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.
