Objective To review present situation and progress in cl inically treating floating shoulder injury. Methods Recent l iterature concerned treatment of floating shoulder injury was reviewed and analyzed in terms of anatomy, pathogenesis, diagnosis, and treatment. Results Conservative treatment and operative treatment can get good outcome. But the value of the results was l imited, because different evaluation criteria were used in the l iterature. Conclusion There is no uniform standards about the treatment of the floating shoulder injury. Both conservative treatment and operative treatment have advantages and disadvantages, which method will be used to treat the floating shoulder injury based on local damage and the patient’s general condition.
Objective To investigate the key parameters of three-dimensional anatomy of the proximal humerus and compare the differences between male and female, and between left and right sides in Chinese by volume rendering technique with multi-slice spiral CT (MSCT) so as to provide a reference for a new prosthesis of the proximal humerus which can adjust to the anatomical characteristics of Chinese. Methods A total of 100 healthy volunteers were collected from Chongqing of China, including 59 males and 41 females with an average age of 40.4 years (range, 21-57 years). The humeral retroversion angle (RA), neck-shaft angle (NSA), medial offset (MO), and posterior offset (PO) were measured by volume rendering technique with MSCT. The average values were compared between male and female and between left and right sides, the correlation of these parameters was also analysed. Results In 100 volunteers (200 sides), the RA was (19.9 ± 10.6)°, the NSA was (134.7 ± 3.8)°, the MO was (4.0 ± 1.1) mm, and the PO was (2.6 ± 1.3) mm. There were significant differences in RA and MO between left and right sides (Plt; 0.05); there was no significant difference in NSA and PO between left and right sides (P gt; 0.05). The PO and RA of both sides in male were significantly larger than those in female (P lt; 0.05); the NSA and MO in male were similar to those in female (P gt;0.05). PO was correlated positively with RA (r=0.617, P=0.000); MO was not correlated with NSA (r= —0.124, P=0.081). Conclusion Because of significant side differences in RA and MO, and significant gender differences in RA and PO, the differences should be considered in the design of new proximal humeral prosthesis and proximal humerus reconstruction.
【Abstract】 Objective To study the shoulder anatomy characteristics of the Chinese people and to design a newkind of humeral prosthesis, which could real ize the adjustment in three-dimensional space and be adjusted repeatedly, based on Chinese humeral anatomy characteristics. Methods A double-gear structure as a rotating part was adopted to design the structure of this new kind humeral prosthesis. Results The humeral prosthesis could satisfy both the needs of Chinese individual shoulder characteristics and the Westerners’ demands. Conclusion A novel concept of shoulder prosthesis design with a b appl ication value in design and development of the new prosthesis is proposed.
ObjectiveTo summarize the effectiveness of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after internal fixation of the proximal humeral fracture.MethodsBetween June 2014 and January 2018, 17 patients with deep infection and humeral head necrosis or bone nonunion after internal fixation of proximal humeral fractures were treated. There were 8 males and 9 females, aged from 52 to 78 years (mean, 63.8 years). The infection occurred at 19-66 months after the initial internal fixation (mean, 34.8 months). Microbial culture of joint fluid was positive in 14 cases and negative in 3 cases. The preoperative Constant score, American shoulder and elbow surgeons (ASES) score, and visual analogue scale (VAS) score were 36.41±8.65, 31.06±7.43, and 7.29±0.99, respectively. The preoperative ranges of forward flexion, abduction, external rotation were (45.88±12.46), (42.18±12.31), and (16.76±4.92)°, respectively. The preoperative range of internal rotation was buttock in 9 cases, lumbosacral joint in 3 cases, L3 in 5 cases. At the first-stage surgery, the thorough debridement was done and the antibiotic-impregnated bone cement spacer was placed after the removal of internal fixation. After the infections disappeared, the two-stage reverse total shoulder arthroplasty was performed. The mean interval between the two procedures was 4.2 months (range, 3.0-6.5 months).ResultsAll the incisions healed primarily and no complications such as recurrent infection or vascular nerve injury occurred. All patients were followed up 15-32 months (mean, 22.0 months). At last follow-up, the ranges of forward flexion, abduction, and external rotation were (109.00±23.66), (98.53±16.92), (41.41±6.82)°, respectively; and the range of internal rotation was lumbosacral joint in 5 cases, L3 in 8 cases, T12 in 4 cases. The range of motion of shoulder joints at last follow-up was significant improved when compared with the preoperative range of motion (P<0.05). The Constant score (64.88±8.70), ASES score (65.18±8.10), and VAS score (2.94±1.25) were significantly superior to the preoperative scores (P<0.05). X-ray films showed that no prosthesis loosening occurred.ConclusionTwo-stage reverse total shoulder arthroplasty is an effective treatment for the postoperative deep infection after internal fixation of the proximal humeral fracture, which has advantages of low risk of infection recurrence, good shoulder function, and satisfactory short-term effectiveness.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=−12.07 min, 95%CI (−17.21, −6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=−1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (−0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
OBJECTIVE: To study the reconstructional method and effect of shoulder joint function in the older obstetrical palsy with medial rotation contracture deformity. METHODS: From April 1996 to July 1999, 7 patients of older obstetrical palsy were adopted in this study. Among them, there were 5 males and 2 females, aged from 13 to 21 years old. No previous operation history and the main deformity was medial rotation contracture of shoulder. During operation, these patients were treated with "Z"-shape elongation of the tendon of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. RESULTS: Followed up for 6 to 44 months(averaged 19 months), the Gilbert grading and Mallet scoring were 1.57, 7.57 preoperatively versus 3.45, 10.86 postoperatively, the abduction and external rotation of the shoulder joints recovered obviously. CONCLUSION: It is an effective operation for the older obstetrical palsy with medial rotation contracture of shoulder.
Objective To investigate the operative method and cl inical results of arthroscopic assisted treatment of shoulder dislocation combined with fracture of greater tuberosity of humerus. Methods From February 2006 to June 2008,12 cases of shoulder dislocation (6 left, 6 right) combined with greater tuberosity fractures were treated. There were 4 males and 8 females with an average of 58.5 years (range 34-79 years). Eleven cases fall down and one was crushed. The time from injury to hospital averaged 2.1 hours (range 30 minutes-24 hours). X-ray films revealed greater tuberosity fractures with average 5.8 mm (range 5-12 mm) displacement, and MRI showed Bankart lesion in 2 cases. Arthroscopic examination taken 3-14 days after reduction revealed 3 cases of Bankart lesion and 1 case of SLAP lesion. Three cases of great tuberosity fractures were fixed with canulated screws, 2 cases with absorbable screws, 7 cases with titanium suture anchor. Three cases were repaired under arthroscopy, and 9 cases were repaired under arthroscopic assistance mini-incision. Results All the incisions were healed at first intention without infection. All patients were followed up for 6-32 months (average 16 months). The shoulder joints were fixed stably without redislocation. Six months after operation, there were 3 cases with mild l imitation of abduction and 1 case with pain in flexion related with impingement. The X-ray films showed all fractures healed 2-6 months after operation (average 3.2 months). The American Shoulder and Elbow Surgeons and University of Cal ifornia at Los Angeles scores were 16.03 ± 1.03 and 32.65 ± 4.83, respectively. Eight cases were excellent, 3 were good, 1 were fair and the excellent and good rate was 91.7%. Conclusion For shoulder dislocation combined with fracture of greater tuberosity of humerus, the treatment by shoulder arthroscopy is a safe and mini-invasive operative method with comprehensively accurate intraoperation diagnosis, satisfying therapeutic effect, good functional recovery, as well as obvious rel ief of pain.
ObjectiveTo investigate the cl inical characteristics of Eyres type V coracoid fracture combined with superior shoulder suspensory complex (SSSC) injuries, and the effectiveness of open reduction and fixation. MethodsBetween March 2004 and July 2012, 13 patients with Eyres type V coracoid fracture and SSSC injuries were treated. There were 10 males and 3 females with an average age of 41 years (range, 23-59 years). Injury was caused by fall ing from height in 4 cases, by traffic accident in 6 cases, and by impact of the heavy weight in 3 cases. The interval from injury to operation was 3-10 days (mean, 5.2 days). SSSC injuries included 9 cases of acromioclavicular joint dislocation, 5 cases of clavicular fractures, and 4 cases of acromion fractures. The coracoid fractures were fixed with cannulated screws; the acromioclavicular joint dislocations were fixed with hook plate (6 cases) or Kirschner wires (2 case) except 1 untreated case; the clavicular fractures were fixed with anatomical locking plate (3 cases) and hook plate (2 cases); the acromion fractures were fixed with cannulated screws (1 case), Kirschner wires (2 cases), or both of them (1 case). ResultsThe mean operation time was 158.0 minutes (range, 100-270 minutes), and the mean intraoperative blood loss was 207.7 mL (range, 150-300 mL). The other patients obtained primary healing of incision except 1 patient who had inflammation around incision, which was cured after change dressing. All patients were followed up for 22.6 months on average (range, 17-35 months). All fractures achieved union at a mean time of 3.6 months (range, 2-6 months). No nerve injury and implant fixation failure complications were observed. At last follow-up, the Constant score and the disabil ity of the arm, shoulder, and hand (DASH) score had a significant improvement when compared with scores at pre-operation (P<0.05). The shoulder range of motion in flexion, abduction, and external rotation at last follow-up were significantly higher than those at pre-operation (P<0.05). ConclusionEyres type V coracoid fracture associated with SSSC injuries usually results in the instabil ity of the shoulder. With individual surgical treatment, the satisfactory function and good effectiveness can be obtained.
ObjectiveTo compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. Methods A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score (P>0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences (P<0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films.Results All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B (P>0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups (P<0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups (P<0.05), there was no significant difference in other indicators between the two groups (P>0.05). ConclusionArthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.
ObjectiveTo investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations. Methods Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index. ResultsMultiple linear regression analysis showed that the K value had no correlation with the inclusion index (P>0.05), and was positively correlated with the chimerism index and the fit index (P<0.05). Regression equation was K=–24.898+35.982×inclusion index+8.280×fit index, R2=0.084. ConclusionHumeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.