الملخص
Objective:To investigate the clinical efficacy of arthroscopic double-row double-pulley technique in the treatment of Ideberg type IA scapular glenoid fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 16 patients with Ideberg type IA scapular glenoid fracture admitted to Jiading Branch of Shanghai General Hospital from January 2018 to December 2021, including 10 males and 6 females, aged 25-65 years [(42.9±5.1)years]. The patients were treated with arthroscope-assisted reduction and double-row double-pulley technique. The operation time was recorded. Three-dimensional reconstruction of the shoulder joint with CT was performed to assess fracture displacement and healing. Modified University of California Los Angeles (UCLA) score and Constant-Murley score were used to evaluate shoulder function and Visual Analogue Scale (VAS) score was used to evaluate pain before surgery, at 3, 6, 12 months after surgery and at the last follow-up. The complications were observed.Results:All the patients were followed up for 12-36 months [(20.3±4.4)months]. The operation time was 60-90 minutes [(74.7±8.9)minutes]. Three-dimensional construction of the shoulder joint with CT performed at 3 months after surgery showed that there was no fracture re-displacement and all the patients had bone union. The modified UCLA score, Constant-Murley score and VAS score at 3 months after surgery were (30.4±0.4)points, (84.3±1.4)points and 2.0(1.3, 3.0)points, respectively, which were significantly improved compared with those before surgery [(21.1±0.5)points, (56.4±1.3)points and 5.0(5.0, 6.0)points respectively] ( P<0.05). The modified UCLA score, Constant-Murley score and VAS score at 6 months after surgery were (33.1±0.4)points, (91.0±0.5)points and 1.0(1.0, 2.0)]points respectively, which were significantly improved compared with those at 3 months after surgery ( P<0.05). The modified UCLA score, Constant-Murley score and VAS score at 12 months after surgery were (33.5±0.3)points, (92.6±0.6)points and 1.0(0.3, 1.8)points respectively, showing no significant differences from those at 6 months after surgery ( P>0.05). The modified UCLA score, Constant-Murley score and VAS score at the last follow-up were (33.8±0.8)points, (93.7±1.8)points and 1.0(0.0, 1.0)points respectively, with no significant differences from those at 12 months after surgery ( P>0.05). There were no complications such as wound infection, neurovascular injury or shoulder stiffness after surgery. Conclusion:Arthroscopic double-row double-pulley technique for the treatment of Ideberg type IA scapular glenoid fracture has a short operation time, a high fracture healing rate, good shoulder function recovery, and pain relief, with no common complications.
الملخص
Objective:To evaluate the curative effect of arthroscopic long head of biceps tendon (LHBT) transfer to reconstruct shoulder superior capsule for repairing massive rotator cuff tears.Methods:A retrospective case-control study was conducted on clinical data of 64 patients with massive rotator cuff tears admitted to Shanghai Tenth People's Hospital of Tongji University between December 2017 to January 2019. There were 26 males and 38 females, with the age of 50-75 years [(62.5±4.8)years]. All patients were treated by arthroscopic superior capsular reconstruction with LHBT. The shoulder range of motion in flexion, abduction, external rotation, acromiohumeral distance, visual analogue scale (VAS), Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score were evaluated and recorded before operation and at the last follow-up. The MRI was used to evaluate the integrity of the reconstructed structure at the last follow-up and rotator cuff re-tear rate. Postoperative complications were detected.Results:All patients were followed up for 13-25 months [(18.2±4.3)months]. At the last follow-up, the shoulder range of motion was (149.5±7.8)° in flexion, (162.0±6.6)° in abduction, and (60.6±11.8)° in external rotation; the acromiohumeral distance was (7.4±0.6)cm, the VAS was 1.0(0.0, 1.0)points, the Constant-Murley score was (90.5±2.6)points, the ASES was (90.8±4.2)points, which were significantly improved compared with those before operation [flextion: (73.8±5.3)°, abduction: (85.8±5.5)°, external rotation: (34.3±5.8)°, acromiohumeral distance: (5.9±0.8)cm, VAS: 6.5(6.0, 7.0)points, Constant-Murley score: (41.8±5.4)points, ASES: (41.4±6.1)points, respectively]( P<0.01). of all, 56 patients had intact reconstruction structure at the last follow-up, 7 patient with smalll retears in the reconstruction were not revised, and 1 patient underwent revision operation after reconstruction failure. The retear rate after rotator cuff repair was 13% (8/64). There were no obvious surgical complications after operation, with the incision free from infection. Conclusion:Arthroscopic superior capsular reconstruction with LHBT for repairing massive rotator cuff is safe and reliable, which can effectively relieve the pain of shoulder joint, recover the function and improve the joint mobility.