previous ganglion cyst excision in the elbow: a case report. 与肘部神经节囊肿切除术相关的眶管综合征:病例报告。
Pub Date : 2024-03-01 Epub Date: 2022-11-11 DOI: 10.5397/cise.2022.01102
Woojin Shin, Taebyeong Kang, Jeongwoon Han

Cubital tunnel syndrome refers to compression neuropathy caused by pressure on the ulnar nerve pathway around the elbow. A 63-year-old male patient visited the clinic complaining of decreased sensation and weakness in his left ring finger and little finger, stating that the symptoms first began 6 months prior. He had undergone surgery to remove a ganglion cyst from his left elbow joint about 5 years prior in Mongolia. Magnetic resonance imaging revealed a cystic mass located at the previous surgical site, which was compressing the ulnar nerve within the cubital tunnel. Ulnar nerve decompression and anterior transposition were performed, and the cystic mass was excised. Upon pathological examination, the mass was diagnosed as a ganglion cyst. The patient's symptoms including sensory dysfunction and weakness improved over the 1-year follow-up period. This report describes a rare case of ganglion cyst recurrence compressing the ulnar nerve in the cubital tunnel after previous ganglion cyst excision.

眶管综合征是指肘部周围尺神经通路受压引起的压迫性神经病。一名 63 岁的男性患者前来就诊,主诉其左手无名指和小指感觉减退和无力,并称症状最早出现在 6 个月前。大约 5 年前,他在蒙古接受了切除左肘关节神经节囊肿的手术。磁共振成像显示,之前的手术部位有一个囊性肿块,压迫了肘管内的尺神经。患者接受了尺神经减压术和前方转位术,并切除了囊性肿块。经病理检查,肿块被诊断为神经节囊肿。随访一年后,患者的感觉功能障碍和乏力等症状有所改善。本报告描述了一例罕见的神经节囊肿复发病例,该病例曾接受过神经节囊肿切除术,但复发后压迫了肘隧道内的尺神经。
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引用次数: 0
Postoperative pain control for shoulder arthroplasty 肩关节置换术术后疼痛控制
Pub Date : 2024-02-14 DOI: 10.5397/cise.2023.00850
Mahala Walker, S. Kamineni
Since its inception in 1893, shoulder arthroplasty has become an increasingly common surgical procedure. Between 1998 and 2008, shoulder arthroplasty procedures increased by nearly 28,000 cases per year in the United States alone and is the fastest growing joint replacement surgery among all joint. Despite its advantages, shoulder arthroplasty is often accompanied by significant postoperative pain. Pain control continues to be a major concern in patient management, as it impacts operative costs, postoperative mobility, length of hospital stay, patient satisfaction, and overall surgical outcomes. This review aims to provide an overview of drugs such as opioids and regional anesthetics, as well as methods such as local wound infiltration, nerve block, brachial plexus infiltration, cryotherapy and multimodal approaches employed in postoperative shoulder arthroplasty pain control.
自 1893 年诞生以来,肩关节置换术已成为一种越来越常见的外科手术。1998 年至 2008 年间,仅在美国,肩关节置换术每年就增加近 28,000 例,是所有关节置换手术中增长最快的一种。尽管肩关节置换术有很多优点,但术后往往伴随着明显的疼痛。疼痛控制仍然是患者管理中的一个主要问题,因为它影响到手术费用、术后活动度、住院时间、患者满意度和整体手术效果。本综述旨在概述阿片类药物和区域麻醉剂等药物,以及局部伤口浸润、神经阻滞、臂丛神经浸润、冷冻疗法和多模式方法等用于肩关节置换术后疼痛控制的方法。
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引用次数: 0
Postoperative pain control for shoulder arthroplasty 肩关节置换术术后疼痛控制
Pub Date : 2024-02-14 DOI: 10.5397/cise.2023.00850
Mahala Walker, S. Kamineni
Since its inception in 1893, shoulder arthroplasty has become an increasingly common surgical procedure. Between 1998 and 2008, shoulder arthroplasty procedures increased by nearly 28,000 cases per year in the United States alone and is the fastest growing joint replacement surgery among all joint. Despite its advantages, shoulder arthroplasty is often accompanied by significant postoperative pain. Pain control continues to be a major concern in patient management, as it impacts operative costs, postoperative mobility, length of hospital stay, patient satisfaction, and overall surgical outcomes. This review aims to provide an overview of drugs such as opioids and regional anesthetics, as well as methods such as local wound infiltration, nerve block, brachial plexus infiltration, cryotherapy and multimodal approaches employed in postoperative shoulder arthroplasty pain control.
自 1893 年诞生以来,肩关节置换术已成为一种越来越常见的外科手术。1998 年至 2008 年间,仅在美国,肩关节置换术每年就增加近 28,000 例,是所有关节置换手术中增长最快的一种。尽管肩关节置换术有很多优点,但术后往往伴随着明显的疼痛。疼痛控制仍然是患者管理中的一个主要问题,因为它影响到手术费用、术后活动度、住院时间、患者满意度和整体手术效果。本综述旨在概述阿片类药物和区域麻醉剂等药物,以及局部伤口浸润、神经阻滞、臂丛神经浸润、冷冻疗法和多模式方法等用于肩关节置换术后疼痛控制的方法。
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引用次数: 0
Utility of three-dimensional printing in the surgical management of intra-articular distal humerus fractures: a systematic review and meta-analysis of randomized controlled trials 三维打印在肱骨远端关节内骨折手术治疗中的应用:随机对照试验的系统回顾和荟萃分析
Pub Date : 2024-02-08 DOI: 10.5397/cise.2023.00591
V. Baburaj, Sandeep Patel, Vishal Kumar, Siddhartha Sharma, M. Dhillon
Background: Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures.Methods: A systematic literature search was carried out using the electronic databases of PubMed, Embase, Scopus, and Ovid. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software.Results: Three randomized controlled trials with 144 cases were included in the final analysis, with 69 cases in the 3D-printed group and 75 in the conventional group. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74–19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45–60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance.Conclusions: Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes.
背景:肱骨远端关节内骨折固定后的临床效果与复位质量直接相关。使用三维(3D)打印骨折模型有利于术前规划,以确保良好的复位。本综述旨在确定与传统方法相比,使用三维打印辅助进行的手术是否更快、并发症是否更少、临床效果是否更好。我们还概述了这种新型技术在肱骨远端骨折手术治疗中的优点和缺点:使用 PubMed、Embase、Scopus 和 Ovid 等电子数据库进行了系统性文献检索。根据标题和摘要对检索结果进行筛选。将符合条件的研究数据提取到电子表格中。使用适当的计算机软件进行 Meta 分析:最终分析包括三项随机对照试验,共144个病例,其中三维打印组69个病例,传统组75个病例。与传统组相比,三维打印组的平均手术时间(平均差异为 16.25 分钟;95% 置信区间 [CI],12.74-19.76 分钟;P<0.001)和术中平均失血量(30.40 mL;95% CI,10.45-60.36 mL;P=0.005)明显更短。根据梅奥肘关节表现评分,三维打印组的并发症也更少,获得良好或卓越结果的可能性更大,但这并不具有统计学意义:结论:三维打印辅助手术治疗肱骨远端骨折在缩短手术时间和降低失血量方面有诸多益处,可间接减少感染和贫血相关问题等其他并发症。未来需要进行高质量的研究,以最终证明三维打印在改善临床效果方面的益处。
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引用次数: 0
Utility of three-dimensional printing in the surgical management of intra-articular distal humerus fractures: a systematic review and meta-analysis of randomized controlled trials 三维打印在肱骨远端关节内骨折手术治疗中的应用:随机对照试验的系统回顾和荟萃分析
Pub Date : 2024-02-08 DOI: 10.5397/cise.2023.00591
V. Baburaj, Sandeep Patel, Vishal Kumar, Siddhartha Sharma, M. Dhillon
Background: Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures.Methods: A systematic literature search was carried out using the electronic databases of PubMed, Embase, Scopus, and Ovid. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software.Results: Three randomized controlled trials with 144 cases were included in the final analysis, with 69 cases in the 3D-printed group and 75 in the conventional group. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74–19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45–60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance.Conclusions: Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes.
背景:肱骨远端关节内骨折固定后的临床效果与复位质量直接相关。使用三维(3D)打印骨折模型有利于术前规划,以确保良好的复位。本综述旨在确定与传统方法相比,使用三维打印辅助进行的手术是否更快、并发症是否更少、临床效果是否更好。我们还概述了这种新型技术在肱骨远端骨折手术治疗中的优点和缺点:使用 PubMed、Embase、Scopus 和 Ovid 等电子数据库进行了系统性文献检索。根据标题和摘要对检索结果进行筛选。将符合条件的研究数据提取到电子表格中。使用适当的计算机软件进行 Meta 分析:最终分析包括三项随机对照试验,共144个病例,其中三维打印组69个病例,传统组75个病例。与传统组相比,三维打印组的平均手术时间(平均差异为 16.25 分钟;95% 置信区间 [CI],12.74-19.76 分钟;P<0.001)和术中平均失血量(30.40 mL;95% CI,10.45-60.36 mL;P=0.005)明显更短。根据梅奥肘关节表现评分,三维打印组的并发症也更少,获得良好或卓越结果的可能性更大,但这并不具有统计学意义:结论:三维打印辅助手术治疗肱骨远端骨折在缩短手术时间和降低失血量方面有诸多益处,可间接减少感染和贫血相关问题等其他并发症。未来需要进行高质量的研究,以最终证明三维打印在改善临床效果方面的益处。
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引用次数: 0
Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional mid-term outcomes 术前肩锁关节注射对无症状肩锁关节骨关节炎的诊断价值:横断面中期疗效回顾性研究
Pub Date : 2024-01-15 DOI: 10.5397/cise.2023.00073
Roderick Jan Maximiliaan Vossen, R. Puijk, I. N. Sierevelt, A. van Noort
Background: It is essential to distinguish between symptomatic- and asymptomatic radiographic acromioclavicular (AC) osteoarthritis (OA) because AC-targeted physical examinations are dubious. This study aimed to determine the diagnostic value of a preoperative AC injection in discriminating between symptomatic- and asymptomatic radiographic AC OA based on patient arthroscopic distal clavicle resection (aDCR) outcomes. Methods: Forty-eight patients who underwent aDCR for AC OA were included. Their satisfaction was objectified using a 5-point Likert scale and patient willingness to repeat the surgery. The Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), and the Numerical Rating Scale (NRS) were used to assess postoperative shoulder function and pain. Patients were subdivided into groups based on their good or minimal reaction to an AC injection (good reaction: ≥7 consecutive days of pain reduction. Minimal reaction: <7 consecutive days of pain reduction).Results: Twenty-seven patients had a good reaction and 21 patients had a minimal reaction to the AC injection (median follow-up, 45.0 months; range, 31.0–52.8 months). No significant differences were found in level of satisfaction (P=0.234) or willingness to repeat the surgery (P=0.861). No significant differences were found in OSS (P=0.612), SSV (P=0.641), NRS at rest (P=0.684) or during activity (P=0.422).Conclusions: This study found no significant differences between patients with a good reaction or a minimal reaction to an AC injection after aDCR surgery. The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome.Level of evidence: IV.
背景:由于针对肩锁关节(AC)的体格检查存在疑点,因此区分有症状和无症状的放射学肩锁关节(AC)骨关节炎(OA)至关重要。本研究旨在根据患者关节镜下锁骨远端切除术(aDCR)的结果,确定术前 AC 注射在区分有症状和无症状的放射性 AC OA 方面的诊断价值。方法:纳入了48名接受aDCR治疗的膝关节OA患者。采用5点Likert量表对患者的满意度和重复手术的意愿进行客观评估。牛津肩关节评分(OSS)、主观肩关节值(SSV)和数字评分量表(NRS)用于评估术后肩关节功能和疼痛。根据患者对 AC 注射的良好反应或轻微反应将其细分为不同组别(良好反应:连续 7 天疼痛减轻。最小反应:<结果:结果:27 名患者对 AC 注射反应良好,21 名患者反应轻微(随访时间中位数为 45.0 个月;范围为 31.0-52.8 个月)。满意度(P=0.234)和重复手术意愿(P=0.861)无明显差异。OSS(P=0.612)、SSV(P=0.641)、休息时的NRS(P=0.684)或活动时的NRS(P=0.422)均无明显差异:本研究发现,在接受 aDCR 手术后,对 AC 注射反应良好或反应轻微的患者之间没有明显差异。这项研究的结果似乎表明,没有必要区分有症状和无症状的放射性 AC OA,因为所有患者对结果都同样满意:证据等级:IV。
{"title":"Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional mid-term outcomes","authors":"Roderick Jan Maximiliaan Vossen, R. Puijk, I. N. Sierevelt, A. van Noort","doi":"10.5397/cise.2023.00073","DOIUrl":"https://doi.org/10.5397/cise.2023.00073","url":null,"abstract":"Background: It is essential to distinguish between symptomatic- and asymptomatic radiographic acromioclavicular (AC) osteoarthritis (OA) because AC-targeted physical examinations are dubious. This study aimed to determine the diagnostic value of a preoperative AC injection in discriminating between symptomatic- and asymptomatic radiographic AC OA based on patient arthroscopic distal clavicle resection (aDCR) outcomes. Methods: Forty-eight patients who underwent aDCR for AC OA were included. Their satisfaction was objectified using a 5-point Likert scale and patient willingness to repeat the surgery. The Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), and the Numerical Rating Scale (NRS) were used to assess postoperative shoulder function and pain. Patients were subdivided into groups based on their good or minimal reaction to an AC injection (good reaction: ≥7 consecutive days of pain reduction. Minimal reaction: <7 consecutive days of pain reduction).Results: Twenty-seven patients had a good reaction and 21 patients had a minimal reaction to the AC injection (median follow-up, 45.0 months; range, 31.0–52.8 months). No significant differences were found in level of satisfaction (P=0.234) or willingness to repeat the surgery (P=0.861). No significant differences were found in OSS (P=0.612), SSV (P=0.641), NRS at rest (P=0.684) or during activity (P=0.422).Conclusions: This study found no significant differences between patients with a good reaction or a minimal reaction to an AC injection after aDCR surgery. The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome.Level of evidence: IV.","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139530343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Arthroscopic remplissage: history, indications, and clinical outcomes 关节镜再植术:历史、适应症和临床结果
Pub Date : 2023-12-04 DOI: 10.5397/cise.2023.00325
M. Fares, Mohammad Daher, Peter Boufadel, Emil R. Haikal, Jonathan Koa, Jaspal Singh, Joseph A. Abboud
Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.
几种外科手术方法已被提出,以解决前盂肱骨不稳,这是在一般人群中最常见的投诉之一。该手术于21世纪初首次被描述,是一种与关节镜下Bankart修复术同时进行的手术,用于纠正大的、接合的Hill-Sachs病变(hsl)。该手术通过将冈下肌腱固定到HSL内以填补和脱离缺损来稳定关节。这种手术之所以受到欢迎,是因为它风险相对较低,能够改善肩部稳定性,同时比其他骨阻断手术的侵入性更小。这种复位术已经成为一种有价值的附加技术,可以大大改善不稳定患者接受关节镜Bankart修复的结果。然而,文献中的一些研究对其在严重不稳定患者中的疗效以及术后可能出现的活动范围限制提出了担忧。应该进行更多的比较研究和试验,以适当地确定复位在治疗前路不稳中的作用,特别是在严重骨质流失的患者中。
{"title":"Arthroscopic remplissage: history, indications, and clinical outcomes","authors":"M. Fares, Mohammad Daher, Peter Boufadel, Emil R. Haikal, Jonathan Koa, Jaspal Singh, Joseph A. Abboud","doi":"10.5397/cise.2023.00325","DOIUrl":"https://doi.org/10.5397/cise.2023.00325","url":null,"abstract":"Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Midterm outcomes of suture anchor fixation for displaced olecranon fractures 缝合锚固定治疗肩胛骨移位骨折的中期疗效
Pub Date : 2023-12-04 DOI: 10.5397/cise.2023.00528
Michael J. Gutman, Jacob M. Kirsch, Jonathan Koa, M. Fares, Joseph A. Abboud
Background: Displaced olecranon fractures constitute a challenging problem for elbow surgeons. The purpose of this study is to evaluate the role of suture anchor fixation for treating patients with displaced olecranon fractures.Methods: A retrospective review was performed for all consecutive patients with displaced olecranon fractures treated with suture anchor fixation with at least 2 years of clinical follow-up. Surgical repair was performed acutely in all cases with nonmetallic suture anchors in a double-row configuration utilizing suture augmentation via the triceps tendon. Osseous union and perioperative complications were uniformly assessed. Results: Suture anchor fixation was performed on 17 patients with displaced olecranon fractures. Functional outcome scores were collected from 12 patients (70.6%). The mean age at the time of surgery was 65.6 years, and the mean follow-up was 5.6 years. Sixteen of 17 patients (94%) achieved osseous union in an acceptable position. No hardware-related complications or fixation failure occurred. Mean postoperative shortened disabilities of the arm, shoulder, and hand (QuickDASH) score was 3.8±6.9, and mean Oxford Elbow Score was 47.5±1.0, with nine patients (75%) achieving a perfect score. Conclusions: Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. Additionally, this technique resulted in high rates of osseous union without any hardware-related complications or fixation failures.
背景:移位的鹰嘴骨折对肘部外科医生来说是一个具有挑战性的问题。本研究的目的是评估缝合锚定固定在治疗鹰嘴移位骨折患者中的作用。方法:回顾性分析所有连续接受缝合锚钉固定治疗的鹰嘴移位骨折患者,随访至少2年。所有病例均采用经肱三头肌肌腱加强缝合的双排非金属缝合锚钉进行急性手术修复。统一评估骨愈合和围手术期并发症。结果:17例鹰嘴移位骨折均行缝合锚钉固定。收集了12例(70.6%)患者的功能结局评分。手术时平均年龄为65.6岁,平均随访时间为5.6年。17例患者中有16例(94%)在可接受的位置实现骨愈合。无硬件相关并发症或固定失败发生。术后臂、肩、手缩短残疾(QuickDASH)评分平均为3.8±6.9分,牛津肘评分平均为47.5±1.0分,9例(75%)患者达到满分。结论:带缝线锚钉固定移位的鹰嘴骨折可获得良好的中期功能预后。此外,该技术导致骨愈合率高,没有任何与硬件相关的并发症或固定失败。
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Clinics in Shoulder and Elbow
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