Objective:To investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear (IMRCT). Methods:A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022. Among them, there were 11 males and 13 females with an average age of 56.2 years (range, 42-68 years). There were 12 cases of falling injuries, 3 cases of traction injuries, and the other 9 cases had no obvious causes. The disease duration ranged from 1 to 25 months (median, 6 months). The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases, and Goutallier grade 1 in 3 cases, grade 2 in 20 cases, and grade 3 in 1 case. All patients were treated with arthroscopic superior fulcrum reconstruction. Visual analogue scale (VAS) score, Constant-Murley score, the University of California at Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score were recorded before operation and at 1, 3, 6, and 12 months after operation. Results:The operations were all successfully completed. The incisions healed by first intention and no related complications occurred. All patients were followed up 12-33 months (mean, 24.6 months). The VAS, Constant-Murley, UCLA, and ASES scores at different time points after operation were superior to those before operation ( P<0.05). All of the above indicators further improved with time. Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months ( P>0.05), the differences between the other time points were significant ( P<0.05). At 12 months after operation, according to UCLA scoring standard, shoulder joint function was rated as excellent in 4 cases, good in 19 cases, and poor in 1 case, with an excellent and good rate of 96.0%. MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed. Conclusion:The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain, improve the shoulder range of motion, and restore good shoulder function.
Objectives: To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of degenerative lumbar disease (DLD) and its impact on postoperative lumbar stability. Methods: This is a retrospective case series study. A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively. There were 47 males and 62 females, aged (53.3±8.2) years (range: 21 to 80 years). The surgical segments were single segment in 80 cases, two segments in 25 cases, and three segments in 4 cases. The low back pain and leg pain of visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(β angle). At 12 months after surgery, X ray of the flexion and extension lumbar spine were reviewed. The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations. Results: All 109 patients underwent operative procedures successfully. The operation time was (94.5±37.1) minutes (range:56 to 245 minutes), the times of X ray was 6.8±4.0 (range:4 to 16 times), and the days of hospitalization was (5.3±3.7) days (range:4 to 14 days). Complications included dural tears in 4 cases, transient lower limb numbness in 4 cases, epidural hematoma in 2 case. The follow-up time was (19.6±7.2) months (range:12 to 36 months). The postoperative low back pain VAS, leg pain VAS, JOA score and ODI were significantly improved(all P<0.05). According to the modified MacNab criteria, the excellent and good rate was 88.99%(97/109) at 12 months after surgery. One case underwent revision surgery because of recurrent lumbar disc herniation. In term of radiographic evaluation, the area of the surgical side facet joints after UBE surgery was reserved more than 60%. The β angle was less than 90° in all patients. After 12 months of surgery, there was no surgical segment instability or spondylolisthesis by the X-ray of the flexion and extension lumbar spine. Conclusion: UBE can achieve satisfactory clinical efficacy in the treatment of DLD, and maintain the stability of the lumbar spine.
This study aims to explore the relationship between Lower limb alignment parameters and the degree of Medial Meniscal Extrusion (MME) in patients with Knee Osteoarthritis (KOA), in hopes of providing new reference data for the prevention and treatment of KOA. A retrospective study design was employed, analyzing 623 KOA patients treated at our hospital from 2022 to 2023, with 307 patients' information collected according to inclusion and exclusion criteria. Patients were divided into mild and severe groups based on the degree of MME, and differences in Lower limb alignment parameters between the two groups were compared. Univariate analysis, Pearson correlation analysis, and multivariate stepwise regression analysis were used, along with Receiver operating characteristic(ROC) curve assessment to evaluate the predictive value of Lower limb alignment parameters on the degree of MME. Univariate analysis showed significant correlations between Anatomic Mechanical Axis (AMA), Joint Line Convergence Angle (JLCA), mechanical Lateral Distal Femur Angle (mLDFA), Medial Proximal Tibia Angle (MPTA), and the degree of MME (P < 0.05). Pearson correlation analysis further confirmed the positive correlations between these parameters and the degree of MME. Multivariate stepwise regression analysis indicated that AMA, JLCA, and mLDFA are significant independent predictors of the severity of MME. ROC analysis suggested that the combination of AMA, JLCA, and mLDFA could better predict severe MME. AMA, JLCA, and mLDFA are closely related to the degree of MME in KOA patients and can serve as important parameters for assessing the severity of MME, holding significant implications for the early prevention and treatment of KOA.
畸形愈合是桡骨远端骨折后较为常见的并发症,可累及桡腕关节、尺腕关节和下尺桡关节等.桡骨远端畸形愈合可对下尺桡关节的生物力学和临床预后等方面产生一定的影响,可有疼痛、前臂旋转受限、下尺桡不稳定、下尺桡关节炎等临床表现.既往国内外关于桡骨远端骨折畸形愈合的文献中,较多的学者对桡腕关节和尺腕关节进行了研究,而对下尺桡关节的研究相对较少.本文综述了近年来桡骨远端骨折畸形愈合对下尺桡关节影响的相关研究进展,为临床诊治及进一步研究提供参考.
[目的]比较跗骨窦入路与外侧L形入路开放复位内固定Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效.[方法]回顾性分析2018年7月—2021年8月手术治疗的Sanders Ⅱ、Ⅲ型跟骨骨折患者40例(44足)的临术资料.根据术前医患沟通结果,21足采用跗骨窦入路结合埋头螺钉及微创锁定接骨板(跗骨窦组),23足采用传统外侧L形入路结合跟骨解剖锁定接骨板(L形组).比较两组围手术期、随访及影像结果.[结果]跗骨窦组手术时间、切口长度、术中出血量以及住院时间均显著少于L形组(P＜0.05).两组患者术中透视次数及术后下地行走时间的差异无统计学意义(P＞0.05).40例患者随访12个月以上,两组术后完全负重活动时间的差异无统计学意义(P＞0.05).随术后时间推移,两组VAS评分显著减少(P＜0.05),AOFAS踝-后足评分、足内-外翻ROM均显著增加(P＜0.05).术后第1d跗骨窦组VAS评分显著小于L形组(P＜0.05)、术后6个月及末次随访时两组VAS评分的差异均无统计学意义(P＞0.05),相应时间点,两组AOFAS踝-后足评分、足内-外翻ROM的差异均无统计学意义(P＞0.05).影像方面,与术前相比,两组术后即刻及末次随访时Gissane角、B?hler角、跟骨长度及宽度均显著改善(P＜0.05);相应时间点,两组上述影像指标的差异均无统计学意义(P＞0.05).[结论]相较于传统外侧L形入路锁定解剖钢板固定,经跗骨窦入路微创锁定接骨板联合埋头螺钉治疗Sanders Ⅱ、Ⅲ型跟骨骨折具有手术时间短、术中出血量少、切口小、并发症少等优点.
