[Effectiveness analysis of arthroscopically assisted treatment of rotator cuff injury].

OBJECTIVE: To explore the method and effectiveness of arthroscopically assisted treatment of rotator cuff injury. METHODS: Between November 2009 and March 2011, 27 patients with rotator cuff injury were treated. There were 17 males and 10 females with a mean age of 43.6 years (range, 29-66 years). The disease duration was 1 to 36 months (mean, 27 months). The location was the left shoulder in 11 cases and the right shoulder in 16 cases. Of them, 12 cases had a history of trauma and 15 cases had no obvious predisposing causes. All patients had limitation of shoulder flexion and abduction. Anteroposterior and lateral X-ray films of the shoulder and the out-let X-ray films of the supraspinous muscle were taken. According to the acromion classification of Bigliani, there were 5 cases of type I, 13 cases of type II, and 9 cases of type III. MRI images showed all patients had rupture of the rotator cuff. The examination of shoulder arthroscope showed complete rupture of the supraspinatus muscle in 27 cases and acromion impingement in 23 cases. The patients without impingement underwent tear debridement, and the patients with impingement underwent acromioplasty and resection of subacromial bursa after tear debridement. The 3-4 cm incision was made with arthroscopically assisted positioning, and the metal suture anchor was placed on the greater tubercle of humerus to repair rotator cuff. RESULTS: All incisions healed primarily. All patients were followed up 13-27 months (mean, 19 months). No infection, loosening of internal fixation, and rotator cuff re-tear occurred. Pain was relieved and the results was satisfactory after operation. The shoulder range of motion (ROM) at last follow-up was significantly improved when compared with preoperative ROM (P < 0.05). The visual analogue scale (VAS) score was significantly improved from 8.0 +/- 1.8 at preoperation to 1.6 +/- 0.7 at 2 weeks after operation and 0.8 +/- 0.7 at last follow-up (P < 0.05); the University of California Los Angeles (UCLA) score of shoulder was significantly increased from 18.8 +/- 6.6 at preoperation to 32.2 +/- 3.3 at 3 months after operation and 33.6 +/- 2.1 at last follow-up (P < 0.05). CONCLUSION: The effectiveness of arthroscopically assisted treatment of rotator cuff injury is satisfactory. However, long-term effectiveness needs further follow-up observation.

[Clinical treatment of open pelvic fractures associated with perineal injury].

OBJECTIVE: To investigate the method and the effectiveness of open pelvic fractures associated with perineal injury. METHODS: Between August 2000 and July 2010, 16 cases of open pelvic fractures associated with perineal injury were treated. There were 12 males and 4 females with an average age of 41 years (range, 17-69 years). Injury was caused by traffic accidents in 9 cases, by falling from height in 6 cases, and by crushing in 1 case. The mean time between injury and admission was 8 minutes (range, 5-20 minutes). According to Tile classification, 2 cases were rated as type A, 6 as type B, and 8 as type C. The wound size ranged from 5 cm x 3 cm to 15 cm x 12 cm. The perineal injured location included intraperitoneal rectal injury in 2 cases and extraperitoneal anorectal injury in 14 cases. The average injury severity score (ISS) was 29 (range, 25-48). The main treatments included emergency resuscitation, colostomy, external fixation of fractures, repeated debridement with pulsatile irrigation followed by intravenous antibiotics, and vacuum sealing drainage (VSD). RESULTS: In 5 deaths, 3 cases died of hemorrhagic shock and 2 cases died of multiple system organ failure within 4 days of admission. The other 11 cases were followed up 6-46 months (mean, 14 months). The X-ray films showed that bone union was achieved after 2-4 months of operation. Infection in varying degree occurred at perineal wounds; second stage healing of wounds was achieved in 10 cases after debridement and VSD treatment, and wound healed in 1 case after gracilis muscle flap repair. No anal incontinence occurred in the patients having anorectal injury during follow-up. CONCLUSION: For patients with perineal injury and open pelvic fractures, the following treatments should be carried out so as to obtain good effectiveness: early anti-shock, protection of important organ function, treatment of complications, late resistance to infection and stability restoration of the pelvic ring, functional repair and reconstruction of rectum and anal canal and urinary tract.