PURPOSE:In anterior cruciate ligament reconstruction (ACLR), the clinical benefits and limitations of nonpreserving versus different remnant-preserving ACLR are not well defined. There is also a lack of systematic analysis of ACL remnant length. METHODS:Database searches were performed in PubMed, Embase, Web of Science and Cochrane CENTRAL from inception to 25 April 2025. Risk of bias was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa scale (NOS) critical appraisal tools. Certainty of evidence was evaluated using the grading of recommendations assessment, development and evaluation (GRADE) framework. The reported outcomes used for analysis included stability-related indicators, functional scores, synovial coverage and complications. Subgroup analyses were performed across three remnant-preserving surgical approaches: Augmentation, tension and sparing. Meta-regression and network meta-analyses were performed to investigate whether improved outcomes were associated with remnant length. Sensitivity analysis was used to assess the robustness of the results. RESULTS:Our analysis included 36 articles. For stability, the remnant-preserving (R) group showed improved outcomes compared to the nonremnant (NR) group in the Lachman test (weighted mean difference [WMD] = 1.61, p = 0.0003), Side-to-side anterior laxity (SSD, WMD = -0.27, p = 0.03) and Pivot shift test (WMD = 1.34, p = 0.03), with the highest improvement observed in the Sparing subgroup. For functional scoring, the R group exhibited significantly higher Lysholm knee scoring scale scores (WMD = 1.52, p = 0.01), Tegner athletic ability evaluation score (WMD = 0.40, p < 0.00001), and International Knee Documentation Committee (IKDC) subjective scores (WMD = 1.00, p = 0.001), with the Tension subgroup showing the highest overall improvement. The R group also achieved better synovial coverage (odds ratio [OR] = 2.00, p = 0.0004) and lower failure (OR = 0.48, p = 0.002), particularly in the augmentation subgroup. Meta-regression indicated a correlation between increased graft length and reduced SSD (β = -1.33, p = 0.01), improved IKDC scores (β = 20.03, p = 0.01), and fewer complications (β = -2.61, p = 0.01). Network meta-analysis indicated a 75% remnant preservation ratio minimised SSD alongside enhanced functional scores. CONCLUSION:Remnant-preserving ACLR showed improvements in stability and synovial coverage. However, in terms of clinical outcomes, the improvement in functional recovery has not reached a significant level. Sparing exceled in improving stability, while augmentation effectively reduced failure and tension favoured function. Increasing remnant preservation length significantly improved stability and function concomitantly reducing complications. CLINICAL TRIALS:CRD42024550746. LEVEL OF EVIDENCE:Level III.

Objective:To evaluate the mid-term effectiveness of limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet) procedure in treatment of recurrent anterior shoulder dislocation. Methods:Between March 2017 and February 2019, 56 patients with recurrent shoulder dislocation were treated with arthroscopic LU-tarjet procedure. There were 44 males and 12 females with an average age of 26.3 years (range, 18-41 years). Shoulder joint dislocation occurred 2-16 times, with an average of 7.5 times. The time from the initial dislocation to operation ranged from 6 months to 13 years, with a median of 4.6 years. Preoperative shoulder joint fear test and re-reduction test were positive in all patients. The Beighton score of joint relaxation ranged from 1 to 7, with an average of 4.1. The shoulder Instability Severity Index Score (ISIS) ranged from 5 to 10, with an average of 7.8. The size of glenoid defects on the affected side ranged from 15% to 32% (mean, 22.4%). All patients had Hill-Sachs injuries of varying degrees. Six patients had re-dislocation after Bankart surgery. The operation time, incision healing, and postoperative complications were recorded. The range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation) of shoulder joint were compared between pre- and post-operation. The improvement of shoulder function was evaluated using the American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score. X-ray films and three-dimensional CT were used to analyze the location, healing, and remolding of bone graft, the repair of glenoid defect, and degenerative changes of the shoulder joint. Results:All operations were successfully completed. The operation time ranged from 42 to 98 minutes, with an average of 63 minutes. All incisions healed by first intention. All patients were followed up 5-7 years (mean, 6.3 years). During follow-up, 2 patients experienced shoulder subluxation within 1 year after operation and 1 patient experienced recurrent shoulder joint pain. The remaining patients had no related complications. At last follow-up, there was no significant difference between the two groups ( P>0.05) in range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation). The ASES score, Rowe score, and Walch-Duplay score of shoulder significantly improved when compared with those before operation ( P<0.05). Postoperative CT showed that 53 cases (94.64%) of coracoid bone masses were centered placed vertically, 2 cases (3.57%) were superior, and 1 case (1.79%) was inferior; 49 cases (87.50%) of the coracoid bone grafts were flush with the glenoid, 2 cases (3.57%) and 5 cases (8.93%) were medially and laterally positioned. The volume of coracoid bone graft decreased first and then increased, and the shape of the bone graft was continuously remodeling and gradually matched with the track of the humerus head (the optimal circle of the glenoid), all coracoid bone grafts healed. At last follow-up, the coverage rate of optimal glenoid circle was 89.6%-100%, with an average of 97.4%. The area of glenoid defect was 2.6%±1.3%, which significantly decreased when compared with preoperative (22.4%±5.4%) ( P<0.05). At last follow-up, no obvious degenerative changes of shoulder joint was observed. Conclusion:LU-tarjet procedure for recurrent anterior shoulder dislocation has good mid-term effectiveness with short operation time and few complications.

Objective:To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting.Methods:A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively.Results:In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane.Conclusion:In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.

Osteoarthritis (OA) is a common shoulder disorder that impacts shoulder functions. Shoulder arthroplasty is often required to restore function and quality of life. Reverse total shoulder arthroplasty (RSA), which was originally designed mainly for irreparable rotator cuff damage, has gained popularity in recent years for the treatment of advanced shoulder OA instead of the clinically standard total shoulder arthroplasty (TSA). However, this RSA has some nonnegligible flaws such as higher complications rate and economic cost, not mention the following problems caused by irreversible physical structural damage. Therefore, the employment of RSA needs to be carefully considered. This study aimed to compare TSA and RSA in OA patients with or without rotator cuff damage to better guide clinical decision making. We believe the radical use of RSA in patients without rotator cuff deficiency may cause more harm than good. We queried the Nationwide Inpatient Sample (NIS) database from 2011 to 2014 to collect information on OA patients who received TSA and RSA. Patients were divided into 2 groups of comparison according to the presence of rotator cuff deficiency and matched with propensity score analysis. A total of 57,156 shoulder arthroplasties were identified. RSA patients in the rotator cuff deficiency group had significant higher transfusion rates and longer hospital stays. RSA patients without rotator cuff deficiency had a statistically significantly higher number of implant-related mechanical complications, acute upper respiratory infections and postoperative pain. Overall, RSA incurred higher costs in both groups. For OA patients with rotator cuff deficiencies, RSA has its benefits as complication rates were comparable to TSA. For those patients without rotator cuff deficiencies, the use of RSA should be reconsidered as there were more complications with higher severity.

目的:探讨双侧股骨髋臼综合征(B-FAI)的临床特点和关节镜治疗效果.方法:回顾性分析2015年5月至2017年5月进行分期两次髋关节镜手术治疗的18例B-FAI患者,记录并比较手术前后双侧髋关节的影像学指标、临床症状和关节镜下病理表现,以及术前与末次随访时疼痛视觉模拟量表(VAS)评分和改良髋关节Harris评分(mHHS).结果:本组18例患者第一次手术和第二手术时间间隔为3～14个月,平均(6.2±4.5)个月.术后随访8～24个月,平均随访时间(8.0±2.5)个月.术前两侧髋关节α角、外侧CE角(LCE)差异均无统计学意义(P均>0.05).第一次手术侧髋关节SeldesⅠ型盂唇撕裂、Ⅱ级盂唇-软骨移行区损伤(ALAD)、OutbridgeⅡ度软骨损伤的比例要高于第二次手术侧髋关节,且差异均有统计学意义(P均<0.05);而两侧髋关节FAI类型、盂唇缝合及关节囊缝合的比例差异均无统计学意义(P均>0.05).与术前相比,末次随访时两侧髋关节VAS评分均降低、mHHS评分均增高,且差异均有统计学意义(P均<0.01);而末次随访时两侧髋关节VAS评分、mHHS评分差异均无统计学意义(P均>0.05).结论:FAI常常累及双侧髋关节,临床中应该常规进行双侧髋关节评估.B-FAI两侧髋关节影像学指标与髋关节的病理损伤相似.分期两次髋关节镜手术治疗B-FAI短期临床效果满意,建议两次手术的合理间隔为3～6个月.

目的 探讨关节镜辅助下经胫骨隧道止点重建治疗外侧半月板后角撕裂的临床疗效.方法 回顾性分析2016年6月至2018年6月深圳市龙岗区骨科医院采用关节镜辅助下经胫骨隧道止点重建治疗膝关节外侧半月板后角撕裂的19例病人,其中男12例,女7例;年龄为16～45岁,平均32.3岁.11例伴有前交叉韧带断裂.收集并比较19例病人术前、术后1年国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分、Lysholm评分、疼痛视觉模拟量表(visual analogue scale,VAS)评分.结果 术后无感染、血管神经损伤、关节活动受限、下肢深静脉血栓形成等并发症发生.随访时间为12～28个月,平均随访19.3个月.术后1年的IKDC评分、Lysholm评分分别为(87.3±2.9)分、(92.0±3.2)分,均较术前明显提高;术后1年的VAS评分为(1.2±0.8)分,较术前明显降低;手术前后各项评分比较,差异均有统计学意义(P均<0.05).结论 关节镜下采用经胫骨隧道止点重建治疗外侧半月板后角撕裂,操作简便,疗效满意,是一种有效的治疗方式.

BACKGROUND:Non-alcoholic fatty liver disease (NAFLD), characterized by the accumulation of excess fat in the liver in people who consume little or no alcohol, is becoming increasingly common around the world, especially in developed countries. Extracts from earthworms have been used as alternative therapies for a variety of diseases but not in NAFLD. Therefore, the aim of this study was to investigate the effect of earthworm extract (EE) on diet-induced fatty liver disease in guinea pigs.METHODS:EE was extracted, and the effect of EE on the lipid levels and liver damage in guinea pigs fed a high-fat diet (HFD) was assessed. Thirty male guinea pigs at 3 weeks of age were allocated equally to five groups, namely, chow diet, HFD, and HFD with different dosages (0.3, 1.4 and 6.8 µg per kg bodyweight per day) of EE for 4 weeks, and their body weight was monitored throughout the experiment. Liver tissues were examined for gross morphology and histology. Serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), alanine transaminase (ALT) and aspartate aminotransferase (AST) were determined using an autoanalyser.RESULTS:HFD induced NAFLD in guinea pigs. HFD-fed guinea pigs that received EE treatment showed milder increases in the serum levels of TC, TG and LDL-C, as well as in the body weight growth rate, compared to the HFD group without EE supplementation. EE intervention reduced the number of lipid-containing hepatocytes, hepatocellular ballooning and sinusoidal distortion in the liver in HFD-fed animals. ALT in serum was significantly elevated by HFD. No statistically significant difference in ALT levels was found between the chow diet group and the HFD group with EE treatment.CONCLUSIONS:This study demonstrates that the administration of EE suppressed the induction of serum TC, TG and LDL-C in response to HFD. EE also reduced liver damage in HFD-fed guinea pigs. These findings suggest that EE has alleviating effects on dyslipidaemia and liver damage associated with NAFLD.

OBJECTIVE:To compare the clinical outcomes and complications of hip arthroscopic treatment for femoroacetabular impingement (FAI) performed with either Inside-out or Outside-in approach.METHODS:The clinical date of 48 patients with FAI treated by hip arthroscopy surgery and follow-up from June 2016 to June 2019 were retrospectively analyzed. According to the different operative methods, the patients were divided into two groups. Inside-out group, from central compartment to peripheral compartment;Outside-in group, from peripheral compartment to central compartment. There were 14 males and 10 females in Inside-out group with an averageage of (39.8±7.6)years old, 13 males and 11 females in Inside-out group with an average age of (39.5±9.1)years old in Outside-in group. There was no significant difference in age, gender, body mass index, side, impingement type, medical history and follow-up time between the two groups. The complication occurrence rate, modified Harris hip score (mHHS)and nonarthritic hip score (NAHS) were compared between these two groups.RESULTS:The mHHs and NAHS scores of the two groups were significantly higher than those before operation, but there was no significant difference between the two groups (P>0.05). In the Inside-out group, there were 4 cases of nerve traction injury and 3 cases of iatrogenic injury, while only 1 case of nerve traction injury occurred in the Outside-in group. The incidence of complications in the inside out group was higher than that in the outside in group (16.7% vs 4.2%, χ2=5.400, P=0.020).CONCLUSION:Both hip arthroscopic surgery methods can obtain satisfactory clinical efficacy in the treatment of FAI, but the incidence of postoperative complications of Outside-in surgical method is lower. The out-side in method can be preferentially selected for the patients with the indications of operation.

Background: Graft impingement is one of the main concerns in double-bundle anterior cruciate ligament reconstruction (DB-ACLR). Impingement between the anteromedial (AM) and posterolateral (PL) bundles has been postulated to cause graft deterioration or rerupture, but this has not been thoroughly investigated, and the interbundle impingement pressure (IIP) has not been well researched. Purpose: To determine the IIP between the AM and PL bundles in the native anterior cruciate ligament (ACL) and in DB-ACLR with individualized and nonindividualized double-tunnel placement. Study Design: Controlled laboratory study. Methods: A total of 30 fresh-frozen, nonpaired, human cadaveric knees were randomly divided into 3 groups of 10 knees: native intact ACL (NI group), DB-ACLR tunnel placement using the preserved remnant procedure (individualized reconstruction) (PR group), and DB-ACLR tunnel placement using the bony landmark procedure (nonindividualized reconstruction) (BL group). Pressure sensors were inserted between the AM and PL bundles. The knee was moved passively from full extension to full flexion, and the IIP between the 2 ACL bundles was measured every 15°. Similarly, the impingement pressure was measured between the ACL and intercondylar roof and between the ACL and posterior cruciate ligament (PCL). Results: No significant differences were found in the maximum, mean, or minimum ACL-roof and ACL-PCL impingement pressures among the 3 groups. The IIP significantly increased when the knee joint was flexed >120° in all 3 groups ( P < .001). Compared with the other 2 groups, the BL group had significantly higher maximum and mean IIP throughout the range of knee movement ( P < .001) and from maximum extension to 120° of flexion ( P < .001). The BL group also had significantly higher minimum IIP than the other 2 groups when knee flexion was >120° ( P < .001). No significant differences were seen in maximum, minimum, or mean IIP between the NI and PR groups. Conclusion: The PR procedure (individualized DB-ACLR) was more consistent with the interbundle biomechanical conditions of the native ACL, whereas the BL procedure (nonindividualized DB-ACLR) had higher maximum and mean IIP. The IIP was higher than the ACL–intercondylar roof or ACL-PCL pressures, and it increased significantly when knee flexion was >120°. Clinical Relevance: These data suggest that surgeons can perform individualized DB-ACLR using preserved remnants for tunnel placement as impingement-free DB-ACLR.

BACKGROUND:It is unclear whether coracoacromial ligament release during the Latarjet procedure will increase superior translation of the shoulder joint. PURPOSE:To evaluate whether a modified suture button Latarjet procedure can decrease the acromiohumeral distance (AHD). STUDY DESIGN:Case series; Level of evidence, 4. METHODS:A retrospective analysis was conducted among 155 patients who underwent a modified suture button Latarjet procedure between 2013 and 2015. AHD was measured on bilateral computed tomography scans taken preoperatively and on scans of the affected shoulder taken on postoperative day 1 and postoperative month (POM) 6, POM 36, and POM 60. At each time point, we recorded pain on a visual analog scale (VAS) and objective shoulder function using the American Shoulder and Elbow Surgeons, Rowe, and Walch-Duplay scores. Preoperative and final follow-up VAS and functional scores were compared using the paired t test. Pairwise comparison of AHD values at each follow-up time point were compared with the preoperative intact side using the paired t test. Intra- and interobserver reproducibility of the AHD measurements was evaluated using the intraclass correlation coefficient. RESULTS:A total of 104 patients who met the criteria completed the final follow-up, which occurred at 62.6 ± 2.4 months (mean ± SD). When compared with presurgery, the VAS and all functional scores improved significantly at the last follow-up (P < .001 for all). Intra- and interobserver intraclass correlation coefficients indicated good reliability for the ADH measurements. Preoperatively, there were no differences in AHD values between the intact and affected shoulders (7.8 ± 0.8 mm for both; P = .851). The AHD values at postoperative day 1 and POM 6, POM 36, and POM 60 were 9.6 ± 0.7 mm, 8.6 ± 0.9 mm, 8.0 ± 0.8 mm, and 7.9 ± 0.8 mm, respectively, all of which were larger than those of the preoperative intact side (P < .001 for all). CONCLUSION:The modified suture button Latarjet procedure not only offered satisfactory therapeutic effects but also did not decrease the AHD at 5-year follow-up.

目的:通过肩关节三维模型构建和有限元分析探讨改良线袢法Latarjet术后移植骨块微动的生物力学机制.方法:采集美国虚拟人网站(Visible Hum)的男性人体(亚洲)数据库右肩数据,根据肩关节复发脱位改良线袢法Latarjet手术技术过程构建有限元模型,包含肩胛骨、肱骨、锁骨、移植骨块,模拟肱骨在肩胛骨平面外旋,模拟肱骨头与关节盂相对活动,收集相关应力数据、应力图片和位移图片(以骨块中心为基点,分别设置X-骨块沿肩胛骨左侧滑行方向、Y-骨块向肩胛骨下方滑行方向、Z-骨块向外运动方向),分析肱骨及移植骨块应力变化.结果:1)肱骨外旋并与移植骨块撞击开始后,骨块所承受的撞击应力主要集中在移植骨块与高强线连接处.但随着肱骨的外旋角度增大,应力不再集中在移植骨块与高强线连接处,而表现为上下延展向骨块四周扩布,类似肱骨沿撞击中心的扩散分布.2)随着肱骨的外旋角度增大,移植骨块在被撞击过程中于X、Y、Z方向产生位移.大致可以分为两个阶段:肱骨外旋角度为0°～10.89°时,Z方向位移几乎没有(小于0.2且增值较小),该阶段中移植喙突骨块主要向肩胛骨内、下位移,其X方向位移最大值为2.05 mm,其Y向位移最大值为0.50 mm;当肱骨外旋角度为10.89°～24°时,Z方向的位移不断增加直至2.22 mm,骨块沿X方向增加直至2.89 mm,而骨块沿Y向的位移不再增加,保持在0.40 mm左右.此时移植骨块位移以向外侧翻转为主,附带向X方向的少量滑移.总的来说,3个方向位移距离随外旋过程增大;其位置由稍外于关节盂关节面,逐渐与之持平,最后稍偏内于关节面.结论:改良线袢固定法Latarjet术后早期移植骨块在肩关节外旋过程中产生微动;且肱骨与移植骨块的接触区始终为最大应力区,总体应力沿撞击中心向四周类同心圆样扩散分布,应力大小则呈阶梯状由内到外层层递减,可能与骨块塑形有关.

目的 分析关节镜下双排锚钉缝线桥技术治疗肩关节前脱位合并Mutch Ⅰ型肱骨大结节骨折的临床疗效.方法 回顾性分析自2016-06-2019-06采用关节镜下双排锚钉缝线桥技术治疗的16例肩关节脱位合并Mutch Ⅰ型肱骨大结节骨折,术中关节镜探查损伤情况并对症处理,进入并清理肩峰下间隙,Ⅲ型肩峰行肩峰成形术.复位大结节骨折块,近关节软骨缘置入带线锚钉固定,采用缝线桥技术将尾线呈交叉"网状"覆盖骨块表面,在骨折远端使用外排锚钉固定.结果 16例均顺利完成手术并获得随访,随访时间12～36个月,平均23.5个月.骨折均愈合,愈合时间8～16周,平均11.8周.末次随访时肩关节活动度:前屈150°～180°,平均163.8°;外旋40°～65°,平均54.4°;内旋背手4例为T5水平,5例为T6水平,2例为T7水平,5例为T8水平;ASES评分84～98分,平均89.3分;Constant评分86～96分,平均90.7分;Rowe评分85～98分,平均92.1分.结论 关节镜下双排锚钉缝线桥技术治疗肩关节前脱位合并Mutch Ⅰ型肱骨大结节骨折不仅手术创伤小、术后恢复快、临床效果好,而且还可以处理其他关节内合并损伤及病变,值得推广应用.

OBJECTIVE:To investigate the mid-term effect of lateral placement of bone graft on shoulder joint degeneration after modified arthroscopic Latarjet surgery with elastic fixation for recurrent anterior shoulder dislocation with an anterior glenoid bone defect. METHODS:According to the inclusion and exclusion criteria, 18 patients with recurrent anterior shoulder dislocation and anterior glenoid bone defect who received the modified arthroscopic Latarjet surgery with elastic fixation between January 2015 and November 2016 were enrolled in this study. There were 12 males and 6 females with an average age of 26.2 years (range, 19-37 years). The number of shoulder dislocation ranged from 4 to 30 times (mean, 8.8 times). The disease duration was 8-49 months (mean, 23.8 months). The mean anterior glenoid bone defect was 25.2% of the glenoid surface (range, 20%-29%). The mean preoperative Instability Severity Index Score (ISIS) was 7.6 (range, 7-10). According to Samilson-Prieto classification, the shoulder joint degeneration was rated as grade 0 in 13 cases, grade Ⅰ in 3 cases, and grade Ⅱ in 2 cases. Before and after operation, the visual analogue scale (VAS) score, American Society of Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, Rowe score, and shoulder mobility were used to evaluate the effectiveness. Imaging examination was performed to observe the shoulder joint degeneration, the position of the bone graft, and the postoperative shaping of the scapular glenoid. RESULTS:All patients were followed up 55-62 months, with an average of 59.6 months. There was no neurovascular injuries, infections, fixation-related and bone graft-related complications. No re-dislocation and revision occurred. All patients returned to normal life, 17 of whom returned to sport. The VAS score was significantly decreased and ASES, Walch-Duplay, and Rowe scores were significantly improved at last follow-up ( P<0.05). No significant difference was found in range of motion of forward flexion, abduction, lateral rotation at 90° abduction, internal rotation at 90° abduction, or lateral rotation at 0° between pre- and post-operation ( P>0.05). Three-dimensional CT showed that the centers of all bone grafts were between 3∶30 and 4∶30 (right shoulder) or between 7∶40 and 8∶20 (left shoulder) and no bone grafts were positioned superiorly or inferiorly in the glenoid En-face view. All bone grafts were positioned lateral to the scapular glenoid with an average distance of 3.5 mm (range, 2.3-4.6 mm) in cross-sectional imaging by CT. Compared with the preoperative Samilson-Prieto classification results, all cases showed no progression of shoulder joint degeneration at 36, 48 months and last follow-up. All bone grafts remodeled to a steady state within 24 months after operation. The bone graft and glenoid finally remodeled analogous to the shape of the intact glenoid in the En-face view and became flush with the glenoid rim, remodeling to a curved shape congruent to the humeral head in cross-sectional imaging by CT. The shape of the remodeled glenoid at last follow-up was not significantly different from that at 24 months after operation. CONCLUSION:The lateral placement of the bone graft during modified arthroscopic Latarjet surgery with elastic fixation do not accelerate the imaging changes of shoulder joint degeneration.

Gout is a common metabolic disease. Gouty arthritis is associated with the deposition of urate crystals in the synovial fluid or para-articular soft tissues, which often affects the hands, feet, wrists, ankle and knees joints. However, the shoulder joint is unusual involved. In the present study, a 49-year-old male patient complained of right shoulder pain for 9 months and aggravating with limited range of motion for 2 weeks. Physical examination showed that the external rotation was 10° and hand back was S 5 of the right shoulder. The MRI showed shoulder joint effusion and intra-articular loose bodies. The patient was admitted to the hospital with the diagnosis of "loose bodies of the right shoulder with synovial chondromatosis possibly". Arthroscopic examination revealed that a lots of urate crystals were deposited on synovium, cartilage and rotator cuff. Loose bodies removal and joint debridement were performed. Histopathologic examination of the specimen demonstrated synovitis hyperplasia with urate crystals deposition. Shoulder gouty arthritis characterized by pain and limited movement. The imaging of tophi depends on the calcium-containing deposits. Tophus with calcium deposits can be found on X-ray and CT. MRI can not only evaluate the tophus but also the evaluate the other intra-articular pathologies. Due to no typical manifestations and specific images of shoulder gouty arthritis, pathological diagnosis is the "gold standard". Shoulder arthroscopy provide a minimal invasive technique in diagnosing and treating of the shoulder disease. Undoubtedly, it could be a reliable diagnosis and treatment method for shoulder gouty arthritis.

目的 对比评估双骨道四袢与单骨道双袢固定修复急性肩锁关节RockwoodⅤ型脱位疗效.方法 回顾性分析2010年5月至2016年5月于深圳大学第一附属医院接受关节镜下双骨道四袢与单骨道双袢固定修复急性肩锁关节RockwoodⅤ型脱位的所有患者,其中入选82例手术患者,四袢双骨道组与双袢单骨道组各41例.术后2年内随访观察患者的视觉模拟评分(visual analogue scale,VAS)、患者恢复运动时间、恢复运动患者数量、Constant功能评分、Karlsson肩锁关节功能评分,并通过影像学观察评估喙锁关节和肩锁关节的间隙.结果 术后2年内末次随访X线片显示四袢双骨道组患侧平均喙锁关节和肩锁关节的间隙与双袢单骨道组对比明显减小,且差异具有统计学意义(P<0.05);双袢单骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比明显减小,且差异具有统计学意义(P<0.05);然而四袢双骨道组患者健侧平均喙锁关节和肩锁关节的间隙与患侧对比差异无统计学意义(P>0.05).两组患者术后末次随访患肢疼痛均有明显减轻,术前与术后VAS评分对比差异具有统计学意义,两组组间对比差异无统计学意义.四袢双骨道组重返运动的时间较双袢单骨道组明显缩短,重返患者数目明显多于双袢单骨道组,且Constant功能评分、Karlsson肩锁关节功能评分均明显优于双袢单骨道组,差异均具有统计学意义(P<0.05).四袢双骨道组并发症明显少于双袢单骨道组.结论 采用关节镜下双骨道四袢固定治疗Rockwood V型脱位,方法固定可靠,并发症少,较双袢单骨道固定效果更佳,是治疗急性肩锁关节Rockwood V型脱位损伤较好的方法.

背景:类固醇具有强大的抗炎、止吐及镇痛作用而被广泛用于围术期镇痛,有研究表明膝关节置换后膝关节周围注射含类固醇的鸡尾酒镇痛疗法可缓解术后疼痛、改善膝关节活动度及减少相关并发症,但也有研究认为类固醇可增加术后感染、髌腱断裂等风险.因此膝关节周围注射含类固醇鸡尾酒疗法在膝关节置换后镇痛中的安全性和疗效尚存在争议.目的:通过荟萃分析系统评价膝关节置换后运用含类固醇鸡尾酒疗法镇痛的疗效和安全性.方法:检索PubMed/Medline、Cochrane Central Register of Controlled Trials、EMBASE数据库2019年4月前的文献,收集所有膝关节置换后局部运用类固醇镇痛的随机对照试验,筛选出符合条件的文献.由2名研究者分别单独使用Cochrane 5.0风险偏倚评估工具对文献方法学偏倚进行评价,提取文献数据并用Review Manager 5.2软件进行荟萃分析.结果 与结论:①共纳入1 0篇随机对照试验,820例患者;②Meta分析显示:类固醇组术后第1天的目测类比评分低于对照组[MD=-1.52,95％C/(-2.94,-0.10),P=0.04],术后第1,2,3,4,5天的关节活动度高于对照组[MD=1 1.57,95％C/(9.85,13.30),P＜0.000 01;MD=9.03,95％C/(6.67,11.38),P＜0.000 01;MD=5.73,95％CI(0.85,10.60),P=0.02;MD=5.53,95％C/(0.68,10.38),P=0.03;MD=5.90,95％C/(0.87,10.93),P=-0.02],吗啡使用量少于对照组[MD =-7.94,95％C/(-14.35,-1.53),P=-0.02],住院时间短于对照组[MD=-0.98,95％C/(-1.25,-0.71),P＜0.000 01],直腿抬高所需时间短于对照组[MD=0.65,95％C/(-0.86,0.44),P＜0.000 01],术后C-反应蛋白水平低于对照组[WMD=-4.82,95％C/(7.41,2.23),P=0.000 3];两组膝关节KSS评分、并发症发生率比较差异无显著性意义;③结果表明,膝关节置换后关节周围运用含类固醇的鸡尾酒疗法安全有效.

Background: Whether coracoacromial ligament (CAL) release during Latarjet procedure will increase superior instability of shoulder joint postoperatively remains controversial. This study aims to observe changes in the acromiaohumeral distance (AHD) of patients who underwent modified double-button Latarjet procedure and provide evidence to address the issue. Methods: A retrospective analysis was conducted among 155 patients who underwent modified double-button Latarjet procedure in our department from 2013 to 2015. Preoperative CT scan of bilateral shoulders were used for glenoid defect evaluation. CT scans were performed immediately after operation (PO 0) and during the follow-up at 6, 36, and 60 months postoperatively (POM) to observe the healing and remodeling of the graft, and AHD was measured. The intact sides were set as control group. VAS and objective shoulder scores, including ASES, ROWE, and Walch-Duplay scores, were recorded at each time point. Results: A total of 104 cases who met the criteria completed follow up. The average follow-up time was 62.6 ± 2.4 months. Compared with preoperative conditions, the function scores of the shoulders were significantly improved at the last follow-up. There were no statistical differences of the AHD values between bilateral shoulders preoperatively. The AHD values at PO 0 and POM 6 were significantly higher than those of intact side (p < 0.05). The AHD values at POM 36 and 60 were slightly higher than those of intact side and the differences were statistically significant (p < 0.05). Conclusions: The modified double-button Latarjet procedure not only offers satisfactory therapeutic effect but also will not cause obvious superior instability at the 5-year follow-up.

OBJECTIVE:To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis. METHODS:Ten pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared. RESULTS:There was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups ( t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups ( t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft's tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups ( P=0.395). CONCLUSION:Although the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.

目的:采用Socket-anchor技术在全关节镜下重建距腓前韧带,并观察其临床预后.方法:回顾分析2017年1月至2018年6月治疗的20例慢性踝关节外侧不稳患者,男18例、女2例,年龄30.3±4.64岁(20～38岁).通过术前影像学及术中评估,判断距腓前韧带结构缺失.所有患者均行关节镜下距腓前韧带重建术,距骨侧采用Socket-anchor技术.术前1周及术后第12个月进行疗效评估,评价指标包括:疼痛视觉模拟评分(VAS),美国足踝外科学会(AOFAS)评分和Tegner运动水平评分,并记录并发症.结果:20例患者平均随访时间21.3±5.28月(12～30月).患者术前VAS评分2.9±0.55分,术后VAS 0.4±0.5分,差异具有统计学意义.AOFAS评分术前73.55±7.52分,术后96.45±4.96分,差异具有统计学意义(P<0.05);Tegner评分从术前2.6±0.82分提升到术后6.35±0.67分,差异有统计学意义(P<0.05).1例患者踝关节轻度僵硬,无韧带再断裂、神经损伤等严重并发症.结论:运用Socket-anchor技术行全关节镜下距腓前韧带重建取得了良好的临床疗效.