RESUMO
INTRODUCTION: The study aim is to compare Video-Assisted (VATS) and Robotic-Assisted (RATS) lobectomy in the effort to identify advantages and limits of robotic procedures considering the high costs and specific surgeon training. MATERIALS AND METHODS: This is a monocentric prospective randomized trial in which patients suitable for mini-invasive lobectomy were randomized 1:2 in two groups: Group A, RATS (25 patients), and Group B, VATS (50 patients). The two groups were compared in terms of perioperative and postoperative results with a mean follow up of 37.9 (±10.9) months. RESULTS: We observed a significant reduction of pleural effusion on day 1 (140 ml vs 214, p = 0.003) and day 2 (186 vs 321, p = 0.001) for group A. The Visual Analogue Scale (VAS) showed significantly lower pain in the 1st p.o. day in group A (0,92 vs 1,17, p = 0,005). Surgery time in Group B was significantly lower (160 min vs 180, p = 0.036), but had a higher onset of atrial fibrillation and other cardiac arrhythmias (0/25 vs 9/50, p = 0.038). The OS and DFS were similar between the two groups (95.5 % vs 93.1 %, and 95.5 % vs 89.7 %, respectively). Furthermore, no statistical difference in the evaluation of quality of life during follow-up was found. CONCLUSIONS: The RATS approach, although burdened by higher surgical costs, constitutes a valid alternative to VATS; as it determines a lower inflammatory insult, with a consequent reduction in pleural effusion, less post-operative pain and cardiological comorbidities for the patient, it can potentially determine the shortening in hospitalization. In addition, RATS allows accurate lymph node dissection, which permit to reach results that are not inferior to VATS in terms of long-term outcomes.
Assuntos
Neoplasias Pulmonares , Derrame Pleural , Humanos , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Cirurgia Torácica Vídeoassistida , Qualidade de Vida , Estudos Prospectivos , Pneumonectomia/métodos , Dor Pós-OperatóriaRESUMO
The treatment of severe glenoid bone loss in shoulder arthroplasty represents a challenge, and the results of current prosthetic designs with only glenoid fixation still remain unsatisfactory. In the past decade, customized glenoid prostheses have been developed to address severe glenoid arthritis and in the revision setting. In this review, we analyzed the current surgical options, the classification limits, past literature evidence, and our preliminary results of 6 patients (3 male, 3 female) treated with a reverse implant and custom-made glenoid implant (ProMade; LimaCorporate, Italy). Computer analysis of the residual shape and the amount of glenoid bone stock in association with new classifications could help the surgeon to obtain good clinical and radiological outcomes. The development of navigation systems could improve the adequacy of the implant and, thus, the reliability and longevity of the implant itself.
Assuntos
Artroplastia do Ombro/métodos , Articulação do Ombro/cirurgia , Humanos , Radiografia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Articulação do Ombro/diagnóstico por imagemRESUMO
To evaluate incidence of and risk factors for respiratory bacterial colonization and infections within 30 days from lung transplantation (LT). We retrospectively analyzed microbiological and clinical data from 94 patients transplanted for indications other than cystic fibrosis, focusing on the occurrence of bacterial respiratory colonization or infection during 1 month of follow-up after LT. Thirty-three percent of patients developed lower respiratory bacterial colonization. Bilateral LT and chronic heart diseases were independently associated to a higher risk of overall bacterial colonization. Peptic diseases conferred a higher risk of multi-drug resistant (MDR) colonization, while longer duration of aerosol prophylaxis was associated with a lower risk. Overall, 35% of lung recipients developed bacterial pneumonia. COPD (when compared to idiopathic pulmonary fibrosis, IPF) and higher BMI were associated to a lower risk of bacterial infection. A higher risk of MDR infection was observed in IPF and in patients with pre-transplant colonization and infections. The risk of post-LT respiratory infections could be stratified by considering several factors (indication for LT, type of LT, presence of certain comorbidities, and microbiologic assessment before LT). A wider use of early nebulized therapies could be useful to prevent MDR colonization, thus potentially lowering infectious risk.
Assuntos
Bactérias/crescimento & desenvolvimento , Transplante de Pulmão/efeitos adversos , Pneumonia Bacteriana/etiologia , Complicações Pós-Operatórias/etiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/microbiologia , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Complicações Pós-Operatórias/microbiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Transplantados/estatística & dados numéricosRESUMO
BACKGROUND: Metal plates are the fixation devices used most frequently to proximal humeral fractures (PHFs). However, in recent years carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plates have become increasingly common. This study compares the clinical and radiographic outcomes of 42 Neer three- and four-part PHFs treated with CFR-PEEK or metal (titanium) plates. MATERIALS AND METHODS: Forty-two PHF patients were managed with CFR-PEEK plates (n = 21, males/females 9/12; mean age 57.4 years; mean follow-up 30.7 months; CFR-PEEK group) or metal plates (n = 21; males/females 7/14; mean age 55.8 years; mean follow-up 52.7 months; Metal group). Active shoulder mobility (anterior elevation, lateral elevation, external rotation, and internal rotation), the Constant-Murley Score, the Simple Shoulder Test Score, and the pain score were recorded. Preoperative computed tomography scans and X-rays were obtained. Postoperative fracture healing and displacement, tuberosity resorption and/or malposition, hardware position, and cortical thinning (CT) under the plate were assessed radiographically. RESULTS: Shoulder mobility, clinical, and pain scores were similar in both patient groups. CT was significantly greater in CFR-PEEK patients (mean difference, 1.14 mm; p = 0.0003). In both groups, incomplete or poor calcar reduction was associated to a significantly higher complication rate, especially stiffness and muscle weakness (p = 0.016). The rate of tuberosity resorption was significantly higher in the Metal group (p = 0.040). Two patients required revision to a hemiarthroplasty (CFR-PEEK) and reverse arthroplasty (Metal group). CONCLUSIONS: CFR-PEEK plates provide a viable alternative to conventional titanium plates in PHFs, ensuring similar clinical outcomes and a lower rate of tuberosity resorption, but they involve higher stress shielding under the plate.
Assuntos
Placas Ósseas , Fibra de Carbono , Cetonas , Polietilenoglicóis , Fraturas do Ombro/cirurgia , Titânio , Adulto , Idoso , Benzofenonas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polímeros , Desenho de Prótese , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The self-administered Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow questionnaire is a reliable and sensitive outcome tool to assess upper extremity athletic performance and functional changes affecting return to play in overhead athletes. We report the results of a study of return to sport in professional overhead athletes at a mean follow-up of 2 years after arthroscopic repair of rotator cuff tears and associated labral injuries using the Italian version of the score. MATERIALS AND METHODS: A total number of 38 patients completed the 10-item questionnaire before and after surgery. They were also asked (1) whether they had returned to play; (2) how many months after the operation they had done so; (3) the level of postoperative performance (preinjury or less); and (4) whether they had had to change sport due to their shoulder problems. RESULTS: Significant differences were found (1) between preoperative and postoperative scores; (2) between the scores of patients who returned to play at preinjury level and those who merely returned to competition; and (3) between the postoperative subscores of 8/10 items, which were higher in the patients who returned to preinjury performance than in those who merely returned to play; the two items that were not significantly different between these subgroups concerned pain and joint stability. Even though item analysis highlighted a major role for athletic performance in recovery of preinjury performance, it also stressed that the athlete's relationship with coach, agent, and staff and his/her feeling of the extent to which the arm affects current performance significantly contribute to the final score. CONCLUSIONS: The KJOC Shoulder and Elbow score provides an accurate and exhaustive assessment of the recovery of the athlete's shoulder in relation to preinjury performance and provides the surgeon with key information on the pros and cons of surgical management.
Assuntos
Artroscopia , Autoavaliação Diagnóstica , Volta ao Esporte , Lesões do Manguito Rotador/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Itália , Masculino , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Implant registries have proved valuable in assessing the outcomes of arthroplasty procedures. Moreover, by identifying lesser quality implants they have indirectly improved the quality of care. The registry of prosthetic shoulder implants was established in 2008. METHODS: It records information on all types of primary and revision arthroplasty procedures involving the glenohumeral joint, including reverse and total arthroplasty, hemiarthroplasty, resurfacing, removal, and any other surgical procedures that are required to manage these patients. The collected data include patient demographics, weight, height, operated side, cuff status, and diagnosis/reason for revision surgery, information on previous surgical procedures involving either shoulder, comorbidities, antibiotic and thromboembolic prophylaxis, blood transfusions, surgical approach, cuff repair procedures performed during arthroplasty, bone grafts, drains, and perioperative complications, and data about the prosthetic components implanted, including the fixation method. RESULTS: Procedures were performed on 3754 shoulders. They included 2226 RSA, 320 TSA, 730 HA, 233 resurfacing procedures, 245 revisions, and 77 "other" procedures. The survival curves of the implants are greater than 90%, and no differences were found among prosthesis from different manufacturers. The diagnosis that prompted to arthroplasty was: osteoarthritis in 60.9% of cases and fractures, bone necrosis, sequelae of fracture and rotator cuff tear arthropathy for the rest of implants. DISCUSSION AND CONCLUSION: This study describes the epidemiological data and mid-term implant outcomes of the shoulder arthroplasty procedures performed in our region, from 2008 to 2014, and compares them with published data from national registries of similar size. LEVEL OF EVIDENCE: III.
Assuntos
Sistema de Registros , Prótese de Ombro , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos Diagnósticos Relacionados , Feminino , Seguimentos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Reoperação , Prótese de Ombro/estatística & dados numéricos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: The reverse shoulder prosthesis (RSP) was developed to relieve pain and improve functional outcomes in patients with glenohumeral arthritis and deficiency of the rotator cuff. Even if clinical and functional outcomes regarding the use of the RSP were reported by literature, data concerning progressive deltoid adaptation to this non-anatomic implant are still missing. The purpose of our study was to correlate clinical and functional outcomes with deltoid fibers activity and muscle fatigability in patients with reverse shoulder prosthesis at 2 years follow-up. METHODS: Twenty patients with reverse shoulder prosthesis due to symptomatic deficient or nonfunctional rotator cuff associated with osteoarthritis were referred by Cervesi Hospital Shoulder and Elbow Surgery Unit. Exclusion criteria were: axillary nerve palsy, a nonfunctioning deltoid muscle, diabetes, previous trauma, malignancy. Furthermore patients who received the RSP for revision arthroplasty, proximal humerus fractures were excluded. All the patients underwent clinical and functional evaluation with the support of electromyography measurement focused on deltoid activity. RESULTS: RSP surgical treatment in shoulder osteoarthritis confirms his good outcome in terms of pain relief. At 2 years anterior and lateral deltoid electromyographic activity was significantly lower compared with contralateral side (p < 0.001). Posterior deltoid activity was no detectable. Range of motion at 2 years of follow-up decreased in terms of forward flexion (p = 0.045), abduction (p = 0.03) and external rotation (p < 0.001). CONCLUSIONS: Our study demonstrates that even if the patients remain pain-free, progressive deterioration of the deltoid activity is unavoidable and may lead to poor functional outcomes overtime.
Assuntos
Artroplastia do Ombro , Músculo Deltoide/fisiopatologia , Adaptação Fisiológica , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fadiga Muscular , Osteoartrite/cirurgia , Amplitude de Movimento Articular , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Prótese de Ombro , Resultado do TratamentoRESUMO
PURPOSE: Scapular dyskinesis is a recognized cause of shoulder pain in the throwing shoulder of baseball pitchers and athletes who participate in overhead sports. Past studies have assessed scapular kinematics using electromagnetic tracking devices and have shown a correlation between posterior shoulder tightness and forward scapular posture. The purpose of our study is to evaluate the scapular kinematics, before and after a 4-week posterior stretching protocol in asymptomatic pitchers. METHOD: Eleven asymptomatic collegiate baseball pitchers were involved in the study and divided into group A (6 pitchers) underwent 4 weeks of a regimented therapy protocol and group B (5 pitchers) did not receive any treatment. Each pitcher was tested on two separate days: at the first day of the study (S1) and after 4 weeks (S2). RESULTS: The results demonstrate that there are statistically significant differences in the kinematics of several athletes from the "treated group" (group A) between S1 and S2. It is also important to notice that variations in group A occurred in both flexextension and ab/adduction movements, strengthening the conclusion that the variation was real. CONCLUSION: The results of the study can indicate that, in order to prevent the pathologic cascade linked to these sports activities, this physical training protocol might become integral part of the normal daily exercises of baseball pitchers and overhead athletes. Level of evidence II.
Assuntos
Traumatismos em Atletas/etiologia , Traumatismos em Atletas/reabilitação , Beisebol , Lesões do Ombro , Adolescente , Adulto , Terapia por Exercício/métodos , Humanos , Masculino , Amplitude de Movimento Articular , Escápula/lesões , Resultado do TratamentoRESUMO
QUESTIONS/PURPOSES: Although the posterior labral tears of the shoulder are known for their disabling clinical course, especially in overhead athletes, no clinical test used in isolation can diagnose it accurately in the preoperative period. We wanted to: (1) introduce "Porcellini test" with its radiological verification furnishing the anatomical basis of its mechanism; (2) determine its accuracy; and (3) compare its accuracy with that of the other established tests for diagnosing posterior labral tears of the shoulder. METHODS: To determine the anatomical basis, we initially performed radiological verification of our test. Then, we evaluated its accuracy in a retrospective case-controlled study on 310 consecutive patients who underwent shoulder arthroscopic procedures at our hospital between January 2013 and December 2013. All patients were examined preoperatively for Porcellini test, and the presence of posterior labral tear was confirmed on arthroscopy. Later, in a cohort study on 91 consecutive patients who underwent shoulder arthroscopic procedures, we compared its accuracy with O'Brien's test, the Kim test, the Jerk test, and the Load and Shift test. The accuracy was interpreted in terms of sensitivity, specificity, and predictive values. RESULTS: The radiological verification conferred the anatomical basis for the mechanism of the Porcellini test. This new test showed high accuracy for posterior labral tears with sensitivity of 100 %, specificity of 99.3 %, the positive and negative predictive values of 92.6 and 100 %, respectively. Also, it had superior accuracy results than every other test. The interexaminer reliability for all test results was found to be >0.80. CONCLUSIONS: We propose "Porcellini test" as a simple, accurate, reproducible, and reliable test for the preoperative diagnosis of posterior labral tears of shoulder.
Assuntos
Artroscopia/métodos , Lesões do Ombro/diagnóstico por imagem , Lesões do Ombro/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ruptura , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
AIMS: We evaluated clinical and radiographic outcomes of total shoulder arthroplasty (TSA) using the second-generation Trabecular Metal (TM) Glenoid component. The first generation component was withdrawn in 2005 after a series of failures were reported. Between 2009 and 2012, 40 consecutive patients with unilateral TSA using the second-generation component were enrolled in this clinical study. The mean age of the patients was 63.8 years (40 to 75) and the mean follow-up was 38 months (24 to 42). METHODS: Patients were evaluated using the Constant score (CS), the American Shoulder and Elbow Surgeons (ASES) score and routine radiographs. RESULTS: Significant differences were found between the pre- and post-operative CS (p = 0.003), ASES (p = 0.009) scores and CS subscores of pain (p < 0.001), strength (p < 0.001) and mobility items (p < 0.05). No glenoid or humeral components migrated. Posterior thinning of the keel and slight wear at the polyethylene-TM interface was observed in one patient but was asymptomatic. Radiolucent lines were found around three humeral (< 1.5 mm) and two glenoid components (< 1 mm) and all were asymptomatic. DISCUSSION: TSA with the second-generation TM Glenoid component results in satisfactory to excellent clinical performance, function, and subjective satisfaction at a mean follow-up of about three years. Radiographic changes were few and did not affect the outcome. TAKE HOME MESSAGE: This paper highlights that the second generation Trabecular Metal Glenoid has better outcomes than those reported with the first-generation component.
Assuntos
Artroplastia de Substituição/instrumentação , Materiais Biocompatíveis/uso terapêutico , Articulação do Ombro/cirurgia , Tantálio/uso terapêutico , Atividades Cotidianas , Adulto , Idoso , Artroplastia de Substituição/métodos , Artroplastia de Substituição/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/fisiopatologia , Osteoartrite/reabilitação , Osteoartrite/cirurgia , Polietileno/uso terapêutico , Desenho de Prótese , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Articulação do Ombro/fisiologia , Resultado do TratamentoRESUMO
BACKGROUND: Elbow osteoarthritis (OA) is a degenerative condition which in the advanced stage can severely impair joint mobility. Conservative treatment remains the first choice; surgery should be considered in case of failure in patients prepared to adhere to a demanding rehabilitation protocol. We assess the effectiveness of arthroscopic joint debridement and capsular release in a series of patients with primary and post-traumatic elbow arthritis. MATERIALS AND METHODS: Forty-eight subjects (40 males, eight females; mean age 48 years) with a preoperative diagnosis of primary (19, 40 %) or post-traumatic OA (29, 60 %) were evaluated at a mean follow-up of 44 months. Outcome measures were active range of motion (ROM), pain score, Oxford elbow score (OES), and Mayo elbow performance score (MEPS). OA severity was graded into three classes (I-III) based on X-ray findings. Statistical significance was set at 5 %. RESULTS: At the final follow-up evaluation, active flexion/extension increased significantly (p < 0.01); pronation and supination improved, but the difference was not significant (p > 0.05). The pain score improved from 7.2 to 4.3 (p < 0.01). Both OES and MEPS improved significantly (p < 0.001). Patients with post-traumatic OA had better ROM (p = 0.0391) and clinical scores (OES, p = 0.011; MEPS, p = 0.010). ROM and clinical scores were lower but not significantly so in class II than in class I patients. A smooth coronoid and olecranon fossa was found in 38 (79 %) patients and a preserved ulnotrochlear joint space in 40 (80 %). CONCLUSIONS: Elbow OA has become more common as a result of earlier diagnosis and an increased number of acute injuries involving the joint. Arthroscopy is an effective technique to treat OA which provides the best results with the correct indications. Prospective studies are needed to help develop guidelines enabling selection of the best treatment option.
Assuntos
Artroscopia/métodos , Desbridamento/métodos , Articulação do Cotovelo/cirurgia , Osteoartrite/cirurgia , Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/etiologia , Radiografia , Amplitude de Movimento Articular , Fatores de Tempo , Lesões no CotoveloRESUMO
PURPOSE: The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears. METHODS: Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated. RESULTS: All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p < 0.0001). Strength at belly-press and Jobe tests significantly improved (p < 0.0001). All patients with the exception of one were satisfied with the intervention. CONCLUSIONS: Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing.
Assuntos
Força Muscular , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/fisiologia , Idoso , Artroscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/etiologia , Lesões do Manguito Rotador/reabilitação , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The cuff tendon that is most prone to full-thickness rotator cuff tears is the supraspinatus (SSP). Arthroscopic SSP repair ensures good to satisfactory mid- to long-term clinical outcomes. However, the intense postoperative pain reduces rehabilitation compliance and is cause of patient dissatisfaction. Many natural compounds act by inhibiting inflammatory pathways in a similar way to anti-inflammatory drugs MATERIALS AND METHODS: This was a prospective randomized trial designed to assess the analgesic effect of a dietary supplement (DS) containing Boswellia serrata and Curcuma longa in a population of subjects with full-thickness SSP tendon tear treated by arthroscopy. Three weeks before surgery, patients were randomized to receive Tendisulfur(®) (group T) or a placebo (group P) for 2 months. The primary outcome measure was subjective VAS pain. Secondary outcomes measures were Constant-Murley score simple shoulder test, and patient global assessment (PGA) scores. Patients were assessed immediately at baseline and subsequently at 1, 2, 4, 6, 8, 12, and 24 weeks. RESULTS: Stratification of pain scores and subscores demonstrated significantly lower overall pain scores in group T versus group P at 1 week (p = 0.0477), and lower but not significantly different scores on week 2 (p = 0.0988); at subsequent time points, differences were not significant (p > 0.05). PGA scores were good in all subjects. CONCLUSIONS: In conclusion, this study provides objective data on the effect of a DS containing natural substances, added to standard analgesics, on postoperative RC pain. DS alleviated short and partially mid-term pain, while long-term pain was unchanged. This limitation can probably be addressed by a dosage increase over the first 4 weeks and by extending treatment by 1 or 2 months.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia , Boswellia/química , Curcuma/química , Suplementos Nutricionais , Dor Pós-Operatória/prevenção & controle , Extratos Vegetais/uso terapêutico , Lesões do Manguito Rotador/cirurgia , Anti-Inflamatórios não Esteroides/administração & dosagem , Arginina/administração & dosagem , Arginina/uso terapêutico , Colágeno Tipo I/administração & dosagem , Colágeno Tipo I/uso terapêutico , Colágeno Tipo II/administração & dosagem , Colágeno Tipo II/uso terapêutico , Dimetil Sulfóxido/administração & dosagem , Dimetil Sulfóxido/uso terapêutico , Combinação de Medicamentos , Feminino , Glicosaminoglicanos/administração & dosagem , Glicosaminoglicanos/uso terapêutico , Humanos , Lisina/administração & dosagem , Lisina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Fitoterapia/métodos , Extratos Vegetais/administração & dosagem , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Ruptura/cirurgia , Sulfonas/administração & dosagem , Sulfonas/uso terapêuticoRESUMO
BACKGROUND: Snapping scapula is characterized by crepitus between the scapula and the chest wall due to abnormal tissue at this site. Surgical treatment, when needed, may be either open or arthroscopic. The aim of this study was to evaluate prospectively the clinical outcomes of arthroscopic decompression in ten subjects with symptomatic snapping scapula. PATIENTS AND METHODS: Ten subjects, five men and five women, mean age 24 years, were treated by arthroscopy after unsuccessful conservative management for 6 months. Clinical outcomes were evaluated with the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score (CS), and simple shoulder test (SST). Follow-up was at 3 and 6 months; the final evaluation was conducted at a mean interval of 24 months. The final and preoperative X-rays were compared. RESULTS: The WORC index increased significantly at 3 (p < 0.05), 6 (p < 0.01), and 24 months (p < 0.01). Similar outcomes were found for the CS at all 3 follow-up points (3 months, p < 0.05; 6 months, p < 0.01; 24 months, p < 0.01). Mean "yes" responses on the SST were 9.8 ± 1.4 at 3 months (p < 0.05), 10.2 ± 1.2 at 6 months (p < 0.01), and 10.6 ± 1.2 at 24 months (p < 0.01). X-ray examination depicted flattening of the anterior surface of the superior-medial angle of the scapula in the five patients who had had bone resection, whereas no significant difference with preoperative imaging was detected in the five patients who were managed by bursectomy and debridement alone. CONCLUSIONS: Arthroscopy is a feasible and minimally invasive treatment for painful snapping scapula syndrome. Comparative clinical trials are needed to collect conclusive data to state that it is the most suitable treatment for this condition.
Assuntos
Artroscopia , Bursite/cirurgia , Escápula/cirurgia , Dor de Ombro/cirurgia , Adulto , Artroscopia/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Escápula/fisiopatologia , Síndrome , Resultado do TratamentoRESUMO
BACKGROUND: Ulnar collateral ligament (UCL) has the main function to be stress-resistant to elbow valgus overload. Multilayer tears require a reconstruction with a tendon graft. In this study, we report the clinical, radiographic, and ultrasound outcomes after tendon graft reconstruction for symptomatic UCL insufficiency. MATERIALS AND METHODS: Among twenty-six subjects underwent elbow UCL reconstruction from 2006 to 2012, fifteen were available to be evaluated at a mean follow-up of 36 months. Preoperative assessment included clinical examination and MRI. The outcome measures were the Mayo Elbow Performance Score (MEPS); the Oxford Elbow Score (OES); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Conway-Jobe Scale. Overall population was postoperatively investigated with X-ray and ultrasound (US). Reconstruction was performed with autograft (palmaris longus) in five cases and allograft (semitendinosus) in ten cases using the figure-of-eight configuration (five cases), the docking technique (eight cases), or a fixation with screws (two cases). RESULTS: We found a significant improvement in postoperative MEPS, OES, and DASH scores (p < 0.01). One case was unsatisfied and required an additional procedure of ulnar nerve transposition 12 months after the reconstruction. X-ray showed calcifications along the graft in ten cases. At US examination, all the grafts assessed appeared anatomically intact without structural changes, and the dynamic examination showed a slight medial laxity with the valgus stress maneuver without pain or other sign of medial instability. CONCLUSIONS: This study confirms the efficacy of the graft reconstruction for chronic UCL insufficiency and introduces fresh insight on the role of musculoskeletal ultrasound to evaluate the reconstructed UCL.
Assuntos
Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Imageamento por Ressonância Magnética , Radiografia , Reconstrução do Ligamento Colateral Ulnar , Ultrassonografia , Adulto , Aloenxertos , Autoenxertos , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Radiografia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Reconstrução do Ligamento Colateral Ulnar/métodos , Ultrassonografia/métodosRESUMO
BACKGROUND: The transosseous approach has been well known for a long time as a valid repair approach. Over time, various criticisms have been raised over this technique principally classifiable in two main categories: technical difficulty and related reproducibility in an arthroscopic environment, and repair stability (in the suture-bone contact area). About cyclic performance, several authors have conceived test setups with the aim of simulating a real environment in dynamic load conditions. The aim of this study was to monitor gap formation in a cyclic test setup. METHODS: The performance (measured as gap formation) has been monitored as a function of bone density to verify the effect of the latter. The test blocks have been shaped using sawbones® test bricks (Malmo, Sweden) of different densities, and the following values have been tested: 10, 15, 20, 30 and 40pcf. FINDINGS: The comparison has been made between the two groups: traditional transosseous and new approach with an interposed device. Regarding the traditional transosseous approach in a 10-pcf environment, not even the first loading cycle was completed, the whole bone bridge was destroyed in the first loading ramp and no further loading capability was present in the repair. By increasing the block density, the surface damage in the suture-block contact decreased. INTERPRETATION: With this work, it has been demonstrated how the traditional transosseous approach is strongly influenced by the bone quality up to the point where, in certain conditions, a safe and reliable repair is not guaranteed.
Assuntos
Densidade Óssea , Manguito Rotador/cirurgia , Técnicas de Sutura , Artroscopia/métodos , Fenômenos Biomecânicos , Modelos Biológicos , Reprodutibilidade dos Testes , Manguito Rotador/fisiopatologia , Suporte de Carga/fisiologiaRESUMO
INTRODUCTION: Total reverse shoulder arthroplasty is becoming more and more the standard therapeutic practice for glenohumeral arthropathy with massive lesions of the rotator cuff. The biomechanical principle of this prosthesis is represented by the reversion of the normal anatomy of the shoulder joint. This non-anatomical prosthesis leads to a medialization of the rotation centre of the glenohumeral joint and also to a distalization of the humeral head. All that causes a deltoid tension increasing so allowing a larger abduction of the arm. Main complications of the reverse shoulder prosthesis are due to the joint instability, the scapular notching and the wear of the polyethylene insert. PURPOSE: The main goal of the present work is to study the effect of the positioning of the humeral component on the intrinsic stability of the reverse shoulder prosthesis. In particular, through finite element method simulations, the variation of the stability ratio of the shoulder joint has been calculated for both vertical and horizontal dislocating loads depending on the humeral stem version angle. Moreover, in order to estimate the wear of the polyethylene cup, some analyses have been developed to calculate the pressures on the polyethylene insert. RESULTS: The obtained results demonstrate the dislocation of a shoulder prosthesis and the wear of the polyethylene insert can be prevented or limited by conveniently varying the version angle of the humeral component.
Assuntos
Artroplastia de Substituição/métodos , Articulação do Ombro/cirurgia , Humanos , Úmero , Desenho de PróteseRESUMO
PURPOSE: Throwing a baseball requires a coordinated sequence of scapula and humerus movements also called scapulo-humeral rhythm (SHR). Fatigue associated with repetitive throwing can lead to scapular dyskinesia, a recognized cause of shoulder disability in pitchers and overhead athletes. We introduce a novel device, the Xbus Kit, which can objectively assess scapular biomechanics and the effect of pitching on SHR. METHODS: SHR was studied using the Xbus Kit (Xsens Technologies B.V., NL). Thirteen collegiate baseball pitchers (aged 20 ± 2.6) were studied, evaluating SHR in forward elevation and abduction in three sessions: before throwing (S1), after 60 pitches (S2) and 24 h after a pitching session (S3). RESULTS: SHR changes were found in 85 % of pitchers (11 cases), and no changes were observed in 2 cases (15 %). We were able to subdivide pitchers into four groups, based on their response to pitching. CONCLUSION: Repetitive movement of pitching leads to SHR changes and sometimes, incomplete restoration of normal shoulder biomechanics.
Assuntos
Beisebol/fisiologia , Úmero/fisiologia , Escápula/fisiologia , Fenômenos Biomecânicos , Humanos , Adulto JovemRESUMO
PURPOSE: Humeral resurfacing is a treatment option to conventional shoulder arthroplasty, conferring the advantages to preserve the bone stock and the normal joint geometry. Aim of the current study was to report clinical and radiographic mid-term outcomes in a population of 60 patients, aged 50 years or younger, who underwent shoulder resurfacing in osteoarthritis. METHODS: The mean age was 48 ± 8.4, 36 were male and 24 female, dominant arm in 43 cases. Glenoid arthritis was treated in 36 cases (60 %) using a meniscus allograft in 22 cases, biologic patch in 4 cases and microfractures in 10 cases. Clinical and radiographic assessment was performed with Constant-Murley score and standard X-ray. RESULTS: At an average follow-up of 44 months, the mean values of the constant score increased of 30 points (p < 0.05), the pain decreased of 4.56 points (p < 0.05) and the Simple Shoulder Test increased of 4.3 points (p < 0.05). We found lower scores (p > 0.05) in 9 patients (15 %) treated for glenoid arthritis using homologous meniscus (7 cases) and biologic patch (2 cases). A significant narrowing of joint space (5.92 mm postoperative versus 1.65 mm at 37 months) (p < 0.05) was found in the 22 cases treated with meniscus interposition. In 4 cases with type A2 preoperative glenoid morphology and in 9 cases type B1, we registered significantly lower scores compared with the overall study population (p < 0.01). Five unsatisfied patients (7 %), underwent to meniscus removal and glenoid reaming in 3 cases and conversion in total shoulder arthroplasty in 2 cases. CONCLUSIONS: Resurfacing arthroplasty is an effective device in young patients with advanced glenohumeral arthropathy; however, the high rate of postoperative glenoid erosion and the failure of biologic allograft lead us to consider glenoid replacement as the best option to improve clinical outcomes.
Assuntos
Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Radiografia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
AIM: Recent studies have reported a high incidence of perioperative in-stent trombosis with myocardial infarction (MI), in patients undergoing non-cardiac surgery, early after coronary angioplasty and stenting. The short and long-term results of surgery for non-small cell lung cancer (NSCLC) after prophylatic coronary angioplasty and stenting were analyzed. METHODS: Prospective collected data were examined for postoperative complications and long-term survival in 16 consecutive patients who underwent mayor lung resection for NSCLC after prophylactic coronary angioplasty and stenting for significant coronary artery disease , from 2001 to 2008. One and two non-drug-eluting stents were placed in 75% or (25% of the patient, respectively. All patients had four weeks of dual antiplatelet therapy, that was discontinued 5 days prior to surgery and replaced by low molecular weight heparin. Patients were keep sedated and intubated overnight, according to our protocol. RESULTS: There were no postoperative deaths nor MI. A patient experienced pulmonary embolism with moderate troponin release and underwent coronary angiography that showed patency of the stent. Two patients developed postoperative bleeding complications haemothorax requiring a re-thoracotomy in 1, gastric bleeding requiring blood transfusion in 1. At the mean follow-up of 30 months (range 3-95), none of the patients showed evidence of myocardial ischemia, while 5 (31%) patients died, mostly (N.=4) due to distant metastasis. The five-year survival rate was 53%. CONCLUSION: In contrast to previous reports, lung resection after prophylactic coronary angioplasty and stenting is a safe and effective treatment for NSCLC and myocardial ischemia. The application of a refined protocol could be the key factor for improved results.