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Glenohumeral versus subacromial steroid injections for impingement syndrome with mild stiffness: a randomized controlled trial. 肩关节与肩峰下注射类固醇治疗轻度强直性撞击综合征:一项随机对照试验。
Pub Date : 2023-12-01 Epub Date: 2023-10-05 DOI: 10.5397/cise.2023.00346
Yong-Tae Kim, Tae-Yeong Kim, Jun-Beom Lee, Jung-Taek Hwang

Background: The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified.

Methods: This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection.

Results: GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores.

Conclusions: GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.

背景:肩峰下间隙是治疗撞击综合征常用的注射部位。对于肩部僵硬,通常进行肩关节(GH)注射。然而,在轻度肩部僵硬的撞击综合征病例中,类固醇注射的最佳部位尚未确定。方法:这项前瞻性随机研究比较了超声引导下GH和SA类固醇注射治疗被诊断为撞击综合征和轻度僵硬患者的短期疗效。每组包括24名接受生长激素或SA注射40mg曲安奈德的患者。在注射前和注射后3、7和13周评估运动范围和临床评分。结果:经过13周的随访,GH和SA注射显著改善了运动范围和临床评分。值得注意的是,靶向GH关节导致了早期的前向抬高、外旋、,3周内旋转(P结论:GH注射可能比SA注射更有利于治疗轻度僵硬的撞击综合征,尤其是在改善早期活动范围方面。然而,3个月后,手术显示出类似的结果。证据水平:I。
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引用次数: 0
Concomitant open distal clavicle excision is associated with greater improvement in range of motion without increased risk of acromial stress fracture after reverse total shoulder arthroplasty: a retrospective cohort study. 一项回顾性队列研究表明,同时行锁骨远端切开切除与肩关节逆行全肩关节置换术后肩胛应力性骨折的风险增加有关。
Pub Date : 2023-12-01 Epub Date: 2023-11-08 DOI: 10.5397/cise.2023.00465
Ajay C Kanakamedala, Dhruv S Shankar, Neil Gambhir, Matthew R Boylan, Michael Boin, Matthew G Alben, Mandeep S Virk, Young W Kwon

Background: The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA).

Methods: A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups.

Results: Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up.

Conclusions: Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. Level of evidence: III.

背景:本研究的目的是评估同时开放性远端锁骨切除术(DCE)对有症状的肩锁关节骨性关节炎(acjoa)患者行逆行全肩关节置换术(RTSA)后临床结果和肩峰应力性骨折(asf)发生率的影响。方法:采用单外科医生回顾性队列研究,纳入2015年至2019年接受原发性选择性RTSA伴或不伴DCE的患者,随访期至少6个月。术前、术后分别记录肩关节活动度(AROM)和视觉模拟疼痛评分(VAS)。通过术后记录和/或x光片确定asf和其他不良事件。采用学生t检验、Mann-Whitney U检验或Fisher精确检验比较RTSA组和RTSA- dce组的特征和结果。p值结果:RTSA患者46例(平均年龄67.9±8.7岁;男性60.9%;平均随访24.9±16.6个月)和70例RTSA-DCE患者(平均年龄70.2±8.9岁;男性20.0%;平均随访22.7±12.9个月)。ASF发生率组间无显著差异(RTSA, 0.0% vs RTSA- dce, 1.4%;P=1.00),应激反应(RTSA, 8.7% vs RTSA- dce, 11.4%;P=0.76)、再手术、翻修或感染(均P < 0.05),或最新随访时术前至术后VAS疼痛减轻(P=0.17)。然而,RTSA- dce组在屈曲AROM方面有更大的术后改善(RTSA, 43.7°±38.5°vs RTSA- dce, 59.5°±33.4°;P=0.03)和内旋(IR) AROM (P=0.02)。结论:RTSA患者合并DCE可改善肩部屈曲和IR AROM,减轻肩部疼痛,且不增加asf的风险。证据水平:III。
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引用次数: 0
Classification system for partial distal biceps tendon tears: a descriptive 3-Tesla magnetic resonance imaging study of tear morphology. 部分远端二头肌腱撕裂的分类系统:撕裂形态的描述性3-T磁共振成像研究。
Pub Date : 2023-12-01 Epub Date: 2023-11-14 DOI: 10.5397/cise.2023.00458
Alex B Boyle, Simon Bm MacLean

Background: There is minimal literature on the morphology of partial distal biceps tendon (DBT) tears. We sought to investigate tear morphology by retrospectively reviewing 3-Tesla magnetic resonance imaging (3T MRI) scans of elbows with partial DBT tears and to propose a basic classification system.

Methods: 3T MRI scans of elbows with partial DBT tears were retrospectively reviewed by two experienced observers. Basic demographic data were collected. Tear morphology was recorded including type, presence of retraction (>5 mm), and presence of discrete long-head and short-head tendons at the DBT insertion.

Results: For analysis, 44 3T MRI scans of 44 elbows with partial DBT tears were included. There were 9 isolated long-head tears (20%), 13 isolated short-head tears (30%), 2 complete long-head tears with a partial short-head tear (5%), 5 complete short-head tears with a partial long-head tear (11%), and 15 peel-off tears (34%). Retraction was seen in 5 or 44 partial tears (11%), and 13 of the 44 DBTs were bifid tendons at the insertion (30%).

Conclusions: Partial DBT tears can be classified into five sub-types: long-head isolated tears, short-head isolated tears, complete long-head tears with partial short-head involvement, complete short-head tears with partial long-head involvement, and peel-off tears. Classification of tears may have implications for operative and non-operative management. Level of evidence: III.

背景:关于部分远端肱二头肌肌腱(DBT)撕裂的形态学文献很少。我们试图通过回顾性回顾3-特斯拉磁共振成像(3T MRI)扫描肘部部分DBT撕裂的撕裂形态,并提出一个基本的分类系统。方法:由两名经验丰富的观察者回顾性回顾3T MRI扫描肘部部分DBT撕裂。收集基本人口统计数据。记录撕裂形态,包括类型、是否存在回缩(bbb50 mm),以及在DBT插入处是否存在离散的长头和短头肌腱。结果:为了进行分析,纳入了44例肘部部分DBT撕裂的44例3T MRI扫描。分离的长头撕裂9例(20%),分离的短头撕裂13例(30%),完整的长头撕裂2例(5%),完整的短头撕裂5例(11%),部分长头撕裂15例(34%)。5或44例部分撕裂(11%)出现牵回,44例dbt中有13例为止点处的双裂肌腱(30%)。结论:部分DBT撕裂可分为5个亚型:长头孤立撕裂、短头孤立撕裂、部分短头受累的完全长头撕裂、部分长头受累的完全短头撕裂和剥脱撕裂。泪的分类可能对手术和非手术治疗有影响。证据水平:III。
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引用次数: 0
Plate prebending using a three-dimensional-printed model affords effective anatomical reduction in clavicular shaft fractures. 钢板预弯曲采用三维打印模型提供了有效的解剖复位锁骨干骨折。
Pub Date : 2023-12-01 Epub Date: 2023-08-24 DOI: 10.5397/cise.2023.00339
Hyungsuk Kim, Younsung Jung, Hyun Seok Song

Background: A precontoured plate rarely fits properly within the patient's clavicle and must be bent intraoperatively. This study aimed to determine whether anatomical reduction could be achieved using a plate bent before surgery.

Methods: This study included 87 consecutive patients with displaced mid-shaft clavicle fractures who underwent plate fixation and were followed-up for a minimum of 1 year. After exclusions, 39 consecutive patients underwent fixation with a precontoured plate bent intraoperatively (intraoperative bending group), and 28 underwent fixation with the plate bent preoperatively (preoperative bending group). Using free software and a three-dimensional (3D) printer, ipsilateral clavicle 3D-printed models were constructed. Using plain radiographs, the distance between the edge of the lateral inferior cortex and the medial inferior cortex was measured. The angle between the line connecting the inferior cortex edge and the line passing through the flat portion of the superior cortex of the distal clavicle was measured.

Results: Mean length differences between the ipsilateral and contralateral clavicle were smaller on both anteroposterior (AP; P=0.032) and axial images (P=0.029) in the preoperative bending group. The mean angular differences on both AP (P=0.045) and axial images (P=0.008) were smaller in the preoperative bending group. No significant differences were observed between the two groups in functional scores at the last follow-up.

Conclusions: Smaller differences in length and angle between the ipsilateral and contralateral clavicle, indicative of reduction, were observed in the preoperative bending group. Using the precontoured technique with low expense, the operation was performed more effectively as reflected by a shorter operation time. Level of evidence: III.

背景:预塑形钢板很少适合患者锁骨,术中必须弯曲。本研究旨在确定手术前弯曲钢板是否可以实现解剖复位。方法:本研究纳入87例连续移位的锁骨中轴骨折患者,接受钢板固定,随访至少1年。排除后,连续39例患者术中采用预塑形钢板弯曲固定(术中弯曲组),28例患者术前采用弯曲钢板固定(术前弯曲组)。利用免费软件和三维(3D)打印机,建立了同侧锁骨3D打印模型。利用x线平片测量外侧下皮层边缘与内侧下皮层边缘之间的距离。测量连接下皮层边缘的线与穿过锁骨远端上皮层平坦部分的线之间的夹角。结果:同侧锁骨和对侧锁骨的平均长度差异在正前方(AP;P=0.032)和轴向图像(P=0.029)。术前弯曲组AP (P=0.045)和轴向图像(P=0.008)的平均角度差较小。最后一次随访时,两组功能评分无显著差异。结论:在术前弯曲组观察到同侧和对侧锁骨长度和角度的较小差异,表明复位。预轮廓技术成本低,手术时间短,手术效果好。证据水平:III。
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引用次数: 1
Anterior interosseous nerve palsy in the early postoperative period after open capsular release for elbow stiffness: a case report. 肘关节僵硬开放囊松解术后早期骨间神经麻痹1例。
Pub Date : 2023-12-01 Epub Date: 2022-11-21 DOI: 10.5397/cise.2022.00899
Christopher A Colasanti, Michael Boin, Jacques Hacquebord, Mandeep Virk

Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication.

肘关节挛缩的手术解除与穿过肘关节的结构损伤有关。迄今为止,仅有一例报道了在肘关节开放性挛缩解除和清创后立即发生骨间神经(AIN)麻痹的病例。在这里,我们描述了一例术后1周发生AIN性麻痹的患者,包括磁共振成像和电诊断研究,以阐明这种罕见并发症的病因。
{"title":"Anterior interosseous nerve palsy in the early postoperative period after open capsular release for elbow stiffness: a case report.","authors":"Christopher A Colasanti, Michael Boin, Jacques Hacquebord, Mandeep Virk","doi":"10.5397/cise.2022.00899","DOIUrl":"10.5397/cise.2022.00899","url":null,"abstract":"<p><p>Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9428321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
The impact of modern airport security protocols on patients with total shoulder replacements. 现代机场安全规程对全肩关节置换术患者的影响
Pub Date : 2023-12-01 Epub Date: 2023-08-08 DOI: 10.5397/cise.2022.01403
Michael D Scheidt, Neal Sethi, Matthew Ballard, Michael Wesolowski, Dane Salazar, Nickolas Garbis

Background: Advancements in airport screening measures in response to 9/11 have resulted in increased false alarm rates for patients with orthopedic and metal implants. With the implementation of millimeter-wave scanning technology, it is important to assess the changes in airport screening experiences of patients who underwent total shoulder arthroplasty (TSA).

Methods: Here, 197 patients with prior anatomic and reverse TSA completed between 2013 and 2020 responded to a questionnaire regarding their experiences with airport travel screening after their operation. Of these patients, 86 (44%) stated that they had traveled by plane, while 111 (56%) had not. The questionnaire addressed several measures including the number of domestic and international flights following the operation, number of false alarm screenings by the millimeter-wave scanner, patient body habitus, and presence of additional metal implants.

Results: A total of 53 patients (62%) responded "yes" to false screening alarms due to shoulder arthroplasty. The odds of a false screening alarm for patients with other metal implants was 5.87 times that of a false screening alarm for patients with no other metal implants (P<0.1). Of a reported 662 flights, 303 (45.8%) resulted in false screening alarms. Greater body mass index was not significantly lower in patients who experienced false screening alarms (P=0.30).

Conclusions: Patients with anatomic and reverse TSA trigger false alarms with millimeter-wave scanners during airport screening at rates consistent with prior reports following 9/11. Patient education on the possibility of false alarms during airport screening is important until improvements in implant identification are made. Level of evidence: IV.

背景:为应对911事件,机场安检措施的进步导致骨科和金属植入物患者误报率增加。随着毫米波扫描技术的实施,评估全肩关节置换术(TSA)患者机场安检体验的变化具有重要意义。方法:在此,2013年至2020年期间完成的197例术前解剖和反向TSA患者回答了一份关于他们手术后机场旅行筛查经历的问卷。在这些患者中,86例(44%)表示他们乘坐过飞机,111例(56%)没有乘坐过飞机。调查问卷涉及了几项措施,包括手术后国内和国际航班的数量,毫米波扫描仪的假警报筛选次数,患者的身体习惯以及是否存在额外的金属植入物。结果:53例患者(62%)对肩关节置换术引起的假筛查报警回答“是”。有其他金属植入物的患者假警报的几率是没有其他金属植入物的患者假警报的5.87倍(p结论:解剖和反向TSA患者在机场安检时使用毫米波扫描仪触发假警报的比率与9/11事件后的先前报告一致。在植入物识别技术得到改进之前,对患者进行机场检查时假警报可能性的教育是很重要的。证据等级:四级。
{"title":"The impact of modern airport security protocols on patients with total shoulder replacements.","authors":"Michael D Scheidt, Neal Sethi, Matthew Ballard, Michael Wesolowski, Dane Salazar, Nickolas Garbis","doi":"10.5397/cise.2022.01403","DOIUrl":"10.5397/cise.2022.01403","url":null,"abstract":"<p><strong>Background: </strong>Advancements in airport screening measures in response to 9/11 have resulted in increased false alarm rates for patients with orthopedic and metal implants. With the implementation of millimeter-wave scanning technology, it is important to assess the changes in airport screening experiences of patients who underwent total shoulder arthroplasty (TSA).</p><p><strong>Methods: </strong>Here, 197 patients with prior anatomic and reverse TSA completed between 2013 and 2020 responded to a questionnaire regarding their experiences with airport travel screening after their operation. Of these patients, 86 (44%) stated that they had traveled by plane, while 111 (56%) had not. The questionnaire addressed several measures including the number of domestic and international flights following the operation, number of false alarm screenings by the millimeter-wave scanner, patient body habitus, and presence of additional metal implants.</p><p><strong>Results: </strong>A total of 53 patients (62%) responded \"yes\" to false screening alarms due to shoulder arthroplasty. The odds of a false screening alarm for patients with other metal implants was 5.87 times that of a false screening alarm for patients with no other metal implants (P<0.1). Of a reported 662 flights, 303 (45.8%) resulted in false screening alarms. Greater body mass index was not significantly lower in patients who experienced false screening alarms (P=0.30).</p><p><strong>Conclusions: </strong>Patients with anatomic and reverse TSA trigger false alarms with millimeter-wave scanners during airport screening at rates consistent with prior reports following 9/11. Patient education on the possibility of false alarms during airport screening is important until improvements in implant identification are made. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9969801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving visualization in shoulder arthroscopy. 提高肩关节镜的可视性。
Pub Date : 2023-12-01 Epub Date: 2023-02-22 DOI: 10.5397/cise.2022.01291
Emily R McDermott, David J Tennent, Daniel J Song

Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder arthroscopic procedures comes the need for safe, effective, and efficient surgery that maximizes patient outcomes while minimizing complications. Many variables contribute to visualization in shoulder arthroscopy including vascular anatomy, blood pressure control, arthroscopic pump systems, turbulence control, epinephrine, and tranexamic acid. Furthermore, patient positioning can have a dramatic effect on visualization with both the beach chair position and lateral decubitus positioning having various strengths and weaknesses depending on the intended procedure being performed. The purpose of this review is to examine the benefits and complications reported in the literature for improving visualization in shoulder arthroscopy.

关节镜肩关节手术是通过微创技术恢复功能最常用的手术之一。随着对肩关节镜手术的需求,需要安全、有效和高效的手术,以最大限度地提高患者的预后,同时最大限度地减少并发症。肩关节镜下的可视化有很多因素,包括血管解剖、血压控制、关节镜下泵系统、湍流控制、肾上腺素和氨甲环酸。此外,患者的体位会对可视化产生巨大的影响,沙滩椅体位和侧卧体位都有不同的优点和缺点,这取决于所要进行的手术。本综述的目的是研究文献中报道的改善肩关节镜观察的益处和并发症。
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引用次数: 1
Inpatient or outpatient total elbow arthroplasty: a comparison of patient populations and 30-day surgical outcomes from the American College of Surgeons National Surgical Quality Improvement Program. 住院或门诊全肘关节置换术:来自美国外科医师学会国家手术质量改进计划的患者群体和30天手术结果的比较
Pub Date : 2023-12-01 Epub Date: 2023-11-23 DOI: 10.5397/cise.2023.00486
David Momtaz, Farhan Ahmad, Aaron Singh, Emilie Song, Dean Slocum, Abdullah Ghali, Adham Abdelfattah

Background: Total elbow arthroplasty (TEA) is uncommon, but growing in incidence. Traditionally an inpatient operation, a growing number are performed outpatient, consistent with general trends in orthopedic surgery. The aim of this study was to compare TEA outcomes between inpatient and outpatient surgical settings. Secondarily, we sought to identify patient characteristics that predict the operative setting.

Methods: Patient data were collected from the American College of Surgeons National Quality Improvement Program. Preoperative variables, including patient demographics and comorbidities, were recorded, and baseline differences were assessed via multivariate regression to predict operative setting. Multivariate regression was also used to compare postoperative complications within 30 days.

Results: A total of 468 patients, 303 inpatient and 165 outpatient procedures, were identified for inclusion. Hypoalbuminemia (odds ratio [OR], 2.5; P=0.029), history of chronic obstructive pulmonary disorder or pneumonia (OR, 2.4; P=0.029), and diabetes mellitus (OR, 2.5; P=0.001) were significantly associated with inpatient TEA, as were greater odds of any complication (OR, 4.1; P<0.001) or adverse discharge (OR, 4.5; P<0.001) and decreased odds of reoperation (OR, 0.4; P=0.037).

Conclusions: Patients undergoing inpatient TEA are generally more comorbid, and inpatient surgery is associated with greater odds of complications and adverse discharge. However, we found higher rates of reoperation in outpatient TEA. Our findings suggest outpatient TEA is safe, although patients with a higher comorbidity burden may require inpatient surgery. Level of evidence: III.

背景:全肘关节置换术(TEA)并不常见,但发病率正在上升。传统的住院手术,越来越多的在门诊进行,与骨科手术的总体趋势一致。本研究的目的是比较住院和门诊手术的TEA结果。其次,我们试图确定预测手术环境的患者特征。方法:患者资料收集自美国外科医师学会国家质量改进计划。记录术前变量,包括患者人口统计学和合并症,并通过多变量回归评估基线差异,以预测手术环境。采用多因素回归比较术后30天内的并发症。结果:纳入了468例患者,303例住院患者和165例门诊患者。低白蛋白血症(优势比[OR], 2.5;P=0.029)、慢性阻塞性肺疾病(COPD)或肺炎史(or, 2.4;P=0.029),糖尿病(OR, 2.5;P=0.001)与住院患者TEA显著相关,任何并发症的发生率也较高(OR, 4.1;结论:住院TEA患者通常有更多的合并症,住院手术与并发症和不良出院的发生率相关。然而,我们发现门诊TEA的再手术率较高。我们的研究结果表明,尽管合并症负担较高的患者可能需要住院手术,但门诊TEA是安全的。证据水平:III。
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引用次数: 0
Radiofrequency in arthroscopic shoulder surgery: a systematic review. 射频在关节镜肩关节手术中的应用:系统综述。
Pub Date : 2023-12-01 Epub Date: 2022-11-01 DOI: 10.5397/cise.2022.01067
Neeraj Vij, Joseph N Liu, Nirav Amin

Background: Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder.

Methods: This systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines. Embase and PubMed were searched using: "shoulder," "rotator cuff," "biceps," "acromion" AND "monopolar," "bipolar," "ablation," "coblation," and "radiofrequency ablation." The title and abstract review were performed independently. Any discrepancies were addressed through open discussion.

Results: A total of 63 studies were included. Radiofrequency is currently utilized in impingement syndrome, fracture fixation, instability, nerve injury, adhesive capsulitis, postoperative stiffness, and rotator cuff disease. Adverse events, namely superficial burns, are limited to case reports and case series, with higher-level evidence demonstrating safe use when used below the temperature threshold. Bipolar radiofrequency may decrease operative time and decrease the cost per case.

Conclusions: Shoulder radiofrequency has a wide scope of application in various shoulder pathologies. Shoulder radiofrequency is safe; however, requires practitioners to be cognizant of the potential for thermal burn injuries. Bipolar radiofrequency may represent a more efficacious and economic treatment modality. Safety precautions have been executed by institutions to cut down patient complications from shoulder radiofrequency. Future research is required to determine what measures can be taken to further minimize the risk of thermal burns.

背景:射频技术在骨科中的应用越来越广泛,包括髋关节和膝关节的软骨病变清创以及肩关节镜手术中的许多应用。本系统综述的目的是评估射频在肩部的安全性和使用情况。方法:本系统评价在普洛斯彼罗(国际注册中心)注册,并遵循系统评价和荟萃分析方案(PRISMA-P)指南的首选报告项目。Embase和PubMed使用“肩”、“肩袖”、“肱二头肌”、“肩峰”和“单极”、“双极”、“消融”、“消融”和“射频消融”进行搜索。标题和摘要评审独立进行。任何分歧都通过公开讨论加以解决。结果:共纳入63项研究。射频目前用于撞击综合征、骨折固定、不稳定、神经损伤、粘连性囊炎、术后僵硬和肩袖疾病。不良事件,即浅表烧伤,仅限于病例报告和病例系列,有更高水平的证据表明,在低于温度阈值时使用是安全的。双极射频可以缩短手术时间,降低每例费用。结论:肩关节射频治疗在各种肩关节病变中具有广泛的应用前景。肩射频安全;然而,需要从业者认识到潜在的热烧伤伤害。双极射频可能是一种更有效和经济的治疗方式。各机构已执行安全预防措施,以减少肩部射频引起的患者并发症。未来的研究需要确定可以采取哪些措施来进一步减少热烧伤的风险。
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引用次数: 2
Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid: 90-day complication profile in the inpatient versus outpatient setting. 解剖全肩关节置换术与非球形肱骨头和嵌体肩关节:住院患者与门诊患者90天并发症概况
Pub Date : 2023-12-01 Epub Date: 2023-11-01 DOI: 10.5397/cise.2023.00479
Andrew D Posner, Michael C Kuna, Jeremy D Carroll, Eric M Perloff, Matthew J Anderson, Ian D Hutchinson, Joseph P Zimmerman

Background: Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients.

Methods: A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups.

Results: One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups.

Conclusions: TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.

背景:全肩关节置换术(TSA)与非球形肱骨头组件和内嵌肩关节是一种成功的保骨治疗肩关节关节炎。本研究旨在描述使用该假体的90天并发症概况,并比较住院和门诊患者的主要和次要并发症和再入院率。方法:回顾性分析2017年至2023年间,由同一名外科医生在住院和门诊接受非球形肱骨头和嵌体肩关节的TSA患者的连续队列。年龄、性别、体重指数、美国麻醉医师协会(ASA)评分、Charlson合并症指数(CCI)、住院组和门诊组90天并发症和再入院率进行比较。结果:111例患者中发现118例tsa。平均年龄64.9岁(39-90岁),65%的患者为男性。94例(80%)和24例(20%)患者分别接受了门诊和住院治疗。记录了4例并发症(3.4%):腋窝神经牵张损伤、孤立的同侧臂深静脉血栓形成(DVT)、同侧臂深静脉血栓合并肺栓塞需要再入院、胃肠道出血需要再入院。没有再手术或其他并发症。门诊患者年龄较轻,ASA和CCI评分低于住院患者;两组患者并发症发生率(1/24 vs 3/94, P=1.00)和再入院率(1/24 vs 1/94, P=0.37)均无差异。结论:非球形肱骨头和内嵌式关节盂的TSA在住院和门诊都是安全的。早期并发症和再入院率低,根据手术设置没有差异。证据等级:四级。
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Clinics in Shoulder and Elbow
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