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A Pilot Biomechanical Study to Evaluate the Efficiency of New Implant to Fix Acromioclavicular Joint 评价新型肩锁关节植入物固定效果的初步生物力学研究
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-05-08 DOI: 10.1097/BTE.0000000000000192
H. Namazi, Keramat Askari, Mohammad T Karimi, M. Fereidooni
The incidence of acromioclavicular joint (ACJ) injuries is high in daily activities and sports. Various surgical procedures have been used to restore the performance of the shoulder complex in ACJ injuries. This study was aimed to introduce a new implant designed to fix ACJ and to evaluate its efficiency on the basis of biomechanical modeling and finite element analysis approaches. Computerized tomography scan images of 12 normal shoulders were selected to create a 3d model of shoulder joints. The dimensions of the implant were obtained from the models of shoulder joints and then were evaluated on 5 fresh cadavers. The stress developed in the implant and shoulder articular surfaces were evaluated by finite element analysis on the basis of the models obtained from computerized tomography scan images. The designed implant can be used to fix ACJ for both right and left sides. The stress developed in the implant varied between 1.88 and 2.1 MPa. The newly designed implant can be used for most of the subjects to fix ACJ for both rights and left sides. The stress developed in the implant in the abduction of the shoulder joint was significantly less than the yield strength of the material used for the implant. Therefore, it can be used without failure for most of the daily activities.
肩锁关节(ACJ)损伤在日常活动和运动中发生率较高。各种外科手术已被用于恢复ACJ损伤中肩部复合体的性能。本研究旨在介绍一种用于固定ACJ的新型植入物,并在生物力学建模和有限元分析方法的基础上评估其效率。选择12个正常肩部的计算机断层扫描图像来创建肩部关节的三维模型。从肩关节模型中获得植入物的尺寸,然后在5具新鲜尸体上进行评估。基于从计算机断层扫描图像中获得的模型,通过有限元分析来评估植入物和肩部关节表面中产生的应力。所设计的植入物可用于固定左右两侧的ACJ。植入物中产生的应力在1.88和2.1之间变化 MPa。新设计的植入物可用于大多数受试者固定左右侧ACJ。在肩关节外展的植入物中产生的应力明显小于用于植入物的材料的屈服强度。因此,它可以毫无故障地用于大多数日常活动。
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引用次数: 0
Posterior Minimally Invasive Plate Osteosynthesis of Humeral Shaft Fractures: An Anatomic Study of “Danger Zones” 肱骨干骨折后微创钢板内固定术“危险区”的解剖学研究
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-05-08 DOI: 10.1097/BTE.0000000000000189
Kelsey A. Rebehn, Lisa K. Cannada, J. Watson
The most utilized approach for minimally invasive plate osteosynthesis (MIPO) of humeral fractures has been an anterior percutaneous approach. Other approaches include posterior, which places the radial nerve at risk. We performed a cadaveric study to evaluate safe intervals for screw placement using a posterior approach. MIPO fixation of the humeral shaft was performed on 11 fresh frozen cadaveric specimens following a standard protocol using a 10-hole 4.5 locking compression plate (LCP) plate and cortical screws. After fixation, anatomic dissection of the radial nerve was performed and location of the nerve delineated with regards to radiographic landmarks and the fixation construct. A 10-hole LCP plate centered on the humerus will position a screw in the third hole from top of plate only 3.08 cm (±SD 1.05 cm) from the radial nerve. The distal screws in the LCP plate construct do not the place the radial nerve at risk. The literature reports rates of iatrogenic radial nerve injury during formal open reduction and internal fixation approaching 20%, and during MIPO between 0% and 5%. With a posterior MIPO approach the radial nerve is most at risk with screw placement in the fifth and sixth holes from the top of a 10-hole plate.
肱骨骨折微创钢板接骨术(MIPO)最常用的方法是前路经皮入路。其他方法包括后神经,这会使桡神经处于危险之中。我们进行了一项尸体研究,以评估使用后部入路放置螺钉的安全间隔。根据标准方案,使用10孔4.5锁定加压钢板(LCP)和皮质螺钉在11个新鲜冷冻尸体标本上进行肱骨干的MIPO固定。固定后,对桡神经进行解剖解剖,并根据放射学标志和固定结构确定神经位置。以肱骨为中心的10孔LCP钢板将螺钉定位在钢板顶部的第三个孔中,仅3.08 cm(±SD 1.05 cm)。LCP板结构中的远端螺钉不会使桡神经处于危险之中。文献报道,在正式切开复位和内固定期间,医源性桡神经损伤的发生率接近20%,在MIPO期间,发生率在0%至5%之间。对于后部MIPO入路,将螺钉放置在10孔板顶部的第五和第六孔中,桡神经的风险最大。
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引用次数: 0
A Surgical Technique for Revision of Failed Acromioclavicular Joint Reconstruction 肩锁关节重建失败的翻修手术技术
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-05-08 DOI: 10.1097/BTE.0000000000000190
P. Robinson, S. Kanthasamy, L. Funk
There is no “gold standard” technique for the surgical stabilization of acromioclavicular joint (ACJ) disruptions and each of the described techniques has a failure rate. The management of failed ACJ stabilizations is a difficult problem and salvage procedures may often be constrained by the original procedure and the resultant anatomy. Reliable anatomic and biomechanically robust revision procedures for failed ACJ stabilization are therefore required. We describe a technique for revision stabilization of the ACJ that utilizes a synthetic ligament in combination with augmentation from the coracoacromial ligament and biceps short head aponeurosis (“biceps flip” procedure).
肩锁关节(ACJ)断裂的手术稳定没有“金标准”技术,并且所描述的每种技术都有失败率。ACJ稳定失败的管理是一个难题,抢救程序可能经常受到原始程序和最终解剖结构的限制。因此,需要可靠的解剖和生物力学稳健的ACJ稳定失败的翻修手术。我们描述了一种ACJ的翻修稳定技术,该技术利用合成韧带结合从喙肩韧带和二头肌短头神经官能症(“二头肌翻转”程序)中扩增。
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引用次数: 0
Ulnar Cortical Window for Removal of a Well-Fixed Ulnar Component in Total Elbow Arthroplasty: Surgical Technique and Case Report 尺皮质窗在全肘关节置换术中去除固定良好的尺骨构件:手术技术和病例报告
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-03-01 DOI: 10.1097/BTE.0000000000000182
P. Chan, C. Yan, K. Chiu
Infection after total elbow arthroplasty can be a devastating problem. Eradication of the infection can often be difficult and may compromise the already tenuous bone and soft tissue, particularly the elbow extensor mechanism. Resection arthroplasty with the complete removal of all foreign material is often necessary to adequately treat the infection. Components may be well fixed and removal may further compromise bone and soft tissue. The authors present a technique of ulnar cortical window that facilitates the removal of a well-fixed ulnar component and the associated cement mantle. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. This technique provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a well-fixed implant. When comparing with other techniques in the removal of the ulnar component, such as transverse ulnar osteotomy, and extended olecranon osteotomy, our technique did not breach the bony integrity of ulna, and it did not require wiring for rigid fixation of the bony fragment. This may be more applicable in excisional arthroplasty for the management of infected total elbow arthroplasty.
全肘关节置换术后的感染可能是一个毁灭性的问题。根除感染通常是困难的,可能会损害已经脆弱的骨骼和软组织,特别是肘关节伸肌机制。切除关节成形术并完全清除所有异物通常是充分治疗感染所必需的。组件可以很好地固定,移除可能会进一步损害骨骼和软组织。作者提出了一种尺骨皮质窗技术,该技术有助于去除固定良好的尺骨成分和相关的水泥套。一个说明性的外科病例也包括相关的术中和放射图像。该技术提供了可靠的、无创伤的进入尺管、水泥套和组件的通道,以安全拔出固定良好的种植体。与其他去除尺骨构件的技术,如尺骨横截骨、尺骨鹰嘴伸截骨相比,我们的技术没有破坏尺骨的骨完整性,也不需要用钢丝固定骨碎片。这可能更适用于全肘关节置换术中感染的手术切除。
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引用次数: 1
A Novel Technique for Endoscopic Release of the Transverse Scapular Ligament in the Setting of Suprascapular Neuropathy: Case Report and Technique 一种用于肩胛上神经病变的内镜下肩胛横韧带松解的新技术:病例报告与技术
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-03-01 DOI: 10.1097/BTE.0000000000000183
Raymond Skunda, Joshua Wilson, Kenton Panas, S. P. Kelly, C. White
Suprascapular neuropathy is a well-known cause of shoulder pain and dysfunction. Common locations for suprascapular nerve (SSN) entrapment are the suprascapular notch and the spinoglenoid notch. Multiple authors have described both open and arthroscopic approaches for SSN decompression; however, to our knowledge, there is no description of decompression of the SSN at the suprascapular notch using a hybrid endoscopic approach to maximize the advantages of both. The patient was a 27-year-old, white male laborer, who presented with a 6-month history of left shoulder pain and decreased function without a history of trauma. A standard course of conservative treatment including nonsteroidal antiinflammatory drugs, activity modification, and physical therapy was attempted but failed to result in symptomatic improvement. Magnetic resonance imaging and electromyography were subsequently ordered and demonstrated a subacute muscle denervation pattern indicating the SSN as the most probable site of compression. Given the patient’s clinical examination, failure of nonoperative management, age, and his activity level, he was offered surgical intervention. The technique described in this report utilizes a novel, safe, effective, and facile approach for the release of the transverse scapular ligament. We present our hybrid endoscopic technique along with a case report demonstrating a good patient outcome to emphasize the successful application of our technique following appropriate utilization of history, physical examination, and diagnostic tests when deciding to operatively treat a patient with isolated suprascapular neuropathy.
肩胛上神经病变是众所周知的引起肩部疼痛和功能障碍的原因。肩胛上神经(SSN)的常见位置是肩胛上切迹和棘突切迹。多位作者描述了开放和关节镜下入路进行SSN减压;然而,据我们所知,没有描述使用混合内窥镜入路在肩胛上切迹处减压以最大限度地发挥两者的优势。患者27岁,白人男性劳动者,6个月前出现左肩疼痛和功能减退,无外伤史。保守治疗的标准疗程包括非甾体类抗炎药物、活动调节和物理治疗,但未能导致症状改善。随后进行了磁共振成像和肌电图检查,结果显示亚急性肌肉去神经支配模式,表明SSN是最可能的压迫部位。考虑到患者的临床检查,非手术治疗的失败,年龄,和他的活动水平,他被给予手术干预。本报告所描述的技术采用了一种新颖、安全、有效和简便的方法来释放肩胛横韧带。我们提出我们的混合内窥镜技术以及一个病例报告,证明了良好的患者结果,以强调在决定手术治疗孤立性肩胛上神经病变患者时,在适当利用病史、体格检查和诊断测试后成功应用我们的技术。
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引用次数: 0
Treatment of Chronic Lateral Epicondylitis With Autologous Fat Grafting 自体脂肪移植治疗慢性外侧上髁炎
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-03-01 DOI: 10.1097/BTE.0000000000000184
Heta Lukjanov, J. Ikonen, T. Niemi, M. Pääkkönen
Despite the self-limiting nature of lateral epicondylitis (LE) the disease has a prolonged course in some patients. Currently there is no optimal treatment of choice for these patients. We treated 6 elbows in 5 patients with LE with free fat grafting. All patients had symptomatic LE (symptom duration >2 y) and magnetic resonance imaging scan consistent with LE, and no finding of osteoarthrosis of the elbow joint, ligament injury, or other condition causing palpable lateral elbow pain. The fat graft was harvested from the abdomen, centrifuged or decanted and 10 mL was injected in and around the lateral epicondyle. All patients recovered without complications. Pain in visual analogue scale decreased in 5 of the 6 elbows (83%). The routine follow-up was 3 months. Regarding the final results 3 patients were satisfied, 1 was uncertain and 1 was dissatisfied and underwent open surgery 10 months after the fat transfer. Lipomatosis was still visible in the lateral epicondyle. Free adipose transfer is an option in the treatment of LE. Patients undergoing the procedure will have a small bump in the lateral elbow. Level of Evidence: Level IV.
尽管侧上髁炎(LE)具有自限性,但某些患者的病程延长。目前还没有针对这些患者的最佳治疗选择。我们用游离脂肪移植术治疗了5例LE患者的6个肘部。所有患者均有症状性LE(症状持续时间>2 y) 磁共振成像扫描与LE一致,没有发现肘关节骨关节病、韧带损伤或其他引起明显肘外侧疼痛的情况。从腹部采集脂肪移植物,离心或倾析,10 在外侧上髁及其周围注射mL。所有患者均康复,无并发症。6个肘部中有5个(83%)的视觉模拟量表疼痛减轻。常规随访3个月。关于最终结果,3名患者满意,1名不确定,1名患者不满意,并在脂肪转移后10个月接受了开放手术。脂肪增多症仍然可见于外侧上髁。游离脂肪转移是治疗LE的一种选择。接受手术的患者的侧肘会有一个小肿块。证据级别:四级。
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引用次数: 0
Proximal Humerus Fractures Managed With Joshi External Stabilizing System Joshi外固定系统治疗肱骨近端骨折
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-02-14 DOI: 10.1097/BTE.0000000000000181
Ameya U. Kulkarni, Umesh M. Kulkarni
Proximal humerus fractures account for 4% to 5% of all fractures. These fractures have been conventionally treated either conservatively in a shoulder immobilizer or by open reduction and internal fixation with a locking plate. Conservative treatment often leads to a stiff shoulder, and operative management requires extensive soft tissue dissection. In this study, we have chosen a middle path for treating proximal humerus fractures in the form of closed reduction and Joshi external stabilizing system (JESS) with early mobilization, thus overcoming the problem of shoulder stiffness associated with conservative management and excessive soft tissue dissection associated with the open procedure. We conducted a study on 25 patients with proximal humerus fractures with Neer types 2 and 3 fractures. The mean age was 49.6 years with a female preponderance of 64%. JESS was applied after closed reduction in all cases. Mobilization was started on days 1 or 2 of surgery. All patients were followed up at 2, 4, 6, and 8 weeks and at 6 months after surgery. All cases were evaluated functionally using the constant shoulder scoring system. In our study, the mean constant shoulder score was 75.7 at 6 months. All fractures united in 6 to 8 weeks. In our study, we had 2 cases of pin-tract infection and 1 case of shoulder stiffness. The JESS fixator is a good modality of treatment for Neer types 2 and 3 proximal humerus fractures, facilitating early mobilization without compromising on fracture stability and union rates.
肱骨近端骨折占所有骨折的4%至5%。这些骨折通常采用保守的肩部固定器或切开复位加锁定钢板内固定治疗。保守治疗常导致肩关节僵硬,手术治疗需要广泛的软组织剥离。在本研究中,我们选择了一条治疗肱骨近端骨折的中路,即闭合复位和Joshi外稳定系统(JESS),并进行早期活动,从而克服了保守治疗带来的肩部僵硬和开放手术带来的过度软组织剥离的问题。我们对25例肱骨近端骨折合并2型和3型骨折的患者进行了研究。平均年龄49.6岁,女性占64%。所有病例闭合复位后应用JESS。活动开始于手术的第1天或第2天。所有患者于术后2、4、6、8周及6个月随访。所有病例均采用恒肩评分系统进行功能评估。在我们的研究中,6个月时平均肩部评分为75.7分。所有骨折在6 - 8周内愈合。在我们的研究中,我们有2例针道感染和1例肩关节僵硬。JESS固定器是治疗Neer 2型和3型肱骨近端骨折的一种良好方式,可在不影响骨折稳定性和愈合率的情况下促进早期活动。
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引用次数: 2
Surgical Management of Clavicular Malignancies With Resection of the Clavicle Without Reconstruction 锁骨切除不重建治疗锁骨恶性肿瘤
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-02-14 DOI: 10.1097/BTE.0000000000000187
H. Çevi̇k, S. Gümüştaş, S. Kayahan
Clavicular malignancies are very rare, and few papers which reported that primary tumors are predominant, have been published about the functional and oncological outcomes after surgical treatment. The main purpose of the present study was to report the functional and oncological outcomes of 14 patients with clavicular malignancy, who were managed with total/partial claviculectomy without reconstruction, or followed up without surgical intervention. Of the total patients, 26.7% presented with clavicular cancer of unknown primary, and 42.9% with pathologic fractures of the clavicle. Claviculectomy without reconstruction was applied to 57.1% patients, as partial resection in 42.9% and total in 14.3%. The similarity of the clavicle to flat bones rather than long bones, that the surgical decision for partial or total resection of the clavicle because of malignancy is simpler to make than for other long bones because there is no requirement for reconstruction. Level of Evidence: Level IV.
锁骨恶性肿瘤非常罕见,以原发肿瘤为主的文献很少,关于锁骨恶性肿瘤手术治疗后的功能和肿瘤预后的报道也很少。本研究的主要目的是报告14例锁骨恶性肿瘤患者的功能和肿瘤预后,这些患者接受了锁骨全/部分切除而不重建,或随访而不进行手术干预。在所有患者中,26.7%为原发不明的锁骨癌,42.9%为病理性锁骨骨折。57.1%的患者行无重建锁骨切除术,42.9%的患者行部分切除术,14.3%的患者行全切除术。锁骨与平骨而非长骨相似,由于恶性肿瘤而部分或全部切除锁骨的手术决定比其他长骨更容易做出,因为不需要重建。证据等级:四级。
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引用次数: 0
Short-Term to Mid-Term Outcomes of Arthroscopic Stabilization Using PEEK Knotless Anchors 关节镜下使用PEEK无节锚固定的短期到中期结果
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-02-14 DOI: 10.1097/BTE.0000000000000186
Jae H.T. Lee, N. Vivekanandamoorthy, P. Lam, G. Murrell
Outcomes of arthroscopic instability repairs vary depending on repair techniques and anchor materials. The purpose of this study is to determine the short to mid-term redislocation, resubluxation rate and clinical outcomes following arthroscopic stabilization of nonabsorbable, biologically inert polymer polyether ether ketone (PEEK) suture anchors. This is a retrospective study with 140 patients who underwent arthroscopic anterior stabilization surgery using PEEK (Pushlock) anchors with a mean follow-up of 40 months. Patient ranked pain scores, clinically assessed range of motion and strength testing were collected preoperatively and at 1, 6, 12, and 24 weeks after surgery with the final follow-up carried out as a phone interview. After surgery, the redislocation rate increased over time to 18% until it stabilized at 3.8 years. Resubluxation rate increased to 20% until 2.8 years. At 24 weeks, forward flexion, as well as shoulder strength in abduction, adduction, external rotation, internal rotation, and lift-off, improved compared with preoperative levels. Patient ranked pain scores and overall shoulder rating improved significantly at the most recent follow-up compared with before surgery. Arthroscopic stabilization of glenohumeral instability using PEEK knotless anchors results in good short-term to mid-term stability with improved function and reduced pain. Level of Evidence: Level III.
关节镜下不稳定修复的结果因修复技术和锚固件材料而异。本研究的目的是确定非吸收性、生物惰性聚合物聚醚醚酮(PEEK)缝合锚在关节镜下稳定后的中短期再定位、再栓塞率和临床结果。这是一项对140名患者的回顾性研究,这些患者使用PEEK(Pushlock)锚固件进行了关节镜下前部稳定手术,平均随访时间为40个月。在术前和术后1、6、12和24周收集患者疼痛评分、临床评估的活动范围和力量测试,并通过电话采访进行最终随访。手术后,再定位率随着时间的推移增加到18%,直到稳定在3.8年。在2.8年之前,再栓塞率增加到20%。在24周时,前屈以及外展、内收、外旋、内旋和提举的肩部力量与术前水平相比有所改善。与手术前相比,在最近的随访中,患者的疼痛评分和肩部整体评分显著改善。使用PEEK无节锚固件在关节镜下稳定肩关节不稳定,可获得良好的短期至中期稳定性,改善功能,减轻疼痛。证据级别:三级。
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引用次数: 1
Antegrade Reduction and Fixation of Coronoid Fractures: A New Arthroscopic Technique 冠状骨骨折的顺行复位固定:一种新的关节镜技术
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2020-02-14 DOI: 10.1097/BTE.0000000000000185
F. Luceri, J. Lesman, D. Cucchi, M. Domzalski, P. Randelli, P. Arrigoni
The coronoid process (CP) is important for stabilizing the elbow joint. The elbow’s joint fracture is considered the most common factor in several cases of complex elbow dislocations. The surgical indications for recommending the CP in fractures are prolonged instabilities of the elbow. The open fixation of the CP is a demanding procedure, owing to many complications after the surgeries. Arthroscopic reduction and internal fixation have been proposed to overcome the limitations of open approaches. The aim of our study is to describe, step by step, a new surgical procedure for arthroscopically assisted fracture reduction and insertion of an antegrade guidewire for internal fixation of coronoid fractures. To perform this surgery, the knowledge of the portals in elbow arthroscopy is essential. The final stabilization is achieved by accurate positioning of the Kirschner-wire under arthroscopic control and stabilizing by the cannulated screw. The proposed technique is a safe and appealing procedure in the treatment of coronoid fractures.
冠突(CP)对稳定肘关节非常重要。肘关节骨折被认为是复杂肘关节脱位最常见的因素。推荐使用CP治疗肘关节骨折的手术指征是肘关节长期不稳定。由于术后有许多并发症,开放固定CP是一项要求很高的手术。关节镜复位和内固定已被提出以克服开放入路的局限性。我们研究的目的是一步一步地描述一种新的手术方法,用于关节镜辅助骨折复位和插入顺行导丝内固定冠状突骨折。要进行这种手术,肘关节镜中门静脉的知识是必不可少的。最终的稳定是通过在关节镜控制下精确定位克氏针并通过空心螺钉稳定来实现的。该技术是治疗冠状突骨折的一种安全而有吸引力的方法。
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引用次数: 8
期刊
Techniques in Shoulder and Elbow Surgery
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