Objective To estimate the clinical curative effect of replacement of inverttype artificial total scapula and shoulder joint prosthesis and reserving arm with rehabilitation of function in the treatment of malignant tumor in shoulder. Methods From February 2001 and November 2004, five youth patients with primary malignant shoulder tumors were treated operatively by resection of neoplasmsthoroughly, replacement of inverttype artificial total shoulder blade and joint prosthesis, the functional reconstruction. Of them, there were 4 males and 1 female, aging from 19 to 26 years with an average of 23.6 years. Two cases were diagnosed as having osteosarcoma, one as having chondrosarcoma, and 2 as having Ewing sarcoma. After operation, the upper limbs was immobilized for 3 weeks. The rehabilitation training including passive exercise and initiative exercise. Results The average operative time was 425 min (380 to 530 min), and the blood loss ranged from 1 250 ml to1 900 ml(1 540 ml on average). The follow-up ranged from 7 to52 onths,with an average of 24.6 months. Postoperative complication included 1 case of pneumothorax, one case of shoulder incision skin part necrosis and 1 case of clavicle stump raising and pierce skin with shallow infection. No complication of postoperative incision deeply infection, nerve damage and prosthesis exposure or dislocation occurred. According to the scoring system of JOA(Japan orthopaedics association), the average score was 65 (60 to 72). The flexion and extension function of elbow joint recovered to normal. Conclusion The replacement of inverttype artificial total scapula and shoulder joint prosthesis is an efficacious method for the treatment of malignant tumor in shoulder. There are advantages of numerous adaption, wide range of motion and goodstability. It can not only reserve arm but also rehabilitate function.
Objective To introduce a new approach of neurotization to treatment of the shoulder syndrome after the radical neck dissection by using transpositional anastomosis of C7 posterior root and the spinal accessory nerve to reconstruct the function of trapezius muscle. Methods From March 1999 to February 2001, 10 patients underwent the neurotization during the radical neck dissection. In the operation, the apo-cranial part of spinal accessory nerve was preserved from the trapezius muscle (gt;3.0 cm in length) and anastomosed to C7 posterior root. Objective physical examinations and electromyography were conducted before and after operation.One, 6 and 12 months after operation the trapezius muscle function after the transpositional anastomosis was evaluated. Results One, 6 and 12 months after operation, the recovery rates of each part were as follows: 9.8%, 68.9% and 73.5% in upper part; 4.7%, 73.6% and 69.4% in middle part; and 6.2%, 70.5% and 70.3% in lower part. The range of abduction motion of upper arm in 7 cases (70%) exceeded 90°. The mean maximal abduction angle was more than 95°. Evaluation of the shoulder function showed that myoatrophy was mild and the disability of abduction was classified as grade Ⅱ in 7 cases and grade Ⅲ in 3 cases. Conclusion Transpositional anastomosis of the C7 posterior root to thespinal accessory nerve after radical neck dissection can well reconstruct the function of trapezius muscle. This approach provides a wide indication in comparison with the functional neck dissection without impairment of arm function afterthe cutting of C7.
ObjectivesTo systematically review the clinical efficacy of ultrasound-guided percutaneous lavage (UGPL) for calcifying tendinitis of rotator cuff.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CBM, VIP and CNKI databases were electronically searched to collect the randomized controlled trials (RCTs) of ultrasound-guided percutaneous irrigation for calcifying tendinitis of rotator cuff from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 587 patients were included. The results of meta-analysis showed that: there were significant differences between the UGPL group and extracorporeal shock wave therapy (ESWT) group in 12-month follow-up visual analogue scale (VAS) (MD=–1.96, 95%CI –2.18 to –1.75, P<0.000 01), the average particle size of the calcium deposition (MD=–3.13, 95%CI –5.05 to –1.22,P<0.001), the calcification disappearance rate (RR=1.65, 95%CI 1.36 to 2.01,P<0.000 01). However, there were no significant differences between the two groups in 6-week follow-up VAS (MD=–0.85, 95%CI –2.84 to 1.14,P=0.40), and the complications (RR=1.20, 95%CI 0.03 to 49.69, P=0.93).ConclusionsCurrent evidence shows that UGPL has certain clinical effect for the calcifying tendinitis of rotator cuff. Compared with ESWT, UGPL may be superior in clinical pain relief and calcification clearance. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.
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 study the treatment method and effect of abduction and lateral rotation l imitation of the shoulder in obstetric brachial plexus palsy (OBPP). Methods From February 2005 to August 2008, 11 patients with abduction and lateral rotation l imitation of the shoulder in OBPP were treated with dissection of the origin of subscapular muscle,transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. Among them, there were 6 males and 5 females with a mean age of 6 years (1-15 years). The main cl inical manifestations showed adduction, internal rotation contracture deformity of shoulder, l imited active and passive external rotation and severely restricted active abduction of shoulder. The passive abduction was more than 90°. According to Gilbert grading, there were 7 cases of grade 1 and 4 cases of grade 2. Based on Mallet score systems, the scores were 5 points in 3 cases, 6 points in 3 cases, and 7 points in 5 cases. The muscle strength of deltoid, supraspinatus, infraspinatus, teres major muscle and latissimus dorsi all reached 3-4 grades. Results One patient developed postoperative hematoma, wound healed after symptomatic management. Other patients achieved incision heal ing by first intention. All patients were followed up for 12 to 37 months (17 months on average). The active abduction and external rotation of the shoulder joints recovered obviously. The Gilbert grading were grade 2 in 1 case, grade 3 in 1 case, and grade 4 in 9 cases; the Mallet scores were 10 points in 1 case, 11 points in 2 cases, 12 points in 4 cases, 13 points in 3 cases, and 14 points in 1 case; showing significant differences when compared with those before operation(P lt; 0.01). The muscle strength of deltoid, supraspinatus, infraspinatus, teres major muscle and latissimus dorsi increased to 4-5 grades. Conclusion The dissection of the origin of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles can resolve shoulder adduction, internal rotation contracture, and can enhance abduction, external rotation strength. It is an effective operation for abduction and lateral rotation l imitation of the shoulder in OBPP.
Objective To assess the therapeutic effect of acupuncture for shoulder hand syndrome after stroke. Methods We searched MEDLINE (1966 to Sep. 2008), EMbase (1980 to Sept. 2008), CBM (1978 to Sept. 2008), VIP (1989 to Sept. 2008), WANFANG Database (1998 to Sept. 2008), CNKI (1979 to Sept. 2008) and handsearched relevant journals and conference proceedings. We included all randomized controlled trials (RCTs) and quasi-RCTs of acupuncture treatment for patients with shoulder hand syndrome. We evaluated the internal validity of the RCTs and quasi-RCTs. If all included trials were of high quality and homogeneity, then the meta-analysis was conducted. Results Three RCTs were identified but due to the defects in quality and clinical differences between the trials, data from these trials were not combined through meta-analysis, and a descriptive analysis was performed. The results showed that acupuncture was effective for treating shoulder hand syndrome. Conclusions The results of our review suggest that acupuncture may be effective for treating houlder hand syndrome, but because of the defects in the methodological quality of included trials, further large sample, double-blind RCTs are urgently needed.
In recent years, the development of artificial shoulder arthroplasty has been rapid, but postoperative patients often have problems such as joint swelling, pain, activity limitation, muscle strength decline and various complications, which need to be accompanied by standardized and correct rehabilitation treatment. In this paper, we review the postoperative rehabilitation treatment program of artificial shoulder arthroplasty, the selection of the timing of rehabilitation treatment, the continuity treatment of rehabilitation and the rehabilitation strategies to improve the clinical efficacy in the postoperative period, with a view to providing reference and basis for the development of a reasonable rehabilitation program for postoperative patients.
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 explore the clinical effect of open reduction and internal fixation with hollow screw fixation in the treatment of difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus.MethodsFrom January 2011 to March 2014, 15 patients with difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus were treated with open reduction and hollow screw fixation. There were 9 males and 6 females, aged from 45 to 77 years with an average of 63.5 years. The causes of injury included 7 cases of falls, 5 cases of high falling injury, and 3 cases of traffic accident injury. The injury-to-admission time was 2 hours to 5 days with an average of 1.5 days. The shoulder joint was the initial dislocation. The types of dislocation showed 14 cases of anterior dislocation and 1 case of posterior dislocation. There were 9 cases of simple avulsion fracture of greater tuberosity of humerus, 5 cases of comminuted fracture, 1 case of both greater tuberosity of humeru with small tuberosity of humerus fracture, and 2 cases of incomplete nerve injury; no exploration was carried out in operation.ResultsThere were 14 patients with wound healing at first intention; 1 suffered superficial infection of the wound, which healed by anti infection treatment. Fifteen cases were followed up for 6 to 18 months with an average of 12.2 months, with 1 case of shoulder joint re-dislocation 1 month after operation, and 2 cases of tuberosity of humerus defect absorption. One year after operation, the shoulder joint function were evaluated according to Neer Scoring System, and the results were excellent in 9 cases, good in 3 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 80.0%.ConclusionThe curative effect of open reduction and internal fixation with hollow screw fixation on difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus is remarkable, which can obtain satisfactory shoulder joint function.