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International Journal of Shoulder Surgery最新文献

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12 Superior Capsular Reconstruction 12上囊重建
Q Medicine Pub Date : 2019-01-01 DOI: 10.1055/b-0039-167661
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引用次数: 0
52 Patient-Specific Instrumentation for Severe Deformity in Reverse Shoulder Arthroplasty 严重畸形肩关节置换术患者特异性内固定
Q Medicine Pub Date : 2019-01-01 DOI: 10.1055/b-0039-167701
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引用次数: 0
68 Open Reduction and Internal Fixation of Midshaft Clavicle Fracture 68锁骨中轴骨折切开复位内固定
Q Medicine Pub Date : 2019-01-01 DOI: 10.1055/b-0039-167717
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引用次数: 0
49 Superior Approach to the Shoulder 49肩部进路
Q Medicine Pub Date : 2019-01-01 DOI: 10.1055/b-0039-167698
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引用次数: 0
51 Reverse Shoulder Arthroplasty with a Shaped Humeral Head Autograft for B2/B3 and C Glenoids 自体肱骨头成形肩关节置换术治疗B2/B3和C型肩关节
Q Medicine Pub Date : 2019-01-01 DOI: 10.1055/b-0039-167700
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引用次数: 0
1 Subacromial Decompression and Acromioplasty 1肩峰下减压和肩峰成形术
Q Medicine Pub Date : 2019-01-01 DOI: 10.1055/b-0039-167650
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引用次数: 0
Blood transfusion after total shoulder arthroplasty: Which patients are at high risk? 全肩关节置换术后输血:哪些患者高危?
Q Medicine Pub Date : 2016-04-01 DOI: 10.4103/0973-6042.180719
Abdurrahman Kandil, Justin W Griffin, Wendy M Novicoff, Stephen F Brockmeier

Purpose: There are multiple reported risk factors and a wide range of reported blood transfusion rates for total shoulder arthroplasty (TSA). There are no evidence-based guidelines for blood transfusions in TSA patients.

Materials and methods: We utilized the Nationwide Inpatient Sample to analyze 51,191 patients undergoing TSA between 1998 and 2011. The purpose was to describe the incidence and identify the preoperative factors that are independently associated with blood transfusion after TSA. In addition, we studied the association of blood transfusions with certain variables such as length of stay (LOS), total charges, and payer status.

Results: The blood transfusion rate in our study was 6.1%. There was no difference in the rate of blood transfusions over the study period (P < 0.001). In our logistic regression model, significant associations were found with increased age (odds ratio [OR] =1.03), white race (OR = 1.05), higher Charlson-Deyo score (OR = 1.12), presence of ischemic heart disease (OR = 1.24), blood loss anemia (OR = 1.65), female gender (OR = 1.94), presence of coagulation disorders (OR = 2.25), and presence of deficiency anemia (OR = 3.5). Patients receiving a blood transfusion had higher total charges, a longer hospital LOS, and were more likely to be Medicare payers (P < 0.001).

Conclusions: Our study found five clinically significant risk factors for blood transfusions for TSA: female gender, ischemic heart disease, deficiency anemia, coagulation disorder, and blood loss anemia. Patients with these risk factors should be considered higher risk for requiring a blood transfusion after TSA and counseled appropriately.

Level of evidence: Level II, retrospective cohort study, prognostic study.

目的:全肩关节置换术(TSA)有多种危险因素和广泛的输血率报道。对于TSA患者的输血,没有基于证据的指导方针。材料和方法:我们利用全国住院患者样本对1998年至2011年间接受TSA的51,191例患者进行了分析。目的是描述TSA后输血的发生率并确定与输血独立相关的术前因素。此外,我们研究了输血与某些变量的关系,如住院时间(LOS)、总费用和付款人状态。结果:本组患者输血率为6.1%。在研究期间,输血率没有差异(P < 0.001)。在我们的logistic回归模型中,发现年龄增加(优势比[OR] =1.03)、白种人(OR = 1.05)、较高的Charlson-Deyo评分(OR = 1.12)、存在缺血性心脏病(OR = 1.24)、失血性贫血(OR = 1.65)、女性(OR = 1.94)、存在凝血障碍(OR = 2.25)和存在缺乏性贫血(OR = 3.5)具有显著相关性。接受输血的患者总费用较高,住院时间较长,并且更有可能是医疗保险支付者(P < 0.001)。结论:我们的研究发现了5个临床显著的TSA输血危险因素:女性、缺血性心脏病、缺乏性贫血、凝血功能障碍和失血性贫血。有这些危险因素的患者应考虑在TSA后输血的高风险,并给予适当的建议。证据等级:II级,回顾性队列研究,预后研究。
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引用次数: 32
Observation of initial postoperative radiolucent lines using a modern pegged-glenoid design. 使用现代钉状蝶鞍设计观察术后初期放射线。
Q Medicine Pub Date : 2016-04-01 DOI: 10.4103/0973-6042.180718
Nathan G Everding, Jonathan C Levy, Nathan T Formaini, Sara Blum, Carlos C Gil, Kevin Verde

Purpose: Glenoid component loosening remains a common mode of failure for total shoulder arthroplasty and has inspired improvements in implant design, instrumentation, and surgical technique. The purpose of this manuscript was to evaluate the incidence of radiolucent lines and glenoid seating on initial postoperative radiographs using a modern pegged-glenoid design, instrumentation, and surgical technique.

Materials and methods: We performed a retrospective analysis of a consecutive series of 100 pegged-glenoid total shoulder replacements. In cases of excessive glenoid version, the glenoid was asymmetrically reamed to recreate more normal version. Initial postoperative radiographs were evaluated for the presence of radiolucent lines and completeness of glenoid seating. The preoperative glenoid version measured on axial computed tomography (CT) scans was used to compare differences in version among those with complete and incompletely seated glenoids.

Results: The rate of radiolucent lines observed on postoperative radiographs was 0%. Complete glenoid seating (Grade A) was observed in 81 patients (observer 1) and 82 patients (observer 2). Measurements of preoperative CT scans found a higher percentage of abnormal glenoid version for incompletely seated glenoids (47%) than completely seated glenoids (34%) but no significant difference (P = 0.327). The mean preoperative glenoid retroversion for incompletely seated glenoids was 12.1° and 9.1° for completely seated glenoids (P = 0.263).

Conclusions: Modern surgical techniques, surgical instrumentation, and peg glenoid design have facilitated the ability to eliminate radiolucent lines on initial postoperative radiographs with high rates of complete seating of glenoid components. Incomplete seating may be related to incomplete correction of glenoid version.

目的:盂成形组件松动仍是全肩关节置换术的常见失败模式,促使植入物设计、器械和手术技术不断改进。本稿件旨在评估采用现代钉式盂成形设计、器械和手术技术的术后初始X光片上放射线和盂成形的发生率:我们对连续100例钉式盂成形全肩关节置换术进行了回顾性分析。在盂成形过度的病例中,我们对盂进行了不对称铰接,以重建更正常的盂成形。对术后初次X光片进行评估,以确定是否存在放射线和盂成形是否完整。利用轴向计算机断层扫描(CT)测量的术前盂成形度来比较盂成形完全与不完全就位者的盂成形度差异:结果:术后X光片上观察到的放射线比率为0%。81名患者(观察者1)和82名患者(观察者2)的盂骨完全就位(A级)。术前 CT 扫描的测量结果显示,未完全就位的盂成形异常比例(47%)高于完全就位的盂成形异常比例(34%),但无显著差异(P = 0.327)。不完全坐位盂成形术前的平均盂后倾角为12.1°,完全坐位盂成形术前的平均盂后倾角为9.1°(P = 0.263):结论:现代手术技术、手术器械和髋臼设计有助于消除术后初次X光片上的放射线,髋臼组件的完全就位率很高。未完全就位可能与盂成形未完全矫正有关。
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引用次数: 0
Accuracy of patient-specific instrumentation in anatomic and reverse total shoulder arthroplasty. 解剖和反向全肩关节置换术中患者特异性内固定的准确性。
Q Medicine Pub Date : 2016-04-01 DOI: 10.4103/0973-6042.180717
Richard James Dallalana, Ryan A McMahon, Ben East, Liam Geraghty

Purpose: Glenoid component malposition is associated with poor function and early failure of both anatomic and reverse total shoulder arthroplasty. Glenoid positioning is challenging particularly in the setting of bone loss or deformity. Recently, the use of computer assistance has been shown to reduce implantation error. The aim of this study is to evaluate the accuracy of patient-specific instrumentation in cases of anatomic and reverse shoulder replacement in vivo.

Methods: Twenty patients underwent total shoulder arthroplasty using a computed tomography (CT)-based patient-specific instrumentation (PSI) system, ten anatomic and ten reverse. Preoperative three-dimensional digital templating of glenoid component position was undertaken and surgery then performed using a custom-made guide. Postoperative CT scans were used to compare final implanted component position to the preoperatively planned position in the same patient.

Results: Final component position and orientation closely reflected the preoperatively templated position. Mean deviation in the glenoid version from planned was 1.8° ±1.9° (range, 0.1°-7.3°). Mean deviation in inclination was 1.3° ±1.0° (range, 0.2°-4.5°). Mean deviation in position on the glenoid face was 0.5 ± 0.3 mm (range, 0.0-1.3 mm) in the anteroposterior plane and 0.8 ± 0.5 mm (range, 0.0-1.9 mm) in the superoinferior plane. Actual achieved version was within 7° of neutral in all cases except for one where it was deliberately planned to be outside of this range.

Conclusion: PSI in both anatomic and reverse shoulder arthroplasty is highly accurate in guiding glenoid component implantation in vivo. The system can reliably correct bony deformity.

目的:关节盂假体错位与解剖和反向全肩关节置换术功能差和早期失败有关。关节盂定位具有挑战性,特别是在骨质丢失或畸形的情况下。最近,使用计算机辅助已被证明可以减少植入误差。本研究的目的是评估在活体解剖和反向肩关节置换术中患者特异性内固定的准确性。方法:20例患者采用基于计算机断层扫描(CT)的患者专用内固定(PSI)系统行全肩关节置换术,10例解剖,10例反向。术前对关节盂假体位置进行三维数字模板,然后使用定制的导向器进行手术。术后CT扫描用于比较同一患者的最终植入部件位置与术前计划位置。结果:最终构件的位置和方位与术前模板位置吻合较好。关节盂版本与计划的平均偏差为1.8°±1.9°(范围0.1°-7.3°)。平均倾角偏差为1.3°±1.0°(范围0.2°-4.5°)。关节盂面位置的平均偏差在前后平面为0.5±0.3 mm(范围,0.0-1.3 mm),在上下平面为0.8±0.5 mm(范围,0.0-1.9 mm)。实际实现的版本在所有情况下都在中性的7°范围内,除了一个故意计划在这个范围之外。结论:PSI在解剖和反向肩关节置换术中都能高度准确地指导关节内假体植入。该系统可以可靠地矫正骨畸形。
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引用次数: 62
Arthroplasty of the shoulder joint. 肩关节成形术。
Q Medicine Pub Date : 2016-04-01 DOI: 10.4103/0973-6042.180716
Joe de Beer, Deepak N Bhatia
In 2016, the shoulder community hails the forward thinking of Charles S. Neer, II who designed the first shoulder replacement system to deal with painful arthritic shoulders. The solution was clearly needed: shoulder replacement has increased, developed, and surged with leaps and bounds all over our planet (53,000 shoulder replacements are done annually in the USA only). The initial clinical problem catered for was degenerative joint disease of the shoulder joint, but the principle proved so successful that other pathologies of the shoulder that proved to be amenable to related procedures.
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引用次数: 1
期刊
International Journal of Shoulder Surgery
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