The limitations of transferring the coracoid process along with the conjoined tendon are coracoacromial arch damage, technical difficulty, and nerve injury. The long head of the biceps tendon (LHBT) proximal transposition technique has a weaker sling effect and a risk of nerve injury. The arthroscopic subscapularis augmentation technique may have risks of shoulder external rotation restriction and subscapularis transection. Herein, we introduce an arthroscopic technique for the transfer of the LHBT for subscapularis augmentation to address these risks. Indications of this technique were patients younger than 45 years of age who engage in competitive sports, require forceful external rotation and abduction, have a related capsule-ligament insufficiency, and have a glenoid bone loss <25%. The steps include detaching the LHBT at the upper edge of the pectoralis major, transecting and braiding the LHBT, establishing a scapular tunnel, placing a guide suture through the upper third of the subscapular and scapular tunnel, passing the LHBT through the established tunnels, and fixating the LHBT. This technique achieves stability of the anterior shoulder by transecting and transferring the distal end of the LHBT to press on the upper third of the subscapularis muscle.
Background:Acromioclavicular joint dislocation (AJD) is one of the most common shoulder injuries, accounting for about 12% of Shoulder joint injuries. It will mainly cause the shoulder joint to feel pain and movement restrictions during exercise, which will cause inconvenience to the patient's work and life. Therefore, the treatment of this injury is also critical. At present, many doctors and patients have affirmed the clinical efficacy of clavicular hook plate (CHP) internal fixation in the treatment of AJD. However, this method is also prone to complications such as shoulder joint pain. In recent years, the Endobutton titanium plate (ETP) has been used to treat AJD injury and has achieved good therapeutic results. But there is no consensus on the effectiveness of these two methods.Objective:To compare the case curative effect between ETP and CHP in treating AJD.Methods:From June 2017 to May 2021, 46 patients with Rockwood typeⅢ-ⅤAJD treated with ETP and CHP in our department were selected as the research objects. According to the surgical treatment methods, they were divided into CHP internal fixation group (control group, n=22) and ETP fixation group (observation group, n=24) ; The operation time, intraoperative bleeding, length of hospital stays, incidence of complications, of pain before operation, three days, three months and 12 months after procedure, shoulder function and acromioclavicular dislocation reduction six months after operation were compared between the two groups.Results:There was no difference in operation time, intraoperative bleeding, postoperative internal fixation failure, acromion impact, and heterotopic ossification between the two groups (P>0.05) . In contrast, the postoperative hospital stay in the observation group was less than that in the control group (P < 0.05) . The postoperative shoulder pain and total incidence of complications in the observation group were lower than that in the control group (P<0.05) . There was no significant difference in pain visual analogue scale (VAS) score between the two groups before the operation and 12 months after the procedure (P>0.05) ; The pain VAS score of the observation group was lower than that of the control group three days and three months after operation (P<0.05) . The shoulder function Constant-Murley score of the observation group was higher than that of the control group 3 months after the operation (P<0.05) . There was no significant difference in the sound, moderate, and poor recovery rate of shoulder joint function between the two groups 12 months after the operation (P>0.05) ; The excellent and excellent rate of shoulder function recovery in the observation group 12 months after operation was significantly higher than that in the control group (P< 0.05) ; There was no significant difference in the distance from clavicle to coracoid process between the two groups 12 months after operation (P>0.05) .Conclusion:The Endobutton plate's clinical efficacy in treating acromioclavicular joint dislocation is relatively better than that of the clavicular hook plate in the incidence of shoulder pain and other complications, postoperative pain relief, and joint function recovery.
肱骨近端骨折是常见的老年骨质疏松性骨折，接骨板或髓内钉内固定治疗是目前的主流治疗方案，通过多角度螺钉的置入以增加对肱骨近端骨质的把持力。有效的功能康复锻炼可以改善肱骨近端骨折内固定术后的肩关节活动度，提高生活质量，但不恰当的功能康复时机可能是导致骨折术后骨不连、肱骨头坏死以及内植物失效的原因。本文从肱骨近端骨折术后的早期康复锻炼入手，结合"悬臂-杠杆重建-不稳定"理论，进一步分析了肱骨近端固定后的"悬臂杠杆结构"，并指出肱骨近端骨折内固定后形成绝对省力的杠杆结构，早期各向活动导致肱骨头内螺钉受力发生交替性改变，进而挤压破坏肱骨近端骨质，引发肱骨近端内固定相关并发症。该理论揭示了目前肱骨近端骨折术后内固定失效的本质是不合理的康复锻炼对骨和内植物产生的"支撑-牵张"效应。以该理论为基础，本文作者提出了肱骨近端内固定后新的康复策略和理念，将为不同肩部病损的康复带来新的思路和方法。
Background:Superior labral anterior to posterior (SLAP) injury is a lesion of the upper lip of the shoulder joint that often causes pain or even instability in the shoulder joint during specific movements. In 1990, Snyder divided the upper glenoid lip injuries into four types based on the injuries described by Andrews and named them SLAP injuries. The most common type II injury was the avulsion of the upper glenoid lip and the long head tendon of the biceps muscle from the glenoid pelvis. In 1995, Maffet et al. added three SLAP injuries to the Snyder classification, totaling seven types of injuries. Bankart injury is an avulsion injury in the anterior and inferior glenohumeral ligament complex of the shoulder glenoid and labial. According to the classification of Maffet, type V SLAP injury refers to the continued upward extension of the Bankart injury and the separation of the LHB stop, that is, type II SLAP injury combined with Bankart injury. The incidence of type V SLAP injuries is about 4%-15% of all SLAP injuries, and Gartsman believes that the incidence of type V SLAP injuries in chronic forward shoulder instability is about 57%. Compared with Type II SLAP injury and Bankart injury surgery, Type V SLAP injury surgery requires the management of both anterior labial and upper labial biceps tendon complex tears, more extensive tear repair and insertion of more anchors, more line crosses, and management of multiple sutures, and requires more technical requirements. In addition, the implant site or the crossing site of the anchor is not appropriate, which may lead to too tight suture, leading to external rotation of the shoulder joint after surgery.Objective:To investigate the surgical technique and clinical efficacy of arthroscopic suture anchor repair for type Ⅴ SLAP injury.Methods:A total of 12 patients with type Ⅴ SLAP injury from January 2013 to June 2018 were retrospectively analyzed, and their labral injuries were repaired with suture anchor under arthroscopy. They were followed up for 1 year after surgery. The visual analogue scale, range of motion, Rowe score and ASES score were used to evaluate the surgical effect.Results:The VAS scores of 12 patients 6 months and 1 year after surgery were statistically different before surgery (P<0.05) . The ROM of external rotation 6 months after surgery was statistically different compared with the unaffected side (P<0.05) but not statistically significant compared with the unaffected side 1 year after surgery (P>0.05) . The scores of Rowe and ASES before surgery were statistically different from 1 year after surgery (P<0.05) .Conclusion:Arthroscopic suture anchor repair for type Ⅴ injury can attenuate shoulder pain and improve function with good clinical efficacy.
Background:Tennis elbow, also known as external humerus epicondylitis, is a common orthopedic and sports medicine disease with a prevalence rate of 1%-3% in the population, and the age of onset is 35-50 years old. Clinically, the main symptoms are evident lateral elbow tenderness and limited elbow and wrist joint activity. Patients whose pain has not been significantly relieved after more than six months of conservative treatment are defined as having intractable tennis elbow, accounting for about 10% of the patients with tennis elbow. Wada et al. reported the first case of arthroscopic treatment of tennis elbow in 1995. After continuous clinical summaries and concept updates, total arthroscopic treatment of tennis elbow has gradually become a trend. In recent years, many studies believe that tennis elbow is tendinopathy near tendon insertion, and extensor carpi radialis brevis (ECRB) is the most commonly involved, and many clinical studies have achieved good results through arthroscopic ECRB surgical treatment. However, the exact evaluation of long-term clinical efficacy is rarely reported.Objective:To investigate the application of arthroscopic reconstruction in treating intractable tennis elbow and its medium- and long-term clinical effects.Methods:The data of 58 patients with intractable tennis elbow treated in Taizhou Bone Injury Hospital from January 2017 to December 2020 were retrospectively selected. According to different treatment methods, 32 patients with intractable tennis elbow who underwent arthroscopic debridement were included in the debridement group. Twenty-six patients with intractable tennis elbow who underwent arthroscopic reconstruction of ECRB were included in the reconstruction group. Using ECRB cross-sectional area, visual analogue scale (VAS), upper extremity functional index, UEFI, Mayo elbow performance score (MEPS), and postoperative complications were evaluated.Results:There was no significant difference in the general data between the two groups (P>0.05). The cross-sectional area of ECRB at different time nodes was separate (P<0.05), and the cross-sectional area of ECRB in the reconstruction group increased gradually at 6, 12, and 24 months after surgery. The cross-sectional area of ECRB decreased six months after the operation and increased steadily at 12 months and 24 months after the procedure. There was no significant difference in VAS, UEFI, and MEPS scores between the two groups before intervention (P>0.05). After the intervention, the VAS score in the reconstruction group was significantly lower than that in the debridement group (P<0.05), and UEFI and MEPS scores in the reconstruction group were considerably higher than that in the debridement group (P<0.05). The two groups had significant differences in VAS, UEFI, and MEPS scores (P<0.05). By pin-to-pair comparison within the group, the VAS score of the two groups was lower than that of the previous one. Still, the VAS score of the cleanup group was lower than that of the operation only six months after the procedure, and the difference was statistically significant (P<0.05). The UEFI and MEPS scores of the two groups were higher after the operation than before the procedure. Still, the UEFI and MEPS scores of the cleanup group were higher than before the operation, only six months after the procedure, and the difference was statistically significant (P<0.05). Postoperative complications such as nerve injury, tendon rupture, infection, and subcutaneous hematoma were not found on the second day after surgery, at discharge, 6 months, 12 months, and 24 months after surgery in both groups, and the safety was good.Conclusion:Arthroscopic repair and reconstruction surgery for intractable tennis elbow has a satisfactory postoperative effect. It can effectively relieve patients' pain and promote the recovery of elbow joint function in the medium and long term, and it is safe and worthy of clinical application.
肘关节是人体众多复杂关节之一，肘关节僵硬会导致日常手势、娱乐活动和工作的不便。临床表现为肘关节屈伸受限、不同程度的运动弧终末点疼痛等，严重者无法满足进食、穿衣等基本需求。在肘关节僵硬中最常见的外部因素是创伤，而内部因素则是异位骨化。开放性松解是肘关节僵硬的传统手术治疗方法，其优点在于手术视野大而且同时可以将所有影响功能的异位骨化切除，并对挛缩的关节囊、肌腱等相关软组织进行松解。关节镜下关节松解术作为一种微创手术被用于肘部僵硬的治疗，它可以非常精确和选择性地去除疤痕组织、骨赘或任何关节内病变，且创伤最小，增加了快速恢复和早期康复。术后早期给予患者有效的康复训练能够提高手术效果，改善患者的生活质量。
肩锁关节脱位是一种常见的肩关节损伤，其治疗一直是临床和研究的焦点。本文回顾了过去几年来在肩锁关节脱位治疗方面取得的重要进展，并对不同治疗方法的疗效进行了评估。治疗方法包括保守治疗、手术干预以及康复治疗。保守治疗主要包括物理疗法、抗炎药物和肩部固定。手术干预方面，包括传统的重建手术和最新的关节镜技术，如锁骨下角切除术、锁骨修复术等。康复治疗在肩锁关节脱位的康复过程中起着重要作用。最后，讨论了当前治疗中的挑战和未来研究的方向。本文的目的是为临床医生和研究人员提供有关肩锁关节脱位治疗的综合资料，以促进患者的治疗效果和康复进程。
肘关节僵硬是肘关节外伤后的常见问题，可导致上肢功能受损。软组织挛缩和异位骨形成是运动受限的两个主要原因。最近的研究已经阐明了导致这些疾病的许多途径，但确切的机制仍然未知。功能障碍的严重程度取决于初始创伤的性质和所使用的治疗方法。根据病情的严重程度和潜在的违规结构，有几种不同的选择。手术治疗可能会显著改善运动，但很少能完全恢复，并发症并不少见。本文旨在阐述创伤后肘关节僵硬的病理机制及治疗进展。
陈旧性肩锁关节脱位临床常见，常因局部疼痛、功能受限给广大患者带来困扰，严重影响日常生活。陈旧性肩锁关节脱位的治疗方法繁多，但因伴有韧带萎缩、愈合能力下降，最佳治疗方案仍存在争议，效果不一。陈旧性肩锁关节脱位的治疗仍是目前研究热点和难点，其治疗目标是重建肩锁关节解剖关系和恢复生物力学特征。随着生物力学研究深入、材料学的发展，目前手术方法越来越趋向于微创化和解剖重建，同时提高手术效果、减少并发症是临床追求的目标。本文拟在文献回顾的基础上，对陈旧性肩锁关节脱位的解剖特点、病因、损伤机制、分型与治疗的现状进行梳理，并对未来研究方向进行展望。
Background:Coronal process fracture and radial head fracture are accompanied by posterior dislocation of the elbow joint, which is called the "terror triad" by Hotchkiss. It consists of the elbow fracture and the medial and lateral collateral ligament injuries of the elbow joint, resulting in severe instability, which is very difficult in clinical treatment as one of the main factors affecting the stability of the elbow joint, coronal process fracture plays a pivotal role in preventing posterior dislocation of the elbow joint. There is no adequate internal fixation for the coronal process fracture fragment with conventional methods, so it has always been a difficult point in clinical treatment. The technique of suture lasso was used in the cases of coronal process fracture of Regan-Morrey type I/II, and the preliminary curative effect was obtained. Objective To explore the operative method and clinical effect of the suture lasso technique in treating Regan-Morrey type I/II coronal process fracture.Methods:From January 2018 to June 2022, the clinical data and follow-up results of 18 patients with coronal process Regan-Morrey type I/II fracture in terror triad of the elbow treated with suture lasso technique were retrospectively analyzed, including 12 males and 6 females. Their ages ranged from 18 to 55 years, with an average age of 32 years. The causes of injuries included 12 cases of traffic injuries, 5 cases of high fall injuries, and 1 case of fall damage. All of them were type I/II according to the Regan-Morrey classification. All the lateral collateral ligaments were injured. All patients were treated through a lateral approach to reduce and fix fractures of the coronal process, radial head, and lateral collateral ligament. After the operation, the elbow joint was set in the functional position for 2 weeks, followed by functional exercise. The outpatients were followed up regularly for 3 weeks, 6 weeks, and 3 months after the operation. The postoperative elbow joint score was evaluated by the MEPS score system.Results:All patients were followed up for 3 to 52 months, with an average of 18 months. Bone union was achieved in all fractures. Elbow joint flexion position (0-30°), extension position (90-125°), with an average range of joint motion being 103.61°; pronation (10-90°), supination (20-90o), with an average rotation range of 142.78°. According to the MEPS Elbow Performance Index, the average postoperative score was 88.89 points (range 65-100 points). Among them, 12 cases were excellent, 3 were good, and 3 were moderate. The excellent and good rate was 83.3%. Three patients developed myositis ossificans. One patient took out the suture anchor due to infection.Conclusion:In the terror triad of the elbow, the clinical effect of the lateral approach of the elbow joint using the suture lasso technique to fix the coronal process fracture of Regan-Morrey I/ II type fracture is satisfactory.
人类社会的进步和科技的发展为临床医学研究的创新提供了动力，基于科学理论指导的技术可以为临床科研活动指明正确的方向，真正挖掘临床现象的本质。笔者基于骨科生物力学专业知识的储备和对日常事物的洞悉，针对股骨近端和肱骨近端分别提出了"杠杆重建平衡"理论和"悬臂-杠杆重建不稳定"理论，用于指导临床诊疗和康复。在此基础上结合脊柱生理、病理及损伤的相关研究，创新性探索了脊柱相关杠杆结构，以期发现脊柱内固定术后继发性损伤及退变的本质并提供预防措施。身边的事物为临床科研创新提供了素材，而坚实的理论创新研究将为医学研究的转化和应用奠定坚实的基础。
Background:Diffuse shoulder pain and shoulder joint mobility disorder are the main clinical manifestations of a frozen shoulder. It often occurs on the shoulder of middle-aged and older adults. The lesion involves the shoulder, joint bursae, and other soft tissues. The incidence of frozen shoulder is 2%-5%, but its pathogenesis is unknown, and there are many limitations and poor curative effects in current treatment methods. Therefore, further understanding its pathogenesis and exploring new therapies to improve the quality of life of patients with frozen shoulders is of great significance. Animal and clinical trials have demonstrated that low-intensity pulsed ultrasound (LIPUS) can accelerate fracture healing and promote the repair of other connective tissue injuries, such as muscles, tendons, cartilage, ligaments, etc. So far, no reports have been found about the effect of LIPUS on frozen shoulder animal models. Objective To investigate the effect and mechanism of LIPUS on frozen shoulder model rabbits.Methods:Sixty female New Zealand rabbits were randomly divided into a control group, a model group, and a LIPUS treatment group. After the frozen shoulder model was made by the method of continuous strain and ice compress, the pathological changes of the tissues around the affected shoulder were observed, and the contents of transforming growth factor-β1 (TGF-β1), prostaglandin-E2 (PGE-2) and hydroxyproline (HYP) in serum were detected.Results:With a single variance analysis of multiple data groups, it was found that the contents of TGF-β1, PGE-2, and HYP in the LIPUS treatment group were significantly decreased compared with the model group. In contrast, the contents in the model group were significantly increased compared with the blank control group, with statistically significant differences (P < 0.05). The results of the pathological section showed that the degree of synovial hyperplasia and tendon fiber hyperplasia were improved in the treatment group, and the tissue repair was accelerated.Conclusion:LIPUS can achieve anti-inflammatory and analgesic effects by reducing the contents of TGF-β1, PGE-2, and HYP in the frozen shoulder tissues of New Zealand rabbits, which is worth promoting in clinical use.
Background:Due to the extensive range of motion of the shoulder joint and the particular anatomical structure, the humerus head is prone to dislocation when moving. According to statistics, shoulder joint dislocation accounts for 1/2 of the total body joint dislocation. Long-term and repeated shoulder dislocation is the leading cause of shoulder joint pain and limited activity. After the initial dislocation, the anterior wall of the joint capsule, avulsion of the glenoid or glenoid margin, and posterior concave fracture of the humeral head in some patients were not repaired after reduction, and malunion occurred, leading to repeated dislocation, and previous dislocation was the most common. With the progress of arthroscopy technology and improvement of medical level, arthroscopy has advantages such as comprehensive observation of the injured site, high patient compliance, good postoperative appearance, etc., and shoulder arthroscopy has gradually become the preferred treatment for recurrent shoulder dislocation. Objective To retrospectively analyze and evaluate the efficacy of the suture repair of the glenoid labrum with suture anchor for recurrent anterior dislocation with fibrous Bankart injury.Methods:Forty-one patients with recurrent anterior dislocation of the shoulder joint and fibrous Bankart injury who underwent suture repair of glenoid labrum under shoulder arthroscopy in the People's Hospital of Shanxi Province were enrolled, and the clinical data were analyzed.Results:For eligible cases, regular follow-up was conducted for one year. No recurrent dislocations were observed in the following cases, and all patients were satisfied with the surgical outcome. Follow-up data for 41 patients showed that the external rotation angles were (56.02±4.45) ° and (86.02±2.59) ° one week before and 12 months after surgery, respectively. The flexion and abduction angles were (160.27±7.62) ° and (175.68±3.39) °, respectively. The DASH scores were (39.37±6.47) scores and (10.76±2.84) scores, the ROWE scores were (40.73±7.38) scores and (96.71±3.28) scores, and the Constant-Murley scores were (76.44±4.06) scores and (96.66±2.33) scores. All results had a P value less than 0.01 and were statistically significant.Conclusion:The treatment of recurrent anterior dislocation of the shoulder joint with fibrous Bankart injury by arthroscopic suture repair of the glenoid labrum with the suture anchor has a significant effect.
Background:Subscapular glenoid fracture is rare, accounting for only 0.11% of total body fractures and about 16.2% of scapular fractures. A comprehensive and reliable classification system for subscapular glenoid fractures is necessary. There are many classification systems to describe subscapular glenoid fractures, among which the most commonly used is the Ideberg classification based on X-ray films. However, there are still some shortcomings in fracture morphology, diagnostic accuracy, and completeness. In addition, OTA/AO classification and Bartoníclassification based on 3DCT have been proposed, which significantly improve the diagnostic accuracy and value for treatment decision-making. However, no studies have investigated the reliability of these three classifications in clinical practice. Objective The reliability of the new Bartoní classification in clinical practice was evaluated by comparison with Ideberg and OTA/AO classification.Methods:Sixty-eight patients with scapular glenoid fractures diagnosed and treated in Beijing Chaoyang Hospital, Capital Medical University from January 2015 to January 2022 were enrolled with pre-treatment X-ray and 3DCT data. Four observers (2 orthopedic surgeons and 2 radiologists) classified the two images according to the classifications of Ideberg, OTA/AO, and Bartoní. After 4 weeks, all the original data were renumbered, and the fractures were again classified using the same method by 4 observers. Chron Kappa and intraclass correlation coefficient (ICC) were used to determine inter-observer and intra-observer consistencies for the three classifications.Results:Sixty-eight patients with a mean age of 41 (20 to 76) were enrolled in this study, including 52 males (76.5%). The mean inter-observer Kappa values of Bartoni, OTA/AO, and Ideberg classification based on 3DCT were 0.75±0.03, 0.70±0.03, and 0.57±0.03, respectively. The mean inter-observer Kappa values based on X-ray were 0.52±0.02, 0.46±0.02, 0.51±0.01, and the mean intra-observer ICC values based on 3DCT were 0.78±0.04, 0.72±0.02, 0.68±0.02, respectively. The mean intraobserver ICC values based on X-ray were 0.56±0.02, 0.51±0.02, and 0.55±0.02, respectively. The interobserver kappa values and intraobserver ICC values of Bartoni were significantly higher than those of OTA/AO and Ideberg (P < 0.05), whether based on radiographs or 3DCT.Conclusion:Compared with OTA/AO classification and Ideberg classification, the Bartoní classification has more advantages in reliability.
近年来，随着医学3D打印技术迅猛的发展，其在骨科领域中的应用也越来越多，尤其是在个性化手术导板辅助治疗骨科疾病中尤为突出[1，2，3]。目前少有报道3D打印导板辅助治疗成人肘内翻畸形的文献。本文分享1例使用3D打印的个性化截骨导板治疗肘内翻畸形的病例。
Background:Perioperative hemorrhage during shoulder arthroscopy can lead to an unclear intraoperative field of view, prolonged operation time, associated postoperative shoulder swelling, bruising, and pain, and may increase the risk of infection. Therefore, minimizing perioperative bleeding during shoulder arthroscopy is crucial for reducing complications and speeding up postoperative recovery. Studies have reported that surgical trauma leads to increased fibrinolytic response, which accounts for 60% of the total perioperative blood loss in orthopedic surgery. In shoulder arthroscopic surgery bleeding in shoulder arthroscopic surgery can be reduced to a certain extent through delicate operation, anesthesia-controlled blood pressure reduction, and epinephrine perfusion. However, infiltration and bleeding of bones, muscles, and tissues are inevitable, so more surgeons further consider maintaining a balance between coagulation and fibrinolysis to reduce perioperative bleeding during shoulder arthroscopy. Tranexamic acid (TXA) is the most commonly used antifibrinolytic drug, which reversibly blocks the plasminogen's binding site, thereby preventing plasmin activation and reducing the degradation of plasmin to improve fibrin Clot stability. Many studies have shown that TXA can effectively minimize perioperative blood loss and blood transfusion rate in orthopedic surgery and does not increase the incidence of embolic events. In addition, studies have reported that TXA can regulate the immune system by blocking granules, thereby exerting anti-inflammatory effects. Therefore, in recent years, the clinical application of TXA in shoulder arthroscopic surgery has gradually increased. Liu et al. first reported the application of TXA in shoulder arthroscopic surgery. They found that intravenous injection of TXA can improve the clarity of field of view in shoulder arthroscopic surgery and reduce early postoperative pain and the number of analgesics without apparent side effects. Currently, there is a lack of clear consensus on using TXA in shoulder arthroscopic surgery. Objective A Meta-analysis of the literature was conducted to investigate the efficacy and safety of TXA for arthroscopic shoulder surgery.Methods:We searched PubMed, Embase, Medline, Cochrane, Web of Science, CNKI, and WanFang databases until Nov 1, 2022, including randomized controlled trials and cohort studies, and supplemented relevant literature through traceability search. Meta-analysis was performed using RevMan5.4 statistical software.Results:Six studies were included in this meta-analysis, involving 437 patients, of which 218 were treated with TXA. Meta-analysis showed that patients in the TXA group had better visual clarity in arthroscopic shoulder surgery compared with the control group (SMD=0.38, 95%CI: 0.20, 0.57, P<0.00001), with a statistically significant. There was no statistically significant difference in the comparison of VAS score (SMD=-0.55, 95%CI: -1.21, 0.12, P=0.11), operative time (SMD=-9.83, 95%CI: -12.89, -6.78, P<0.01), irrigation amount used in operation (SMD=-2.10, 95%CI: -3.41, 0.79, P=0.002), and shoulder circumference (SMD=2.58, 95%CI: -2.63, 7.80, P=0.33). In the incidence of the embolic events (deep vein thrombosis, pulmonary embolism), there was no difference between groups between the TXA and control groups (RD=0, 95% CI: -0.02, 0.02, P=1.00) .Conclusion:TXA is safe and effective in arthroscopic shoulder surgery, significantly improves intraoperative visual clarity, and does not increase the incidence of embolic events.
肩锁关节脱位是肩部常见损伤之一，主要表现为患肩疼痛、肿胀和功能受限，严重影响患者的生活质量。目前，肩锁关节脱位的治疗方法主要包括保守治疗及手术治疗，每种治疗方式各有利弊。因此，对肩锁关节脱位各种治疗方法的研究，将有助于选择适合患者的治疗方式，达到最佳的治疗效果。该文主要对肩锁关节脱位的各种治疗方式及其治疗效果的对比进行综述。
肱骨头坏死是临床上常见的骨坏死之一。肱骨头的血供主要来源于旋肱前动脉和旋肱后动脉。由多因素导致的肱骨头血液供应受损，进而发生局部缺血时，肱骨头就会出现骨坏死。肱骨头坏死的病因可分为创伤性和非创伤性两大类，常见的创伤性因素有：骨折、脱位、肩部手术等；非创伤性因素有：糖皮质激素、血红蛋白病、沉箱病、戈谢病、吸烟、酗酒、系统性免疫病等。肱骨头坏死的主要症状是肩关节疼痛、活动受限。由于疾病早期通常无症状或症状较轻，不能引起患者重视，从而延误诊治。因此在临床工作中碰到高风险患者时，医务工作者要提高警惕，避免漏诊、误诊。肱骨头坏死可根据患者病史、临床表现、影像学检查来诊断。影像学检查是疾病分期的依据，疾病分期对治疗具有指导作用。早期肱骨头坏死可通过保守治疗取得较好效果，而晚期多需要手术治疗。无论采用何种治疗方法，其目的均是缓解疼痛、改善患肢功能。
尺骨冠突是肘关节的重要稳定结构，其缺失可导致急性或慢性的肘关节不稳、半脱位或复发性脱位，进而迅速进展成创伤性关节炎[1]。当冠突骨折治疗失败出现关节不稳或活动受限时，重建冠突是必要的手段。当冠突重建后依然存在关节不稳时，应考虑同期对维持肘关节稳定的软组织结构进行修复。
Background:The rotator cuff comprises the supraspinatus tendon, infraspinatus tendon, teres minor tendon, and subscapularis tendon. Rotator cuff injuries often occur during repeated and forceful external shoulder joint rotation, such as in ball sports, swimming, weightlifting, etc. The leading causes of such injuries are an external force, insufficient blood supply, and chronic degeneration of the shoulder. The incidence of rotator cuff injuries is higher in males than in females. The prevalence of rotator cuff injuries in patients under 20 years of age is 9.7%, while in patients over 80, it is 62%. It is generally believed that surgical treatment should be considered when conservative treatment is ineffective for rotator cuff tears. Surgical options include single-row or double-row rotator cuff repair, arthroscopic debridement, superior capsular reconstruction, reverse shoulder arthroplasty, biceps tendon fixation, or tendon release surgery. Common complications after surgery for rotator cuff injuries include fatty infiltration, tendon-bone non-union, and osteoarthritis, which pose significant challenges to treatment. In recent years, significant research progress has been made in this field, including surgical treatment, pathogenesis, imaging features, and biomechanics, with particular emphasis on surgical treatment. Therefore, while the literature in this field continues accumulating, it is necessary to use bibliometric methods for comprehensive and systematic analysis to visualize the current research status and hotspots and even, to some extent, predict future research trends. Objective Based on the Web of science (WOS) core collection database, visual analysis of the surgical treatment of rotator cuff tear was performed using VOS viewer and Citespace software to explore the current research status and research hotspot.Methods:The search was conducted in the WOS core data set, and the period was set to be from January 2000 to April 2022. The search strategy was as follows: #1 rotator cuff tear* (theme) or rotator cuff injur* (theme) or shoulder rotator cuff rupture (theme) or shoulder rotator cuff injur* (subject), #2 surgery (subject) or arthroscop* (subject), (#1) AND #2.Results:A total of 4 953 cited literatures and 40 003 cited literatures were retrieved. The research literature in the field of rotator cuff tear continued to increase, accounting for more than 40% in major journals such as "Journal of Shoulder and Elbow Surgery" and "Journal of Arthroscopic Surgery". The research results and cooperation with national institutions are mainly concentrated in Europe and the United States, and other regions are not closely connected. In recent years, tendon-bone healing, joint reconstruction of the upper capsule, and tendon transposition have become research hotspots.Conclusion:The development of the surgical treatment of rotator cuff injury in the past two decades can be roughly divided into three stages: the preliminary stage of the classification, clinical manifestations, and arthroscopic repair of rotator cuff injury. The exploration stage of biotherapy such as risk factors and PRP; It is believed that there will be further breakthroughs in surgical treatment strategies in the future, as the in-depth exploration of the improvement of surgical techniques such as tendon-bone plane healing, joint reconstruction of the upper capsule and tendon transposition.
