首页 > 最新文献

Journal of Shoulder and Elbow Surgery最新文献

英文 中文
After primary shoulder arthroplasty appropriate vancomycin antibiotic prophylaxis does not lead to increased infectious complications when compared to cefazolin. 原发性肩关节置换术后,与头孢唑啉相比,适当使用万古霉素抗生素预防不会导致感染性并发症增加。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 Epub Date: 2024-05-15 DOI: 10.1016/j.jse.2024.03.059
Ian M Marigi, Kristin Yu, Micah J Nieboer, Erick M Marigi, John W Sperling, Joaquin Sanchez-Sotelo, Jonathan D Barlow
<p><strong>Background: </strong>In primary shoulder arthroplasty (SA), intravenous (IV) cefazolin has demonstrated lower rates of infectious complications when compared to IV vancomycin. However, previous analyses included SA cohorts with both complete and incomplete vancomycin administration. Therefore, it is currently unclear whether cefazolin still maintains a prophylactic advantage to vancomycin when it is appropriately indicated and sufficiently administered at the time of surgical incision. This study evaluated the comparative efficacy of cefazolin and complete vancomycin administration for surgical prophylaxis in primary shoulder arthroplasty with respect to infectious complications.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted utilizing a single institution total joint registry database, where all primary SA types (hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse shoulder arthroplasty) performed between 2000 to 2019 for elective and trauma indications using IV cefazolin or complete vancomycin administration as the primary antibiotic prophylaxis were identified. Vancomycin was primarily indicated for patients with a severe self-reported penicillin or cephalosporin allergy and/or MRSA colonization. Complete administration was defined as at least 30 minutes of antibiotic infusion prior to incision. All included SA had at least 2 years of clinical follow-up. Multivariable Cox proportional hazard regression was used to evaluate all-cause infectious complications including survival free of prosthetic joint infection (PJI).</p><p><strong>Results: </strong>The final cohort included 7177 primary SA, 6879 (95.8%) received IV cefazolin and 298 (4.2%) received complete vancomycin administration. Infectious complications occurred in 120 (1.7%) SA leading to 81 (1.1%) infectious reoperations. Of the infectious complications, 41 (0.6%) were superficial infections and 79 were (1.1%) PJIs. When categorized by administered antibiotics, there were no differences in rates of all infectious complications (1.6% vs. 2.3%; P = .352), superficial complications (0.5% vs. 1.3%; P = .071), PJI (1.1% vs. 1.0%; P = .874), or infectious reoperations (1.1% vs. 1.0%; P = .839). On multivariable analyses, complete vancomycin infusion demonstrated no difference in rates of infectious complications compared to cefazolin administration (hazard ratio [HR], 1.50 [95% confidence interval (CI), 0.70 to 3.25]; P = .297), even when other independent predictors of PJI (male sex, prior surgery, and Methicillin-resistant Staphylococcus aureus colonization) were considered.</p><p><strong>Conclusions: </strong>In comparison to cefazolin, complete administration of vancomycin (infusion to incision time greater than 30 minutes) as the primary prophylactic agent does not adversely increase the rates of infectious complications and PJI. Prophylaxis protocols should promote appropriate indications for the use of cefazolin or vancomycin, and w
简介:在初级肩关节置换术(SA)中,静脉注射头孢唑啉(IV)与静脉注射万古霉素相比,感染性并发症的发生率更低。然而,以前的分析包括完全和不完全使用万古霉素的肩关节置换术队列。因此,目前尚不清楚在手术切口时适当使用头孢唑啉并充分给药的情况下,头孢唑啉是否仍能保持对万古霉素的预防优势。本研究评估了头孢唑啉和万古霉素在初级肩关节置换术手术预防感染并发症方面的疗效比较:利用单一机构的全关节登记数据库开展了一项回顾性队列研究,确定了2000年至2019年期间因择期和创伤适应症而实施的所有初级肩关节置换术类型(半关节置换术、解剖型全肩关节置换术、反向肩关节置换术),并将静脉注射头孢唑啉或全万古霉素作为主要的抗生素预防用药。万古霉素主要适用于自我报告对青霉素或头孢菌素严重过敏和/或有 MRSA 定植的患者。完全用药的定义是在切口前至少输注 30 分钟的抗生素。所有纳入的 SA 均接受了至少 2 年的临床随访。多变量考克斯比例危险回归用于评估全因感染并发症,包括无人工关节感染(PJI)的存活率:最终队列包括 7,177 例原发性人工关节感染,其中 6,879 例(95.8%)接受了静脉注射头孢唑啉,298 例(4.2%)接受了完全万古霉素治疗。120例(1.7%)SA发生感染并发症,导致81例(1.1%)感染性再手术。在感染性并发症中,41 例(0.6%)为表皮感染,79 例(1.1%)为深部感染。按使用的抗生素分类,所有感染性并发症(1.6% vs. 2.3%; P = .352)、表皮并发症(0.5% vs. 1.3%; P = .071)、PJI(1.1% vs. 1.0%; P = .874)或感染性再手术(1.1% vs. 1.0%; P = .839)的发生率均无差异。在多变量分析中,即使考虑到PJI的其他独立预测因素(男性、既往手术和耐甲氧西林金黄色葡萄球菌定植),完全输注万古霉素与头孢唑啉相比在感染性并发症的发生率上也没有差异(危险比[HR],1.50[95% 置信区间(CI),0.70 至 3.25];P = .297):结论:与头孢唑啉相比,完全使用万古霉素(从输液到切口的时间超过 30 分钟)作为主要预防药物不会增加感染性并发症和 PJI 的发生率。预防方案应宣传使用头孢唑啉或万古霉素的适当适应症,并在必要时确保完全使用万古霉素,以降低初次 SA 后的额外感染风险。
{"title":"After primary shoulder arthroplasty appropriate vancomycin antibiotic prophylaxis does not lead to increased infectious complications when compared to cefazolin.","authors":"Ian M Marigi, Kristin Yu, Micah J Nieboer, Erick M Marigi, John W Sperling, Joaquin Sanchez-Sotelo, Jonathan D Barlow","doi":"10.1016/j.jse.2024.03.059","DOIUrl":"10.1016/j.jse.2024.03.059","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In primary shoulder arthroplasty (SA), intravenous (IV) cefazolin has demonstrated lower rates of infectious complications when compared to IV vancomycin. However, previous analyses included SA cohorts with both complete and incomplete vancomycin administration. Therefore, it is currently unclear whether cefazolin still maintains a prophylactic advantage to vancomycin when it is appropriately indicated and sufficiently administered at the time of surgical incision. This study evaluated the comparative efficacy of cefazolin and complete vancomycin administration for surgical prophylaxis in primary shoulder arthroplasty with respect to infectious complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was conducted utilizing a single institution total joint registry database, where all primary SA types (hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse shoulder arthroplasty) performed between 2000 to 2019 for elective and trauma indications using IV cefazolin or complete vancomycin administration as the primary antibiotic prophylaxis were identified. Vancomycin was primarily indicated for patients with a severe self-reported penicillin or cephalosporin allergy and/or MRSA colonization. Complete administration was defined as at least 30 minutes of antibiotic infusion prior to incision. All included SA had at least 2 years of clinical follow-up. Multivariable Cox proportional hazard regression was used to evaluate all-cause infectious complications including survival free of prosthetic joint infection (PJI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final cohort included 7177 primary SA, 6879 (95.8%) received IV cefazolin and 298 (4.2%) received complete vancomycin administration. Infectious complications occurred in 120 (1.7%) SA leading to 81 (1.1%) infectious reoperations. Of the infectious complications, 41 (0.6%) were superficial infections and 79 were (1.1%) PJIs. When categorized by administered antibiotics, there were no differences in rates of all infectious complications (1.6% vs. 2.3%; P = .352), superficial complications (0.5% vs. 1.3%; P = .071), PJI (1.1% vs. 1.0%; P = .874), or infectious reoperations (1.1% vs. 1.0%; P = .839). On multivariable analyses, complete vancomycin infusion demonstrated no difference in rates of infectious complications compared to cefazolin administration (hazard ratio [HR], 1.50 [95% confidence interval (CI), 0.70 to 3.25]; P = .297), even when other independent predictors of PJI (male sex, prior surgery, and Methicillin-resistant Staphylococcus aureus colonization) were considered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In comparison to cefazolin, complete administration of vancomycin (infusion to incision time greater than 30 minutes) as the primary prophylactic agent does not adversely increase the rates of infectious complications and PJI. Prophylaxis protocols should promote appropriate indications for the use of cefazolin or vancomycin, and w","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":"2612-2618"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lateralization of the humerus in reverse total shoulder arthroplasty: can preoperative planning software predict postoperative lateralization and does lateralization influence outcomes? 反向全肩关节置换术中的肱骨外侧化:术前规划软件能否预测术后外侧化?
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 Epub Date: 2024-05-16 DOI: 10.1016/j.jse.2024.03.058
Keith M Baumgarten, Carson Max
<p><strong>Background: </strong>Reverse total shoulder arthroplasty (RTSA) can result in varying amounts of humeral medialization or lateralization. The amount of medial or lateral change-in-arm-position can be predicted using 3D computed tomography planning software. It is not clear if the preoperatively predicted change-in-arm-position correlates with the actual radiographically measured change-in-arm-position or if the predicted or actual change-in-arm-position correlates with patient-reported outcomes or complications.</p><p><strong>Methods: </strong>Patients who received RTSA underwent preoperative 3D computed tomography planning to predict the postoperative medial-to-lateral change-in-arm-position (PCAP). Preoperative and postoperative radiographs were used to calculate the actual medial-to-lateral change-in-arm-position using the measurement of the lateral edge of the greater tuberosity to the lateral edge of the acromion (RCAP-LHO). The Western Ontario Osteoarthritis Score (WOOS), American Shoulder and Elbow Surgeons score (ASES), and Single Assessment Numeric Evaluation (SANE) were recorded at baseline, 1 year, and 2 years. Rates of complications were recorded.</p><p><strong>Results: </strong>A total of 250 patients were eligible for this study including 189 patients reaching the 1-year clinical follow-up point and 144 patients reaching the 2-year clinical follow-up point. One-year and 2-year follow-up rates were 89% and 91%, respectively. The mean PCAP was 3 ± 5 mm and the mean RCAP-LHO was 1 ± 8 mm. There was a moderate correlation between PCAP and RCAP-LHO. There was a weak correlation between increased PCAP lateralization and higher WOOS and ASES at 2 years and an improvement from baseline to 2 years in WOOS. There was a very weak correlation between increased PCAP lateralization and improvement compared with baseline in 1-year SANE and improvement compared with baseline in 2-year SANE. There was a weak correlation between lateralized RCAP-LHO and 2-year postoperative SANE. There was superior 2-year WOOS, ASES, and SANE, and improvement in SANE at 1 year compared with baseline in patients with a lateralized PCAP compared with a medialized or neutral PCAP. There was superior 2-year WOOS, improvement in WOOS from baseline to 2-year follow-up, and 2-year SANE in patients with a lateralized RCAP-LHO compared with a medialized or neutral RCAP-LHO. Overall complication rates were similar between groups although the dislocation rate in shoulders with a lateralized change-in-arm-position was significantly less than that in shoulders with a medial or neutral change-in-arm-position.</p><p><strong>Conclusions: </strong>PCAP correlated with actual RCAP-LHO. Correlations exist with increased humeral lateralization and improved patient-determined outcomes. Patient-determined outcomes in patients with a lateralized change-in-arm-position were the same as or better than those with a medialized or neutral change-in-arm-position. A lateralized change-
导言:反向全肩关节置换术(RTSA)可导致不同程度的肱骨内侧化或外侧化。使用三维 CT 规划软件可以预测手臂位置的内侧或外侧变化量。目前还不清楚术前预测的手臂位置变化是否与实际X光测量的手臂位置变化相关,也不清楚预测的或实际的手臂位置变化是否与患者报告的结果或并发症相关:方法:对接受 RTSA 的患者进行术前三维 CT 规划,以预测术后内侧到外侧的手臂位置变化 (PCAP)。使用术前和术后X光片,通过测量大结节外侧缘到肩峰外侧缘的距离(RCAP-LHO)来计算实际的手臂内外侧位置变化。在基线、1 年和 2 年时记录西安大略骨关节炎评分 (WOOS)、美国肩肘外科医生评分 (ASES) 和单一评估数值评价 (SANE)。并记录了并发症的发生率:共有 250 名患者符合研究条件,其中 189 名患者接受了为期一年的临床随访,144 名患者接受了为期两年的临床随访。一年和两年的随访率分别为 89% 和 91%。平均 PCAP 为 3+5 毫米,RCAP-LHO 为 1+8 毫米。PCAP 与 RCAP-LHO 之间存在中度相关性。PCAP侧位增加与两年后WOOS和ASES升高以及WOOS从基线到两年的改善之间存在弱相关性。PCAP 侧化增加与 1 年 SANE 与基线相比的改善以及 2 年 SANE 与基线相比的改善之间存在极弱的相关性。RCAP-LHO 侧化与术后 2 年 SANE 之间的相关性很弱。与内侧或中性 PCAP 相比,外侧化 PCAP 患者的 2 年 WOOS、ASES 和 SANE 均优于内侧化 PCAP 患者,且 1 年 SANE 较基线有所改善。与内侧或中性 RCAP-LHO 相比,侧位 RCAP-LHO 患者的 2 年 WOOS、从基线到 2 年随访的 WOOS 改善情况以及 2 年的 SANE 均优于内侧或中性 RCAP-LHO 患者。两组患者的总体并发症发生率相似,但肩臂位置外侧改变的肩关节脱位率明显低于肩臂位置内侧或中性改变的肩关节脱位率:结论:PCAP与实际RCAP-LHO相关。结论:PCAP与实际RCAP-LHO相关,肱骨外侧化增加与患者自定结果的改善存在相关性。与内侧化或保持中立的患者相比,手臂位置发生外侧化改变的患者的预后相同或更好。肱骨外侧化不会导致总体并发症的增加,并能防止术后不稳定。
{"title":"Lateralization of the humerus in reverse total shoulder arthroplasty: can preoperative planning software predict postoperative lateralization and does lateralization influence outcomes?","authors":"Keith M Baumgarten, Carson Max","doi":"10.1016/j.jse.2024.03.058","DOIUrl":"10.1016/j.jse.2024.03.058","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Reverse total shoulder arthroplasty (RTSA) can result in varying amounts of humeral medialization or lateralization. The amount of medial or lateral change-in-arm-position can be predicted using 3D computed tomography planning software. It is not clear if the preoperatively predicted change-in-arm-position correlates with the actual radiographically measured change-in-arm-position or if the predicted or actual change-in-arm-position correlates with patient-reported outcomes or complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who received RTSA underwent preoperative 3D computed tomography planning to predict the postoperative medial-to-lateral change-in-arm-position (PCAP). Preoperative and postoperative radiographs were used to calculate the actual medial-to-lateral change-in-arm-position using the measurement of the lateral edge of the greater tuberosity to the lateral edge of the acromion (RCAP-LHO). The Western Ontario Osteoarthritis Score (WOOS), American Shoulder and Elbow Surgeons score (ASES), and Single Assessment Numeric Evaluation (SANE) were recorded at baseline, 1 year, and 2 years. Rates of complications were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 250 patients were eligible for this study including 189 patients reaching the 1-year clinical follow-up point and 144 patients reaching the 2-year clinical follow-up point. One-year and 2-year follow-up rates were 89% and 91%, respectively. The mean PCAP was 3 ± 5 mm and the mean RCAP-LHO was 1 ± 8 mm. There was a moderate correlation between PCAP and RCAP-LHO. There was a weak correlation between increased PCAP lateralization and higher WOOS and ASES at 2 years and an improvement from baseline to 2 years in WOOS. There was a very weak correlation between increased PCAP lateralization and improvement compared with baseline in 1-year SANE and improvement compared with baseline in 2-year SANE. There was a weak correlation between lateralized RCAP-LHO and 2-year postoperative SANE. There was superior 2-year WOOS, ASES, and SANE, and improvement in SANE at 1 year compared with baseline in patients with a lateralized PCAP compared with a medialized or neutral PCAP. There was superior 2-year WOOS, improvement in WOOS from baseline to 2-year follow-up, and 2-year SANE in patients with a lateralized RCAP-LHO compared with a medialized or neutral RCAP-LHO. Overall complication rates were similar between groups although the dislocation rate in shoulders with a lateralized change-in-arm-position was significantly less than that in shoulders with a medial or neutral change-in-arm-position.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;PCAP correlated with actual RCAP-LHO. Correlations exist with increased humeral lateralization and improved patient-determined outcomes. Patient-determined outcomes in patients with a lateralized change-in-arm-position were the same as or better than those with a medialized or neutral change-in-arm-position. A lateralized change-","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":"2655-2663"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pathological formation of subcoracoid bursa effusion on magnetic resonance imaging studies. 磁共振成像研究中的冠状滑囊下积液病理形成。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-25 DOI: 10.1016/j.jse.2024.09.033
Daisuke Nakai, Shoji Fukuta, Jun Kawamata, Hiroshi Yonezu, Toru Maeda, Koichi Sairyo

Background: The subcoracoid space includes the subcoracoid bursa (SCB) and subscapular bursa (SSB). We aimed to clarify the relationship between the presence or amount of SCB effusion and other structures around the SCB on magnetic resonance imaging (MRI) and to discuss the pathological formation of SCB effusion.

Methods: Medical records and MR images of patients who had undergone MRI examinations for shoulder pain were retrospectively reviewed. The presence or absence of SCB, SSB, and subacromial-subdeltoid bursa (SASDB) effusion was evaluated. If SCB effusion was present, the largest diameter of the effusion was measured on sagittal images to represent the amount of SCB effusion. The presence or absence of communication between the SCB and SASDB or SSB effusion were also evaluated on sagittal and axial MRI.

Results: Eighty shoulders in 70 patients were analyzed. The mean age was 70.4 ± 10.4 (range, 50-87) years. Thirty-three of the 80 shoulders (41.3%) showed SCB effusion on MRI. The clinical diagnoses of these 33 shoulders were rotator cuff tear (RCT), n = 23; frozen shoulder, n = 6; subacromial impingement, n = 3; and calcific tendinopathy, n = 1. Multivariate logistic regression analysis showed that RCT (P = 0.015) and SSB effusion (P = 0.036) were significantly associated with the presence of SCB effusion, but SASDB effusion was not. In shoulders with RCT, the SCB communicated with the SASDB in 65.2%, and with the SSB in 4.3%. In other shoulders, the SCB communicated with the SASDB in 60.0%, and with the SSB in 40.0%. The rate of SCB-SSB communication was significantly higher in shoulders without RCT than in shoulders with RCT (P = 0.021). The largest diameter of SCB effusion was normally distributed in 33 shoulders (4.7-34.8 mm), and mean 19.6 ± 7.4 mm. The largest diameter of SCB effusion was 21.9 ± 6.3 mm in 23 shoulders with RCT, and 13.5 ± 6.8 mm in 10 other shoulders (P < 0.05). Multiple regression analysis showed that RCT (P = 0.002) and SSB effusion (P = 0.029) were significantly associated with the largest diameter of SCB effusion, but SASDB effusion was not.

Conclusion: SCB effusion can be recognized and extended by inflow from SASDB effusion in RCT. Without RCT, SCB effusion may occasionally be visible due to inflow from SSB effusion.

背景:肩胛下间隙包括肩胛下滑囊(SCB)和肩胛下滑囊(SSB)。我们的目的是明确磁共振成像(MRI)上弧下滑囊积液的存在或数量与弧下滑囊周围其他结构之间的关系,并探讨弧下滑囊积液的病理形成:方法:回顾性分析因肩部疼痛接受磁共振成像检查的患者的病历和磁共振图像。方法:回顾性分析因肩部疼痛接受磁共振成像检查的患者的病历和磁共振图像,评估是否存在SCB、SSB和肩峰下滑囊(SASDB)积液。如果存在肩峰滑囊积液,则在矢状面图像上测量积液的最大直径,以表示肩峰滑囊积液的量。矢状面和轴向核磁共振成像还评估了 SCB 与 SASDB 或 SSB 渗出物之间是否存在沟通:对 70 名患者的 80 个肩部进行了分析。平均年龄为 70.4 ± 10.4(50-87)岁。80 个肩部中有 33 个(41.3%)在磁共振成像中显示有 SCB 渗出。这 33 个肩部的临床诊断为肩袖撕裂(RCT),23 个;肩周炎,6 个;肩峰下撞击,3 个;钙化性肌腱病,1 个。多变量逻辑回归分析显示,RCT(P = 0.015)和SSB渗出(P = 0.036)与SCB渗出显著相关,但SASDB渗出与之无关。在有 RCT 的肩部中,65.2% 的 SCB 与 SASDB 相通,4.3% 的 SCB 与 SSB 相通。在其他肩部,60.0% 的 SCB 与 SASDB 沟通,40.0% 的 SCB 与 SSB 沟通。无 RCT 肩部的 SCB 与 SSB 沟通率明显高于有 RCT 的肩部(P = 0.021)。在 33 个肩部中,SCB 流出液的最大直径呈正态分布(4.7-34.8 毫米),平均值为 19.6 ± 7.4 毫米。在 23 个有 RCT 的肩部中,SCB 渗出物的最大直径为 21.9 ± 6.3 毫米,在其他 10 个肩部中,最大直径为 13.5 ± 6.8 毫米(P < 0.05)。多元回归分析显示,RCT(P = 0.002)和SSB渗出(P = 0.029)与SCB渗出的最大直径显著相关,但SASDB渗出与之无关:结论:在RCT中,SCB渗出可通过SASDB渗出的流入识别并扩展。结论:在 RCT 中,SCB 流出物可通过 SASDB 流出物的流入而被识别和扩展;在没有 RCT 的情况下,由于 SSB 流出物的流入,SCB 流出物可能偶尔可见。
{"title":"Pathological formation of subcoracoid bursa effusion on magnetic resonance imaging studies.","authors":"Daisuke Nakai, Shoji Fukuta, Jun Kawamata, Hiroshi Yonezu, Toru Maeda, Koichi Sairyo","doi":"10.1016/j.jse.2024.09.033","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.033","url":null,"abstract":"<p><strong>Background: </strong>The subcoracoid space includes the subcoracoid bursa (SCB) and subscapular bursa (SSB). We aimed to clarify the relationship between the presence or amount of SCB effusion and other structures around the SCB on magnetic resonance imaging (MRI) and to discuss the pathological formation of SCB effusion.</p><p><strong>Methods: </strong>Medical records and MR images of patients who had undergone MRI examinations for shoulder pain were retrospectively reviewed. The presence or absence of SCB, SSB, and subacromial-subdeltoid bursa (SASDB) effusion was evaluated. If SCB effusion was present, the largest diameter of the effusion was measured on sagittal images to represent the amount of SCB effusion. The presence or absence of communication between the SCB and SASDB or SSB effusion were also evaluated on sagittal and axial MRI.</p><p><strong>Results: </strong>Eighty shoulders in 70 patients were analyzed. The mean age was 70.4 ± 10.4 (range, 50-87) years. Thirty-three of the 80 shoulders (41.3%) showed SCB effusion on MRI. The clinical diagnoses of these 33 shoulders were rotator cuff tear (RCT), n = 23; frozen shoulder, n = 6; subacromial impingement, n = 3; and calcific tendinopathy, n = 1. Multivariate logistic regression analysis showed that RCT (P = 0.015) and SSB effusion (P = 0.036) were significantly associated with the presence of SCB effusion, but SASDB effusion was not. In shoulders with RCT, the SCB communicated with the SASDB in 65.2%, and with the SSB in 4.3%. In other shoulders, the SCB communicated with the SASDB in 60.0%, and with the SSB in 40.0%. The rate of SCB-SSB communication was significantly higher in shoulders without RCT than in shoulders with RCT (P = 0.021). The largest diameter of SCB effusion was normally distributed in 33 shoulders (4.7-34.8 mm), and mean 19.6 ± 7.4 mm. The largest diameter of SCB effusion was 21.9 ± 6.3 mm in 23 shoulders with RCT, and 13.5 ± 6.8 mm in 10 other shoulders (P < 0.05). Multiple regression analysis showed that RCT (P = 0.002) and SSB effusion (P = 0.029) were significantly associated with the largest diameter of SCB effusion, but SASDB effusion was not.</p><p><strong>Conclusion: </strong>SCB effusion can be recognized and extended by inflow from SASDB effusion in RCT. Without RCT, SCB effusion may occasionally be visible due to inflow from SSB effusion.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tyrolean Iceman's arrow injury to the shoulder: New insights into extent and survival time. 蒂罗尔冰人肩部中箭受伤:对受伤程度和存活时间的新认识。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-23 DOI: 10.1016/j.jse.2024.09.034
Jochen Weber, Joachim Wahl, Albert Zink
{"title":"Tyrolean Iceman's arrow injury to the shoulder: New insights into extent and survival time.","authors":"Jochen Weber, Joachim Wahl, Albert Zink","doi":"10.1016/j.jse.2024.09.034","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.034","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pain Relief Survivorship: A Comparison of Exactech Equinoxe Anatomic and Reverse Total Shoulder Arthroplasty for Primary Osteoarthritis. 疼痛缓解幸存者:埃佳特Equinoxe解剖和反向全肩关节置换术治疗原发性骨关节炎的比较。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-23 DOI: 10.1016/j.jse.2024.09.035
Kevin A Hao, Josie Elwell, Jennifer Traverse, Ryan W Simovitch, Thomas W Wright, Joseph J King, Bradley S Schoch

Background: Pain-relief plays a major deterministic role when assessing postoperative patient satisfaction; however, whether anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) provides the most durable pain-relief has not been studied. The purpose of this study was to evaluate the durability of pain-relief after aTSA compared to rTSA in patients undergoing surgery for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA).

Methods: A retrospective review of a multicenter shoulder arthroplasty database (Exactech Equinoxe) was performed. We included 1,848 aTSAs and 1,464 rTSAs performed for RCI-GHOA between 2007 and 2023. Pain after surgery was assessed postoperatively at 3-months, 6-months, and yearly thereafter. Average postoperative pain on a daily basis and pain at worst were compared between aTSA and rTSA up to 8-years postoperatively. Kaplan-Meier survivorship analysis for pain-relief maintenance was performed to compare the maintenance of clinically-relevant pain-relief defined as pain scores that achieved the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS). Maintenance of favorable patient satisfaction over time was also evaluated. Multivariable cox regression was performed to determine whether the type of prosthesis (aTSA vs. rTSA) was independently associated with pain recurrence.

Results: Maintenance of achievement of the MCID and SCB for both daily pain and pain at worst as well as favorable patient satisfaction was similar between aTSAs and rTSAs. However, aTSA had longer maintenance of average daily pain below the PASS compared to rTSA (P=.024). This was confirmed on multivariable cox regression analysis which found that rTSAs had a 34% greater likelihood of recurrence of postoperative average daily pain exceeding the PASS (VAS rating 1/10) compared to aTSAs.

Conclusion: Patients that undergo either aTSA or rTSA for RCI-GHOA and achieve initial pain-relief postoperatively can expect to maintain their clinically-relevant pain improvement at similar rates up to 8-years postoperatively. However, recurrence of low levels of daily pain was significantly higher after rTSA.

背景:在评估术后患者满意度时,疼痛缓解起着重要的决定性作用;然而,解剖型全肩关节置换术(aTSA)或反向全肩关节置换术(rTSA)是否能提供最持久的疼痛缓解还未得到研究。本研究的目的是评估接受肩袖接触性盂肱骨关节炎(RCI-GHOA)手术的患者在接受aTSA与rTSA手术后疼痛缓解的持久性:我们对一个多中心肩关节置换术数据库(Exactech Equinoxe)进行了回顾性研究。我们纳入了 2007 年至 2023 年间为 RCI-GHOA 实施的 1,848 例 aTSAs 和 1,464 例 rTSAs。术后疼痛在术后 3 个月、6 个月和之后每年进行一次评估。对 aTSA 和 rTSA 术后 8 年的每日平均疼痛和最严重疼痛进行了比较。对疼痛缓解的维持情况进行了卡普兰-梅耶生存分析,以比较临床相关疼痛缓解的维持情况,临床相关疼痛缓解是指达到最小临床意义差异(MCID)、实质性临床获益(SCB)和患者可接受症状状态(PASS)的疼痛评分。此外,还对患者满意度的长期维持情况进行了评估。为了确定假体类型(aTSA 与 rTSA)是否与疼痛复发独立相关,进行了多变量考克斯回归:结果:aTSA和rTSA在维持日常疼痛和最严重疼痛的MCID和SCB以及患者满意度方面的表现相似。然而,与 rTSA 相比,aTSA 的日平均疼痛维持时间更长,低于 PASS(P=.024)。多变量考克斯回归分析证实了这一点,该分析发现,与 aTSA 相比,rTSA 术后日均疼痛超过 PASS(VAS 评分 1/10)的复发几率要高出 34%:结论:接受 aTSA 或 rTSA 治疗 RCI-GHOA 并在术后获得初步止痛效果的患者,可望在术后 8 年内以相似的速度保持临床相关的疼痛改善。然而,rTSA术后低程度日常疼痛的复发率明显更高。
{"title":"Pain Relief Survivorship: A Comparison of Exactech Equinoxe Anatomic and Reverse Total Shoulder Arthroplasty for Primary Osteoarthritis.","authors":"Kevin A Hao, Josie Elwell, Jennifer Traverse, Ryan W Simovitch, Thomas W Wright, Joseph J King, Bradley S Schoch","doi":"10.1016/j.jse.2024.09.035","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.035","url":null,"abstract":"<p><strong>Background: </strong>Pain-relief plays a major deterministic role when assessing postoperative patient satisfaction; however, whether anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) provides the most durable pain-relief has not been studied. The purpose of this study was to evaluate the durability of pain-relief after aTSA compared to rTSA in patients undergoing surgery for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA).</p><p><strong>Methods: </strong>A retrospective review of a multicenter shoulder arthroplasty database (Exactech Equinoxe) was performed. We included 1,848 aTSAs and 1,464 rTSAs performed for RCI-GHOA between 2007 and 2023. Pain after surgery was assessed postoperatively at 3-months, 6-months, and yearly thereafter. Average postoperative pain on a daily basis and pain at worst were compared between aTSA and rTSA up to 8-years postoperatively. Kaplan-Meier survivorship analysis for pain-relief maintenance was performed to compare the maintenance of clinically-relevant pain-relief defined as pain scores that achieved the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS). Maintenance of favorable patient satisfaction over time was also evaluated. Multivariable cox regression was performed to determine whether the type of prosthesis (aTSA vs. rTSA) was independently associated with pain recurrence.</p><p><strong>Results: </strong>Maintenance of achievement of the MCID and SCB for both daily pain and pain at worst as well as favorable patient satisfaction was similar between aTSAs and rTSAs. However, aTSA had longer maintenance of average daily pain below the PASS compared to rTSA (P=.024). This was confirmed on multivariable cox regression analysis which found that rTSAs had a 34% greater likelihood of recurrence of postoperative average daily pain exceeding the PASS (VAS rating 1/10) compared to aTSAs.</p><p><strong>Conclusion: </strong>Patients that undergo either aTSA or rTSA for RCI-GHOA and achieve initial pain-relief postoperatively can expect to maintain their clinically-relevant pain improvement at similar rates up to 8-years postoperatively. However, recurrence of low levels of daily pain was significantly higher after rTSA.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Metal Punch vs. Drill for Rotator Cuff Anchor Socket Creation; Cadaveric and Clinical Comparisons. 用于创建肩袖锚定套筒的金属冲孔器与钻孔器;尸体与临床比较。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-22 DOI: 10.1016/j.jse.2024.09.036
Christopher M Loftis, Mubinah Khaleel, Mathew Resnick, Bree Baker, James L Cook, Clayton W Nuelle, Matthew Smith
<p><strong>Background: </strong>Arthroscopic rotator cuff repair has been shown to decrease pain and increase function of certain rotator cuff tears. One potential source of pain is the technique used for bone tunnel creation in the humerus prior to suture anchor placement. This study compared the standard metal punch method to a continuous drilling method for tunnel creation prior to subsequent suture anchor placement. Our hypothesis was that the use of a drill would result in less bony trauma and therefore superior resolution of postoperative pain following rotator cuff repair.</p><p><strong>Methods: </strong>Tunnels were created for six cadaveric (age: 50.83±3.25; male n=3; female n=3) shoulder humeri using a 4-anchor construct to mimic transosseous equivalent rotator cuff repair. Following suture fixation, μCT scans were performed for evaluation of peri-tunnel bone architecture. A tensile force was applied to the anchor through the suture material at a constant displacement rate of 1mm/s until ultimate failure of the construct. All statistical analyses were performed using SPSS (version 25; IBM, Armonk, NY, USA), and significance was set at p≤0.05. A total of 43 subjects between 18 and 80 years old were randomized into the study, with 22 in the drill group and 21 in the punch group. Following surgery, the first 5 patients in each cohort underwent MRI at the 2-week postoperative visit. Pain and other patient reported measures (PROMs) were assessed at all standard of care postoperative visits. Patient demographics and PROMs were assessed for significance within the groups using repeated ANOVA and unpaired t-test. A P-value of <0.05 was set for significance.</p><p><strong>Results: </strong>Preclinical - There were no statistically significant differences (p>0.05) between punched and drilled anchors with respect to peri-socket bone architecture and material properties. Clinical - There were no statistically significant differences (p>0.05) between punch and drill cohorts for assessments of pain, function, or bone marrow lesion size. However, the punch cohort reported statistically significant and clinically meaningful reductions in pain scores at 2 weeks, 6 weeks, 3 months, and 6 months compared to preoperative scores (p<0.02), whereas the drill cohort reported statistically significant and clinically meaningful reductions in pain scores at 6 weeks, 3 months, and 6 months after surgery (p <0.05). Similarly, the punch cohort reported statistically significant reductions in PROMIS pain interference scores, which were within 1 standard deviation of the healthy adult control population, at 2 weeks, 6 weeks, 3 months, and 6 months compared to preoperative scores (p <0.05), whereas the drill cohort did not report statistically significant improvements in PROMIS PI scores until 3 months postoperatively and were not within 1 standard deviation of the healthy adult control population until 6 months after surgery.</p><p><strong>Conclusion: </strong>Preclin
背景:关节镜下肩袖修复术已被证明可减轻某些肩袖撕裂的疼痛并增强其功能。疼痛的一个潜在来源是缝合锚放置前在肱骨中创建骨隧道的技术。本研究比较了标准金属冲孔法和连续钻孔法,前者用于在随后的缝合锚放置前创建隧道。我们的假设是,使用钻孔法可以减少骨创伤,从而更好地缓解肩袖修复术后的疼痛:方法: 使用 4 锚点结构为六具尸体(年龄:50.83±3.25;男性 n=3;女性 n=3)的肩肱骨创建隧道,以模拟经骨等效肩袖修复术。缝合固定后,进行μCT扫描以评估隧道周围的骨结构。以 1 毫米/秒的恒定位移速率通过缝合材料向锚点施加拉力,直至结构最终失效。所有统计分析均使用 SPSS(版本 25;IBM,Armonk,NY,USA)进行,显著性设定为 p≤0.05。共有 43 名年龄在 18 至 80 岁之间的受试者被随机纳入研究,其中钻孔组 22 人,打孔组 21 人。手术后,每组的前 5 名患者在术后 2 周进行核磁共振成像检查。在所有标准护理术后访视中对疼痛和其他患者报告指标(PROMs)进行了评估。采用重复方差分析和非配对 t 检验法评估患者人口统计学和 PROMs 在组内的显著性。P值为结果:临床前 - 在牙槽骨周围结构和材料特性方面,打孔锚和钻孔锚之间没有统计学意义上的显著差异(P>0.05)。临床 - 在疼痛、功能或骨髓病变大小的评估方面,打孔锚和钻孔锚之间没有明显的统计学差异(p>0.05)。然而,与术前评分相比,打孔组在2周、6周、3个月和6个月的疼痛评分均有统计学意义和临床意义的降低(p结论:临床前和临床数据表明,在关节镜下肩袖修复术中使用打孔法或钻孔法放置缝合锚是合理的,同时考虑到打孔法有可能更早地缓解疼痛。
{"title":"Metal Punch vs. Drill for Rotator Cuff Anchor Socket Creation; Cadaveric and Clinical Comparisons.","authors":"Christopher M Loftis, Mubinah Khaleel, Mathew Resnick, Bree Baker, James L Cook, Clayton W Nuelle, Matthew Smith","doi":"10.1016/j.jse.2024.09.036","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Arthroscopic rotator cuff repair has been shown to decrease pain and increase function of certain rotator cuff tears. One potential source of pain is the technique used for bone tunnel creation in the humerus prior to suture anchor placement. This study compared the standard metal punch method to a continuous drilling method for tunnel creation prior to subsequent suture anchor placement. Our hypothesis was that the use of a drill would result in less bony trauma and therefore superior resolution of postoperative pain following rotator cuff repair.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Tunnels were created for six cadaveric (age: 50.83±3.25; male n=3; female n=3) shoulder humeri using a 4-anchor construct to mimic transosseous equivalent rotator cuff repair. Following suture fixation, μCT scans were performed for evaluation of peri-tunnel bone architecture. A tensile force was applied to the anchor through the suture material at a constant displacement rate of 1mm/s until ultimate failure of the construct. All statistical analyses were performed using SPSS (version 25; IBM, Armonk, NY, USA), and significance was set at p≤0.05. A total of 43 subjects between 18 and 80 years old were randomized into the study, with 22 in the drill group and 21 in the punch group. Following surgery, the first 5 patients in each cohort underwent MRI at the 2-week postoperative visit. Pain and other patient reported measures (PROMs) were assessed at all standard of care postoperative visits. Patient demographics and PROMs were assessed for significance within the groups using repeated ANOVA and unpaired t-test. A P-value of &lt;0.05 was set for significance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Preclinical - There were no statistically significant differences (p&gt;0.05) between punched and drilled anchors with respect to peri-socket bone architecture and material properties. Clinical - There were no statistically significant differences (p&gt;0.05) between punch and drill cohorts for assessments of pain, function, or bone marrow lesion size. However, the punch cohort reported statistically significant and clinically meaningful reductions in pain scores at 2 weeks, 6 weeks, 3 months, and 6 months compared to preoperative scores (p&lt;0.02), whereas the drill cohort reported statistically significant and clinically meaningful reductions in pain scores at 6 weeks, 3 months, and 6 months after surgery (p &lt;0.05). Similarly, the punch cohort reported statistically significant reductions in PROMIS pain interference scores, which were within 1 standard deviation of the healthy adult control population, at 2 weeks, 6 weeks, 3 months, and 6 months compared to preoperative scores (p &lt;0.05), whereas the drill cohort did not report statistically significant improvements in PROMIS PI scores until 3 months postoperatively and were not within 1 standard deviation of the healthy adult control population until 6 months after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Preclin","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Normalization of the Constant score in the Spanish population. 西班牙人口恒定分数的正常化。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-21 DOI: 10.1016/j.jse.2024.09.031
Yaiza Lopiz, Daniel Garriguez-Pérez, Lucía Domínguez Jimenez, Carmen Artiles Martínez, Alfonso Barbero Cubero, Carlos García-Fernandez, Eduardo Ossuna Juntádez, Marta Echevarría-Marín, Fernando Marco

Background: Normal Constant score values for healthy shoulders can vary between regions and change over the years as life expectancy increases and physical condition improves. Spain's population is one of the healthiest and has one of the highest life expectancies in the world, which could be reflected in its normal Constant score values. The purpose of this study is finding the normal Constant score values in the Spanish population.

Methods: Cross-sectional study completed between 2023-2024, including subjects older than 18 years of age without any previous or ongoing shoulder condition. Constant score was taken for both shoulders of every subject. A stratified analysis of total and subtotal scores was performed, grouping subjects by age and sex.

Results: A total of 505 subjects and 1010 shoulders were included, with a mean age of 52.3 ± 18.6 years and men/women ratio of 39.6%/60.4%. Five groups were formed according to age: 18-30 years-old (18.4%), 31-45 years-old (16.4%), 46-60 years-old (29.8%), 61-75 years-old (23.7%), and over 75 years-old (11.7%). Each of these groups were divided in two groups according to sex, making a total of 10 groups. Mean Constant score was 88.9 ± 10.9, the group of men between 18-30 years-old having the highest mean score (99.2 ± 3.0) and the group of women over 75 years-old having the lowest mean score (75.3 ± 8.8). A statistically significant inverse correlation was found between total score and age (r = -.47, p < .001). Total score was also significantly lower in the women (84.5 ± 8.2 vs 92.6 ± 8.5, p < .001). The decrease in mobility (r = -.45, p < .001) and strength (r = -.40, p < .001), and the difference in strength between the men and the women (10.6 ± 3.8 vs 6.0 ± 2.0, p < .001) were the main underlying causes of the difference in total Constant score between groups.

Conclusion: Normal values of the Spanish version of the Constant score in healthy shoulders of the Spanish population decrease with age and are lower in women, the main differences being found in shoulder mobility and strength. Global scores found in this population are higher than those previously published for English, American, and Swiss populations.

背景:健康肩部的正常恒定分值会因地区而异,并随着预期寿命的延长和身体状况的改善而发生变化。西班牙是世界上最健康的国家之一,也是世界上预期寿命最高的国家之一,这可以从其正常恒定评分值中反映出来。本研究的目的是找出西班牙人口的正常恒定分值:横断面研究完成于 2023 年至 2024 年,研究对象包括年龄在 18 岁以上、以前或现在没有任何肩部疾病的人。对每位受试者的双肩进行恒定评分。根据年龄和性别对受试者的总分和小计分进行分层分析:共纳入 505 名受试者和 1010 个肩关节,平均年龄为 52.3 ± 18.6 岁,男女比例为 39.6%/60.4% 。根据年龄分为五组:18-30 岁(18.4%)、31-45 岁(16.4%)、46-60 岁(29.8%)、61-75 岁(23.7%)和 75 岁以上(11.7%)。每组按性别分为两组,共 10 组。恒定平均分为 88.9 ± 10.9,18-30 岁男性组的平均分最高(99.2 ± 3.0),75 岁以上女性组的平均分最低(75.3 ± 8.8)。据统计,总分与年龄之间存在明显的反相关关系(r = -.47,p < .001)。女性的总分也明显较低(84.5 ± 8.2 vs 92.6 ± 8.5,p < .001)。移动能力(r = -.45,p < .001)和力量(r = -.40,p < .001)的下降,以及男女之间力量的差异(10.6 ± 3.8 vs 6.0 ± 2.0,p < .001)是造成不同组间恒定总分差异的主要根本原因:结论:西班牙健康肩部康斯坦茨评分的正常值随年龄增长而降低,女性更低,主要差异体现在肩部活动度和力量上。在该人群中发现的总分高于之前公布的英国、美国和瑞士人群的总分。
{"title":"Normalization of the Constant score in the Spanish population.","authors":"Yaiza Lopiz, Daniel Garriguez-Pérez, Lucía Domínguez Jimenez, Carmen Artiles Martínez, Alfonso Barbero Cubero, Carlos García-Fernandez, Eduardo Ossuna Juntádez, Marta Echevarría-Marín, Fernando Marco","doi":"10.1016/j.jse.2024.09.031","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.031","url":null,"abstract":"<p><strong>Background: </strong>Normal Constant score values for healthy shoulders can vary between regions and change over the years as life expectancy increases and physical condition improves. Spain's population is one of the healthiest and has one of the highest life expectancies in the world, which could be reflected in its normal Constant score values. The purpose of this study is finding the normal Constant score values in the Spanish population.</p><p><strong>Methods: </strong>Cross-sectional study completed between 2023-2024, including subjects older than 18 years of age without any previous or ongoing shoulder condition. Constant score was taken for both shoulders of every subject. A stratified analysis of total and subtotal scores was performed, grouping subjects by age and sex.</p><p><strong>Results: </strong>A total of 505 subjects and 1010 shoulders were included, with a mean age of 52.3 ± 18.6 years and men/women ratio of 39.6%/60.4%. Five groups were formed according to age: 18-30 years-old (18.4%), 31-45 years-old (16.4%), 46-60 years-old (29.8%), 61-75 years-old (23.7%), and over 75 years-old (11.7%). Each of these groups were divided in two groups according to sex, making a total of 10 groups. Mean Constant score was 88.9 ± 10.9, the group of men between 18-30 years-old having the highest mean score (99.2 ± 3.0) and the group of women over 75 years-old having the lowest mean score (75.3 ± 8.8). A statistically significant inverse correlation was found between total score and age (r = -.47, p < .001). Total score was also significantly lower in the women (84.5 ± 8.2 vs 92.6 ± 8.5, p < .001). The decrease in mobility (r = -.45, p < .001) and strength (r = -.40, p < .001), and the difference in strength between the men and the women (10.6 ± 3.8 vs 6.0 ± 2.0, p < .001) were the main underlying causes of the difference in total Constant score between groups.</p><p><strong>Conclusion: </strong>Normal values of the Spanish version of the Constant score in healthy shoulders of the Spanish population decrease with age and are lower in women, the main differences being found in shoulder mobility and strength. Global scores found in this population are higher than those previously published for English, American, and Swiss populations.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons. 根据对 340 名外科医生的临床调查,提出肱骨近端骨折的新治疗算法。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-21 DOI: 10.1016/j.jse.2024.09.026
Maximilian Kerschbaum, Daniel Pangerl, Leopold Henssler, Michael Akers, Florian Zeman, Volker Alt, Lisa Klute

Background: The increasing incidence of proximal humeral fractures (PHF) poses complex challenges in determining the optimal therapeutic strategies due to the diverse fracture patterns and individual patient characteristics. Traumatologists and orthopedic surgeons face significant decisions, as potential consequences such as pain, functional limitations, and complications may significantly affect patients' quality of life. Given the varying viewpoints on appropriate treatment modalities, a thorough examination of current care practices is crucial.

Methods: An adaptive online survey was conducted to present realistic case scenarios, aimed at elucidating decision-making processes in the management of proximal humeral fractures. This survey encompassed relevant patient and fracture-related variables, employing a dynamic querying algorithm that featured up to 48 conceivable case scenarios.

Results: Analysis of 7012 case scenarios unveiled significant differences in treatment preferences across distinct patient age groups. Plate osteosynthesis emerged as the preferred modality for individuals under 50 years of age with complex fracture patterns. On the other hand, a balanced consideration between plate osteosynthesis and reverse shoulder arthroplasty was observed in the 50-70 age cohort. Notably, respondents favored reverse shoulder arthroplasty as the treatment modality of choice for individuals over 70 years of age. A treatment algorithm was developed to outline decision pathways concisely, considering these patient age groups and the option of reverse shoulder arthroplasty.

Discussion and conclusion: This study provides clinically relevant insights into therapeutic decision-making processes in the management of proximal humeral fractures. The illustration of treatment preferences through a visualized algorithm serves as a crucial tool for evidence-based clinical decision-making, offering potential in enhancing the individualized care spectrum for patients with PHF.

背景:肱骨近端骨折(PHF)的发病率越来越高,由于骨折模式和患者个体特征各不相同,因此在确定最佳治疗策略时面临着复杂的挑战。创伤学家和骨科医生面临着重大抉择,因为疼痛、功能限制和并发症等潜在后果可能会严重影响患者的生活质量。鉴于对适当治疗方式的观点不一,彻底检查当前的护理实践至关重要:方法:我们进行了一项适应性在线调查,以呈现真实的病例场景,旨在阐明肱骨近端骨折治疗的决策过程。该调查涵盖了与患者和骨折相关的变量,采用了动态查询算法,提供了多达 48 种可想象的病例情景:结果:对 7012 个病例进行分析后发现,不同年龄段患者的治疗偏好存在显著差异。对于 50 岁以下、骨折形态复杂的患者来说,钢板骨合成是首选治疗方式。另一方面,在 50-70 岁的人群中,钢板骨合成术和反向肩关节置换术之间的考虑较为均衡。值得注意的是,受访者倾向于将反向肩关节置换术作为 70 岁以上人群的首选治疗方式。考虑到这些患者的年龄组和反向肩关节置换术的选择,我们制定了一种治疗算法,以简明扼要地概述决策路径:本研究为肱骨近端骨折的治疗决策过程提供了具有临床意义的见解。通过可视化算法说明治疗偏好是循证临床决策的重要工具,为加强 PHF 患者的个体化治疗提供了可能。
{"title":"Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons.","authors":"Maximilian Kerschbaum, Daniel Pangerl, Leopold Henssler, Michael Akers, Florian Zeman, Volker Alt, Lisa Klute","doi":"10.1016/j.jse.2024.09.026","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.026","url":null,"abstract":"<p><strong>Background: </strong>The increasing incidence of proximal humeral fractures (PHF) poses complex challenges in determining the optimal therapeutic strategies due to the diverse fracture patterns and individual patient characteristics. Traumatologists and orthopedic surgeons face significant decisions, as potential consequences such as pain, functional limitations, and complications may significantly affect patients' quality of life. Given the varying viewpoints on appropriate treatment modalities, a thorough examination of current care practices is crucial.</p><p><strong>Methods: </strong>An adaptive online survey was conducted to present realistic case scenarios, aimed at elucidating decision-making processes in the management of proximal humeral fractures. This survey encompassed relevant patient and fracture-related variables, employing a dynamic querying algorithm that featured up to 48 conceivable case scenarios.</p><p><strong>Results: </strong>Analysis of 7012 case scenarios unveiled significant differences in treatment preferences across distinct patient age groups. Plate osteosynthesis emerged as the preferred modality for individuals under 50 years of age with complex fracture patterns. On the other hand, a balanced consideration between plate osteosynthesis and reverse shoulder arthroplasty was observed in the 50-70 age cohort. Notably, respondents favored reverse shoulder arthroplasty as the treatment modality of choice for individuals over 70 years of age. A treatment algorithm was developed to outline decision pathways concisely, considering these patient age groups and the option of reverse shoulder arthroplasty.</p><p><strong>Discussion and conclusion: </strong>This study provides clinically relevant insights into therapeutic decision-making processes in the management of proximal humeral fractures. The illustration of treatment preferences through a visualized algorithm serves as a crucial tool for evidence-based clinical decision-making, offering potential in enhancing the individualized care spectrum for patients with PHF.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acromial and Scapular Fractures after Reverse Shoulder Arthroplasty: Comparison of 3,018 Reverse Total Shoulders by Inlay and Onlay Humeral Component Design. 反向肩关节置换术后的肱骨和肩胛骨骨折:3,018例反向全肩手术中肱骨组件嵌入式设计与内置式设计的比较。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-21 DOI: 10.1016/j.jse.2024.09.029
Erick M Marigi, Stanley Eboh, Ian M Marigi, John W Sperling, Andrew S Pierce, Fred M Azar, Tyler J Brolin, Thomas W Throckmorton

Introduction: Periscapular fractures specifically acromial and scapular spine fractures, have been identified as one of the leading complications of RSA. However, very little is known of the etiology of these postoperative fractures, or how variations in humeral designs correlates with risk of postoperative fracture development. Therefore, the purpose of this study was to analyze the prevalence, timing, and relationship of humeral component design to acromial or scapular spine fractures.

Methods: A retrospective study of primary reverse total shoulder arthroplasty (RSA) performed for elective and traumatic indications from two tertiary institutions. Exclusions consisted of primary oncologic reconstructions, diagnosis of osteogenesis imperfecta, and less than 1 year of clinical follow-up. A total of 3,018 primary RSAs were included with a cohort of 1,739 (57.6%) females, a mean age of 71 years (range, 20 - 94 years), a mean BMI of 30.6 ± 6.6 kg/m2, and a mean follow-up of 6.4 ± 3.8 years. The implants utilized varied based on surgeon preference and included 9 different types. The humeral component of the RSA were categorized as an inlay design (n = 762; 25.2%), defined as a humeral component where the tray is seated within the metaphysis, or an onlay design (n = 2256; 74.8%) defined as a humeral component where the humeral tray sits on the metaphysis at the level of the humeral neck cut.

Results: A fracture of the acromion or scapular spine was radiographically identified in 64 of 3,018 (2.1%) RSA at an average of 8.5 months ± 12.6 months after surgery. The majority of fractures included the acromion (n = 57; 89.1%) and scapular spine (n = 7; 10.9). Non-operative management (n = 60; 93.8%) was the predominant treatment strategy for fractures, while 4 (6.2%) RSA underwent open reduction and internal fixation. When compared by humeral component design (inlay versus onlay), there was no differences in rates of acromial or scapular spine fractures (2.6% vs. 2.0%; P = .264). Similarly, there were no treatment differences between non-operative (90% vs. 95.5%) or operative management (10% vs. 4.5%) of the fractures based on the type of humeral component design (P = .403).

Conclusions: Acromial and scapular spine fractures complicated the postoperative course of 2.1% of primary RSA when performed across two high volume shoulder arthroplasty centers with multiple surgeons including a wide range of implant types. Most of the fractures involve the acromion, with less frequent involvement of the spine of the scapula. When comparing by inlay versus onlay humeral component design, the rates of postoperative acromial or scapular spine fractures were statistically similar.

简介肩胛骨周围骨折,特别是肩峰和肩胛骨脊柱骨折,已被确定为 RSA 的主要并发症之一。然而,人们对这些术后骨折的病因以及肱骨设计的变化与术后骨折发生风险的关系知之甚少。因此,本研究旨在分析肱骨组件设计与肩峰或肩胛骨骨折的发生率、时间和关系:方法:对两家三级医疗机构中因选择性和创伤性适应症进行的初次反向全肩关节置换术(RSA)进行回顾性研究。排除的病例包括原发性肿瘤重建、诊断为成骨不全及临床随访不足1年。共纳入了 3,018 例原发性 RSA,其中 1,739 例(57.6%)为女性,平均年龄为 71 岁(20 - 94 岁),平均体重指数(BMI)为 30.6 ± 6.6 kg/m2,平均随访时间为 6.4 ± 3.8 年。所使用的植入物根据外科医生的偏好而有所不同,包括 9 种不同类型的植入物。RSA的肱骨组件分为内嵌式设计(n = 762;25.2%)和外嵌式设计(n = 2256;74.8%),前者是指肱骨托盘位于骨骺内,后者是指肱骨托盘位于肱骨颈切口水平的骨骺上:在3018例RSA中,有64例(2.1%)在术后平均8.5个月(±12.6)个月时经X光检查发现肩峰或肩胛骨脊柱骨折。大多数骨折包括肩峰(57 例;89.1%)和肩胛骨脊柱(7 例;10.9%)。非手术治疗(n = 60;93.8%)是骨折的主要治疗策略,4 例(6.2%)RSA 接受了切开复位和内固定术。根据肱骨组件设计(内嵌式与外嵌式)进行比较,肩峰或肩胛骨脊柱骨折的发生率没有差异(2.6% vs. 2.0%; P = .264)。同样,根据肱骨组件的设计类型,骨折的非手术治疗率(90% vs. 95.5%)和手术治疗率(10% vs. 4.5%)也没有差异(P = .403):结论:在两家高产量肩关节置换中心,由多名外科医生和多种类型的植入物共同完成的一次RSA手术中,有2.1%的患者术后出现肩峰和肩胛骨骨折。大多数骨折涉及肩峰,而较少涉及肩胛骨脊柱。通过比较内嵌式与外嵌式肱骨组件设计,术后肩峰或肩胛骨脊柱骨折的发生率在统计学上相似。
{"title":"Acromial and Scapular Fractures after Reverse Shoulder Arthroplasty: Comparison of 3,018 Reverse Total Shoulders by Inlay and Onlay Humeral Component Design.","authors":"Erick M Marigi, Stanley Eboh, Ian M Marigi, John W Sperling, Andrew S Pierce, Fred M Azar, Tyler J Brolin, Thomas W Throckmorton","doi":"10.1016/j.jse.2024.09.029","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.029","url":null,"abstract":"<p><strong>Introduction: </strong>Periscapular fractures specifically acromial and scapular spine fractures, have been identified as one of the leading complications of RSA. However, very little is known of the etiology of these postoperative fractures, or how variations in humeral designs correlates with risk of postoperative fracture development. Therefore, the purpose of this study was to analyze the prevalence, timing, and relationship of humeral component design to acromial or scapular spine fractures.</p><p><strong>Methods: </strong>A retrospective study of primary reverse total shoulder arthroplasty (RSA) performed for elective and traumatic indications from two tertiary institutions. Exclusions consisted of primary oncologic reconstructions, diagnosis of osteogenesis imperfecta, and less than 1 year of clinical follow-up. A total of 3,018 primary RSAs were included with a cohort of 1,739 (57.6%) females, a mean age of 71 years (range, 20 - 94 years), a mean BMI of 30.6 ± 6.6 kg/m2, and a mean follow-up of 6.4 ± 3.8 years. The implants utilized varied based on surgeon preference and included 9 different types. The humeral component of the RSA were categorized as an inlay design (n = 762; 25.2%), defined as a humeral component where the tray is seated within the metaphysis, or an onlay design (n = 2256; 74.8%) defined as a humeral component where the humeral tray sits on the metaphysis at the level of the humeral neck cut.</p><p><strong>Results: </strong>A fracture of the acromion or scapular spine was radiographically identified in 64 of 3,018 (2.1%) RSA at an average of 8.5 months ± 12.6 months after surgery. The majority of fractures included the acromion (n = 57; 89.1%) and scapular spine (n = 7; 10.9). Non-operative management (n = 60; 93.8%) was the predominant treatment strategy for fractures, while 4 (6.2%) RSA underwent open reduction and internal fixation. When compared by humeral component design (inlay versus onlay), there was no differences in rates of acromial or scapular spine fractures (2.6% vs. 2.0%; P = .264). Similarly, there were no treatment differences between non-operative (90% vs. 95.5%) or operative management (10% vs. 4.5%) of the fractures based on the type of humeral component design (P = .403).</p><p><strong>Conclusions: </strong>Acromial and scapular spine fractures complicated the postoperative course of 2.1% of primary RSA when performed across two high volume shoulder arthroplasty centers with multiple surgeons including a wide range of implant types. Most of the fractures involve the acromion, with less frequent involvement of the spine of the scapula. When comparing by inlay versus onlay humeral component design, the rates of postoperative acromial or scapular spine fractures were statistically similar.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictive value of implant removal time and acromion-hook angle on subacromial osteolysis following hook plate fixation for acromioclavicular dislocation. 钩状钢板固定治疗肩锁关节脱位后,植入物移除时间和肩峰与钩角对肩峰下骨溶解的预测价值。
IF 2.9 2区 医学 Q1 ORTHOPEDICS Pub Date : 2024-11-21 DOI: 10.1016/j.jse.2024.09.027
Ligang Huang, Longjian Wang, Lijun Cai, Mingjun Fan, Pengzheng Yu, Dongpeng Tu

Background: Subacromial osteolysis is a typical complication following hook plate fixation for acromioclavicular (AC) dislocation. Many factors can affect the occurrence and progression of subacromial osteolysis (SAO). The objective of this study was to investigate the predictive value of the implant removal time and acromion-hook angle for subacromial osteolysis following hook plate fixation for AC dislocation.

Methods: We conducted a retrospective study of 66 patients who underwent hook plate fixation for AC dislocations. The presence and severity of subacromial osteolysis were assessed at the time of implant removal. Univariate and multivariate logistic regression analyses were conducted to identify the characteristics associated with subacromial osteolysis. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive performance of the implant removal time and acromion-hook angle.

Results: Of the 66 patients, 48 had subacromial osteolysis. Univariate analysis revealed that the implant removal time and acromion-hook angle were associated with subacromial osteolysis. Multivariate analysis revealed that the acromion-hook angle was the only factor independently associated with subacromial osteolysis. In the ROC analysis, the optimal cut-off values of implant removal time were 5.5 months for predicting the occurrence of osteolysis and 11.9 months for predicting the severity of osteolysis. The acromial-hook angle cut-off values were 10° for predicting the occurrence of osteolysis and 16° for predicting the severity of osteolysis.

Conclusion: The implant removal time and acromion-hook angle were significant risk factors for subacromial osteolysis following hook plate fixation. We recommend removing the implant within 5.5 months to minimize osteolysis risk and no more than 11.9 months to prevent severe osteolysis. Maintaining the acromion-hook angle at 10° or less is advised, whereas an angle of 16° or more may indicate a greater risk of severe osteolysis.

背景:肩峰下骨质溶解是钩状钢板固定治疗肩锁关节(AC)脱位后的典型并发症。许多因素都会影响肩峰下溶骨(SAO)的发生和发展。本研究的目的是探讨钩状钢板固定治疗肩锁关节脱位后,植入物取出时间和肩峰与钩角对肩峰下骨溶解的预测价值:我们对 66 例接受挂钩钢板固定治疗交流脱位的患者进行了回顾性研究。在移除植入物时对肩峰下骨溶解的存在和严重程度进行了评估。进行了单变量和多变量逻辑回归分析,以确定与肩峰下骨溶解相关的特征。对植入物取出时间和肩峰钩角度的预测性能进行了受体操作特征(ROC)分析:结果:66例患者中,48例出现肩峰下骨溶解。单变量分析显示,假体取出时间和肩峰钩角度与肩峰下骨溶解有关。多变量分析显示,肩峰钩角度是唯一与肩峰下骨溶解独立相关的因素。在ROC分析中,预测骨溶解发生的最佳截断值为5.5个月,预测骨溶解严重程度的最佳截断值为11.9个月。肱骨钩角度的临界值为10°,用于预测骨溶解的发生,16°用于预测骨溶解的严重程度:结论:钩状钢板固定术后,假体取出时间和肩峰与钩角是肩峰下骨溶解的重要风险因素。我们建议在 5.5 个月内取出假体,以将骨溶解风险降至最低;在不超过 11.9 个月内取出假体,以防止严重骨溶解。建议将肩峰与钩的角度保持在 10° 或更小,而 16° 或更大的角度可能预示着更大的严重骨溶解风险。
{"title":"Predictive value of implant removal time and acromion-hook angle on subacromial osteolysis following hook plate fixation for acromioclavicular dislocation.","authors":"Ligang Huang, Longjian Wang, Lijun Cai, Mingjun Fan, Pengzheng Yu, Dongpeng Tu","doi":"10.1016/j.jse.2024.09.027","DOIUrl":"https://doi.org/10.1016/j.jse.2024.09.027","url":null,"abstract":"<p><strong>Background: </strong>Subacromial osteolysis is a typical complication following hook plate fixation for acromioclavicular (AC) dislocation. Many factors can affect the occurrence and progression of subacromial osteolysis (SAO). The objective of this study was to investigate the predictive value of the implant removal time and acromion-hook angle for subacromial osteolysis following hook plate fixation for AC dislocation.</p><p><strong>Methods: </strong>We conducted a retrospective study of 66 patients who underwent hook plate fixation for AC dislocations. The presence and severity of subacromial osteolysis were assessed at the time of implant removal. Univariate and multivariate logistic regression analyses were conducted to identify the characteristics associated with subacromial osteolysis. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive performance of the implant removal time and acromion-hook angle.</p><p><strong>Results: </strong>Of the 66 patients, 48 had subacromial osteolysis. Univariate analysis revealed that the implant removal time and acromion-hook angle were associated with subacromial osteolysis. Multivariate analysis revealed that the acromion-hook angle was the only factor independently associated with subacromial osteolysis. In the ROC analysis, the optimal cut-off values of implant removal time were 5.5 months for predicting the occurrence of osteolysis and 11.9 months for predicting the severity of osteolysis. The acromial-hook angle cut-off values were 10° for predicting the occurrence of osteolysis and 16° for predicting the severity of osteolysis.</p><p><strong>Conclusion: </strong>The implant removal time and acromion-hook angle were significant risk factors for subacromial osteolysis following hook plate fixation. We recommend removing the implant within 5.5 months to minimize osteolysis risk and no more than 11.9 months to prevent severe osteolysis. Maintaining the acromion-hook angle at 10° or less is advised, whereas an angle of 16° or more may indicate a greater risk of severe osteolysis.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Shoulder and Elbow Surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1