An anatomic and histologic study of the coracohumeral ligament.

Although the anatomy and histology of the coracohumeral ligament (CHL) play an important role in the diagnosis and treatment of frozen shoulder, they remain unclear. Our objective was to study the anatomic features of the CHL and analyze its histology. Twenty-six fresh-frozen, normal cadaveric shoulders were used to examine the position and morphology of the CHL and their relationship with the superior glenohumeral ligament and to determine the CHL's histologic features in comparison with the joint capsule and coracoacromial ligament. The CHLs were all located in the rotator interval, with an irregular trapezoidal structure. The subacromial bursa was above the CHL, and the subcoracoid bursa was below the it. The CHLs in all shoulders originated from the lateral aspect of the base of the coracoid process. In 11 shoulders, it inserted into the supraspinatus tendon, whereas in 11 other shoulders, it inserted into the rotator interval. In 3 shoulders, the CHLs were split and inserted into both the supraspinatus and subscapularis tendons, respectively. Finally, the CHL in 1 shoulder only inserted into the subscapularis tendon. We also observed that the pectoralis minor tendons in 4 shoulders passed over the coracoid process top and inserted into the CHLs. In 11 shoulders, a complex of the CHL and the superior glenohumeral ligament was formed. Histologically, the CHL was found to be similar to the joint capsule without any ligament features. The position, morphology, and origin of the CHL did not change much, but its insertion varied greatly. In addition, the CHL had the histologic feature of a capsule, not a ligament.

[Measurement of humeral head retroversion angle with multislice spiral computerized tomography volume rendering technique].

OBJECTIVE: To verify the accuracy of measurement of humeral head retroversion angle with multislice spiral computerized tomography (MSCT) volume rendering technique. METHODS: Twenty cadaveric humeri, 9 left and 11 right, free from traumatic or degenerative disfigurement, were harvested from embalmed cadavers. Before all soft tissues were removed by sharp dissection these humeri were scanned with 16 slice spiral CT scanner (CT1 group); then underwent anatomical measurement (anatomical measuring group); and at last, these humeri with marked anatomic neck were scanned with 16 slice spiral CT scanner again (CT2 group). The measurement was done by 2 orthopedists independently so as to diminish the measuring error. The differences in the humeral head retroversion angle between the CT1 group and anatomical measuring group, and the CT2 group and anatomical measuring group were analyzed with paired-samples T test. RESULTS: It showed that the results have no significant difference among them. The difference in the average value of humeral head retroversion angle between the CT1 group and anatomical measuring group was 1.64 degrees, and that between the CT2 group and anatomical measuring group was 0.65 degrees. CONCLUSION: Simple, fast, and precise, and suitable for clinical application, MSCT volume rendering technique can be used preoperatively, thus helping to realize the idea of individualization of shoulder arthroplasty and shoulder prosthesis. Although this technique is easy to be influence by the subjective factors of the observers, increase of experience and rational measurement may minimize the measurement error.

[Arthroscopic Bankart lesion repair by double-row vertical mattress suture with anchors for anteroinferior glenohumeral instability].

OBJECTIVES: To introduce a new arthroscopic Bankart repair by vertical mattress suture with anchors, and to evaluate its clinical effectiveness. METHODS: A new arthroscopic Bankart repair by vertical mattress suture with anchors was performed, including to insert only 2 anchors at 3 o'clock and 5 o'clock position and make vertical mattress suture of labrum-ligament complex at 2, 4 and 6 o'clock of labrum, and to shift up the anterior-inferior capsule. Nine cases of anterior glenohumeral instability without severe glenoid bone defect were followed-up for an average period of 14 months (range from 6 to 26 months). The average surgery age was 28 years (range from 21 to 46 years). RESULTS: The average surgery time was 51 min (40 - 75 min). Clinical scores as evaluated by the modified Rowe score advanced from 40 +/- 16 points to 92 +/- 19 points (75 - 94). There was no any recurrence and complication. External rotation was reduced by 5 degrees at 0 degrees adduction and by 3 degrees at 90 degrees of abduction. CONCLUSIONS: The arthroscopic Bankart repair by vertical mattress suture with anchors for anteroinferior glenohumeral instability is favorable as an easy, short-time surgery with excellent clinical results in short-term follow-up.

Tibiotalocalcaneal arthrodesis with headless compression screws.

BACKGROUND: Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. We hypothesized that these screws could be suitable for tibiotalocalcaneal arthrodesis because of their special design. This study aimed to evaluate the clinical outcomes of patients undergoing tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint. METHODS: From 2010 to 2015, 23 patients with severe ankle and subtalar arthropathy underwent tibiotalocalcaneal arthrodesis. All surgeries were completed by a senior surgeon in the same hospital. These patients were 18~76 years (mean 54.6 years) old; the duration of their disease was 9~38 months (mean 13.2 months). The study population included 12 males and 11 females; 12 patients underwent surgery on the left and 11 on the right. Indications for surgery included avascular necrosis of the talus (n = 14), severe posttraumatic arthritis (n = 4), osteoarthritis (n = 2), terminal tuberculous arthritis (n = 1), rheumatoid arthritis (n = 1) and Charcot neuroarthropathy (n = 1). A lateral oblique incision was performed to expose the subtalar joint, and an anteromedial longitudinal incision was used to expose the ankle joint. After the articular surfaces were removed, the tibia, talus and calcaneus were carefully aligned and fixed with two headless compression screws. Patients were followed up at 6 weeks and 3, 6 and 9 months after surgery; they were evaluated by Roles and Maudsley patient satisfaction scores, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) score and radiographic evaluation. RESULTS: Seventeen patients were studied, with a mean follow-up time of 6.5 months (range 5-24). The mean Roles and Maudsley patient satisfaction score was 1.41 at the last follow-up; most of the patients were satisfied with the surgery results. The mean preoperative AOFAS Ankle-Hindfoot Score was 29.6 (range 18-37), while the mean last follow-up AOFAS Ankle-Hindfoot Score was 68.5 (range 61-80). The VAS score for preoperative functional pain was 6.95 (range 3-10) compared to 1.56 (range 0-3) postoperatively (P < 0.001). The mean surgical duration was 57 (range 42-125) min. The mean time to union was 3.8 months (range 3-12 months); fusion of the ankle and subtalar joint was successful in all patients. One patient experienced delayed wound healing. CONCLUSIONS: Tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint is an effective treatment that is minimally invasive and is associated with a short operation time, high fusion rate, low incidence of complications and good postoperative recovery.

[Characteristics of mass distributions of aerosol particle and its inorganic water-soluble ions in summer over a suburb farmland in Beijing].

Agricultural activity is one of the important sources of aerosol particle. To understand the mass distribution and sources of aerosol particle and its inorganic water-soluble ions in the suburb farmland of Beijing, particle samples were collected with a MOUDI cascade impactor in the summer of 2004 in a suburb vegetable field. The mass distributions of the particle and its inorganic water-soluble ions in the diameter range of 0.18 to approximately 18 microm were measured. The dominant ions in the fine particle were SO4(2-), NOS3(-) and NH4+. The association of day to day variation of the concentration of these ions with temperature, humidity and solar radiation suggests that they are formed by the reaction of NH3 released from the vegetable field with the acid species produced from photochemical reactions. K+ in the fine particle is likely from the vegetation emission and biomass burning. Ca2+, Mg2+, NO3(-) and SO4(2-) in the coarse particle are suggested to come from the mechanical process by which the soil particle entered the atmosphere, and from the reactions of the acid species at the surface of the soil particle. The results show that fertilizer and soil are possibly important factors determining the aerosol particle over the agricultural fields, and the vegetable fields in suburb Beijing could contribute significantly to the aerosol particle.