ObjectiveTo explorethe method and effectivenessofarthroscopically assisted treatmentof rotator cuff injury. MethodsBetween 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 was1 to 36 months (mean, 27months). The location was theleft shoulder in 11 cases and theright shoulder in 16 cases. Of them, 12 cases had a history of trauma and 15 caseshad no obvious predisposing causes. All patients had limitation of shoulder flexionandabduction. 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 anchorwas placed on the greater tubercle of humerus to repair rotator cuff. ResultsAll incisions healed primarily. All patients were followed up 13-27 months (mean, 19 months). No infection, loosening of internal fixation, and rotator cuffre-tearoccurred. 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 lt; 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 (Plt; 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 ± 3.3at 3months after operation and 33.6 ± 2.1 at last follow-up (P lt; 0.05). Conclusion The effectivenessofarthroscopically assisted treatmentof rotator cuff injury is satisfactory. However, long-termeffectiveness needs furtherfollow-up observation.
Objective To investigate the effect of canine decellularized tendon slices (DTSs) on tendon-bone healing in repairing rotator cuff injury of rabbit. Methods Canine DTSs were prepared by repetitive freeze/thaw 5 times combined with nuclease processing for 12 hours from the adult Beagles Achilles tendons. Histological observation and cytocompatibility evaluation for the canine DTSs were performed in vitro. Twenty-four mature male New Zealand white rabbits, weighing 2.5-3.0 kg, were randomly selected. U-shaped defect of more than 50% of normal tendon in width and 8 mm in length was made in infraspinatus tendons of unilateral limb as the experimental group; the canine DTSs were used to repair defect, and the insertion of infraspinatus tendon on greater tuberosity of humerus was reconstructed in the experimental group. No treatment was done on the contralateral limb as the control group. At 4, 8, and 12 weeks after operation, the specimens were harvested for histological observation and biomechanical test. Results Histological examination showed that collagen fibers of canine DTSs were well preserved, without residual cells. The cytocompatibility examination showed that fibroblasts attached well to canine DTSs. Biomechanical test showed that the maximum load and stiffness increased significantly with time, and the maximum load and stiffness at 12 weeks were significantly higher than those at 4 and 8 weeks (P lt; 0.05). The maximum load and stiffness of the experimental group at 4 and 8 weeks were significantly lower than those of the control group (P lt; 0.05). The stiffness of the experimental group at 12 weeks was significantly lower than that of the control group (t= — 5.679, P=0.000), but no significant difference was found in the maximum load at 12 weeks between 2 groups (t=0.969, P=0.361). Histological observation showed that the control group displayed a 4-layer structure of the tendon-bone insertion. In the experimental group at 4 weeks, the tendon-bone interface was filled with granulation tissue, and a small amount of Sharpey’s fibers-like connected the tendon to bone; granulation tissue disappeared, and fibroblasts, Sharpey’s fiber, new cartilage, and chondrocytes significantly increased with time; tendon-bone interface became mature, but the tide line was not observed between the unmineralized fibrocartilage and mineralized fibrocartilage. Conclusion Canine DTSs prepared by repetitive freeze/thaw 5 times combined with nuclease processing for 12 hours, can enhance the healing of host tendon-bone and improve the biomechanical characteristics of the rabbit infraspinatus tendon.
Objective To review the progress in the treatment and research of massive rotator cuff tears. Methods Recent l iteratures about the treatment and research of massive rotator cuff tears were reviewed. Results Treatment options of massive rotator cuff tears include nonoperative treatment, debridement, direct repair, tendon transfer, and repair with various substitutes, but the outcome is unpredictable. Recently, many experimental studies on the treatment of massive rotator cuff tears, such as gene therapy, cell therapy, and tissue engineering techniques, can provide cl inicians with new treatment strategies. Conclusion The treatment of massive rotator cuff tears pose a distinct cl inical challenge for the orthopaedist, depending on the overall presentation. The effect of traditional operation method to repair massive rotator cuff tears is limited. The treatment and research of massive rotator cuff tears still need to be studied.
Objective?To analyze the effect of different surgery techniques on the tendon-bone healing of rotator cuff insertion.?Methods?Forty-two adult Japanese rabbits, weighing 2.0-2.5 kg and male or female, were selected. Thirty-six rabbits were given a sharply left-lateral tenotomy of the supraspinatus tendon with subsequent re-attachment of the tendon. According to the depth of re-attachment, 36 rabbits were equally randomized into the cancellous-fixation group (a cancellous bed was prepared with a dental burr) and the cortical-fixation group (the same treatment was performed except the preparation of the bone bed). Six rabbits served as the controls without treatment (control group). At 4 and 8 weeks after operation, the general observation, HE staining, and the biomechanical test were performed.?Results?At 4 weeks after operation, the supraspinatus-humerus specimens morphologically showed atrophy and vague between tendon and new bone in the cancellous-fixation group and the cortical-fixation group; at 8 weeks, no obvious difference was observed between 2 groups and the control group. The histological results of the cortical-fixation group at 4 weeks revealed the interface between tendon and new bone became smooth. The interface became transitional at 8 weeks, and the shape of bone tissue was nearly normal. The interface obtained from the cancellous-fixation group at 4 weeks became sclerotic, and collagen fibers formed in disorder. With ingrowth of new bone and re-establishment of collagen-fiber continuity at 8 weeks, thickness of interface became thin, and bone tissue was remodeling. The ultimate load were significantly higher in the cortical-fixation group than in the cancellous-fixation group at both 4 and 8 weeks, and the results gained at 8 weeks is significantly higher than that at 4 weeks in each group (P lt; 0.05). Except rupture strength at 4 weeks between 2 groups and all tensile strength (P gt; 0.05), there were significant differences in the results of others (P lt; 0.05).?Conclusion?In this model, the tendon-bone healing process and the biomechanical properties of cortical-fixation is superior to those of cancellous-fixation.
Objective To discuss and evaluate the diagnose and surgical techniques of rotator cuff tear with arthroscopic repair and its cl inical results. Methods From November 2006 to April 2008, 22 patients with rotator cuff tear were treated by arthroscopic repair using 5 different methods. There were 13 males and 9 females, aged 28-51 years old (mean37.9 years old). The locations were left shoulder in 6 cases and right shoulder in 16 cases. Eleven cases underwent shoulder joint injury and other 11 cases had no inducement. According to Bigl iani acromion classificatioin, there were 12 cases of type II and 10 cases of type III. There were 5 bursa-side tear, 3 articular-side tear, and 14 full thickness tear. The disease course was 5 months to 6 years (mean 16.6 months). After all the patients underwent acromioplasty, 4 cases were treated by debridement of rotator cuff, 7 cases by single roll suture anchor, 4 cases by double suture anchors, 3 cases by trible suture anchors, and 4 cases by transosseous technique suture. Results Incision healed by first intention and no compl ications occurred in all patients. Twenty-two cases were followed up 12-26 months (mean 15.6 months). The active forward flexion and abduction at the last follow-up were over 150° in 21 cases, 90-l20° in 1 case. Postoperatively, the forward flexion strength was grade 5 in 20 cases and grade 4 in 2 cases. The score of University of Cal ifornia Los Angeles, the pain score, the function score, the forward flexion score, the forward flexion strength were improved significantly when compared with preoperation (P lt; 0.05). The results were excellent in 13 cases and good in 9 cases, the excellent and good rate was 100%. Conclusion Depending on the correct diagnoses, 5 different methods of rotator cuff repair are used according to the different changes of shoulders, the outcome is good in all cases.
Objectives To compare the clinical therapeutic effect of arthroscope and mini-open in treating rotator cuff impairment with Meta-analysi. Methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (Jun 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2007), MEDLINE, EMBASE, and CBM, conference proceedings and reference lists of articles. Selection criteria: Randomized or comparative studies on all arthroscopic rotator cuff repairs and mini-open repairs. Results There were no randomized controlled trials (Level I) was found. Pooled results from all 12 trials showed that postoperative shoulder pain in all arthroscope group was statistically less than in the mini-open group (RR=0.94, 95%CI 0.28 to 1.60). Meanwhile, another evaluates outcomes such as ROM-Forward flexion (RR=0.17, 95%CI –0.10 to 0.45), patient’s satisfaction (RR=1.03, 95%CI 0.98 to 1.08), complication (RR=1.11, 95%CI 0.54 to 2.27), and shoulder functional score (RR=0.04, 95%CI –0.10 to 0.19) indicated no statistical difference in two groups. Conclusions According to Limited evidence, there are some findings as follows: comparing with mini-open treatment of rotator cuff impairment, all arthroscopic surgery can reduce the shoulder pain. Moreover, we found no statistical difference in shoulder functional score, ROM-Forward flexion, patient’s satisfaction and complication. Attention should be paid to outcome assessment in future trials.
【摘要】 目的 探讨0.35 T MRI各方位各序列扫描对肩袖撕裂的诊断价值。 方法 对2010年3月-2011年4月就诊的38例肩关节疼痛患者，分别在斜冠状位、斜矢状位及横轴位行T1加权像（T1 weighted image，T1WI）、T2加权像（T2 weighted image，T2WI）、质子密度加权像（proton density weighted image，PWI）及脂肪抑制像（turbo inversion recovery magnitude，TIRM）扫描。将38例患者的冈上肌及冈下肌肌腱合并为A组、肩胛下肌及小圆肌肌腱合并为B组进行研究，分别比较A、B组采用各方位的扫描表现；再将A组患者分为斜冠状位T1WI+T2WI组与斜冠状位PWI+TIRM组，将B组患者分为横轴位T1WI+T2WI组与横轴位PWI+TIRM组，分别比较各序列组的扫描表现。 结果 A组患者在3个方位扫描像以及斜冠状位T1WI+T2WI组与PWI+TIRM组之间诊断准确度差异有统计学意义（Plt;0.05），其斜冠状位诊断肩袖撕裂的灵敏度为88.9%，特异度为81.8%，准确度为86.8%，为最佳扫描方位，而PWI+TIRM组诊断肩袖撕裂的灵敏度为88.9%，特异度为90.9%，准确度为89.5%，为优选扫描序列；B组患者在3个方位扫描像以及横轴位T1WI+T2WI组与PWI+TIRM组之间诊断准确度差异有统计学意义（Plt;0.05），其横轴位诊断肩袖撕裂的灵敏度为87.5%，特异度为86.4%，准确度为86.8%，为最佳扫描方位，而PWI+TIRM组诊断肩袖撕裂的灵敏度为100%，特异度为83.3%，准确度为94.7%，为优选扫描序列。 结论 低场MRI诊断冈上肌、冈下肌肌腱撕裂以斜冠状位PWI及TIRM扫描序列为首选，诊断小圆肌、肩胛下肌肌腱撕裂则以横轴位PWI及TIRM扫描序列为主。【Abstract】 Objective To explore the clinical value of 0.35 T MRI diagnosing rotator cuff tears with different scan sequence and patient position. Methods From March 2010 to April 2011, there were 38 patients with shoulder pain were separately scanned by MRI at the position of oblique coronal, oblique sagittal and transaxial planes. Otherwise, the MRI images completed with T1 weighted, T2 weighted, PDWI and TIRM technique. The 38 cases were divided into two groups (group A: to study the supraspinatus and infraspinous tendons of the 38 cases; group B: to study the musculus teres minor and musculus subscapularis tendons of the 38 cases). Afterwards, the diagnostic results were compared among images at different patient positions. Furthermore, the images at oblique coronal plane of T1WI+T2WI and PWI+TIRM technique in group A were compared; on the other hands, the images at transaxial plane of T1WI+T2WI and PWI+TIRM technique in group B were compared. Results The difference of diagnostic accuracy in group A at different patient positions and scan sequences were statistical significant (Plt;0.05), and oblique cornal plane was the best patient position with sensitivity of 88.9%, specificity of 81.8% and accuracy of 86.8%; at the same time, the PWI+TIRM sequence was better sequence with sensitivity of 88.9%, specificity of 90.9% and accuracy of 89.5%. The difference of diagnostic accuracy in group B at different patient positions and scan sequences were statistical significant (Plt;0.05), and transaxial plane was the best patient position with sensitivity of 87.5%, specificity of 86.4% and accuracy of 86.8%; at the same time, the PWI+TIRM sequence was better sequence with sensitivity of 100%, specificity of 83.3% and accuracy of 94.7%. Conclusion In low field MRI, the oblique cornal plane with PWI+TIRM sequence are a first-line method for diagnosing supraspinatus tendon tears or infraspinous tendon tears; on the other hands, the transaxial plane with PWI+TIRM sequence are a first-line method for diagnosing musculus teres minor hurt or musculus subscapularis hurt.
ObjectiveTo establish a model of chronic rotator cuff injury by inducing subacromial impingement syndrome in rats, so as to lay a foundation for further study on the mechanism and treatment of chronic rotator cuff injury. MethodsThe polyether-ether-ketone implants were designed and made with three-dimensional printing technique. In 48 male Sprague Dawley rats[weighing, (277.25±22.03) g], one shoulder joint was selected randomly as the experimental group; in the experimental group, the implant was pierced into shoulder joint close tothe acromion medial side and was pierced out under acromion close to the deltoid trailing edge; the penetratingpartof implant was cut off after the implanting part was fixed with 4# braided silk suture. No any treatment was performed on the contralateral shoulder of 24 rats as control group; and the implants were immediately removed after they were pierced into the contralateral shoulder joint of the other 24 rats as sham-operation group. All the rats were exposed to 30 minutes of downhill running at 17 m/minute (-13.5°) every day at 4 days after operation and the general condition of rats was observed. At 2, 4, 6, and 8 weeks after operation, 12 rats were sacrificed to collect shoulder joint samples. The hardtissueslices was used for VanGieson staining and histological observation of the supraspinatus tendon. ResultsAll ratssurvived to the end of experiment, without infection.The rats suffered limp at 2-3 daysafter operation, and the gait of most rats returned to normal at 4 days after operation.The histological results showed that the supraspinatus tendon had smooth edge, without split layers or breakage in the control group and sham-operation group. In the experimental group, the implants were positioned accurately without dislocation; 4 kinds of typical pathological changes were observed. Partial-thickness tear on bursal side appeared at 2 weeks (5 rats) and 4 weeks (2 rats), showing no significant difference between at 2 and 4 weeks (P > 0.05); intratendinous gap formed mainly at 4 weeks (10 rats) and 6 weeks (11 rats), showing significant differences when compared with that at 2 weeks (2 rats) (P < 0.05) and 8 weeks (2 rats) (P < 0.05); partial-thickness tear on articular side mainly appeared at 6 weeks (8 rats), showing significant difference when compared with that at other time points (P < 0.05); full-thickness tear was found mainly at 8 weeks (10 rats), showing significant differences when compared with that at other time points (P < 0.05). ConclusionA model of chronic rotator cuff injury is successfully established in rats through microinvasive implantation of subacromial impingement syndrome inducing implants and the pathological changes in this model are highly similar to the clinical pathological progress.
ObjectiveTo investigate the mechanisms,diagnosis,and surgical procedures of simultaneous lesions of the rotator cuff and the brachial plexus. MethodsBetween July 2006 and June 2012,7 patients with rotator cuff tear associated with brachial plexus injury were treated.There were 3 males and 4 females with a mean age of 47.3 years (range,37-72 years).The reasons of injury were traumatic shoulder dislocation in 6 cases and falling injury from height in 1 case,with a mean disease duration of 17 days (range,5-31 days).The average American Shoulder and Elbow Surgeons (ASES) score was 55.86±9.42,and visual analogue scale (VAS) score was 7.14±1.35.There were 3 cases of large rotator cuff tears (>3 cm) and 4 cases of massive rotator cuff tears (>5 cm) according to Gerber standard;1 case had upper trunk injury of the brachial plexus and 6 cases had bundle branch injury of the brachial plexus according to GU Yudong's classification.The functional score of brachial plexus score was 7.43±1.27 according to the functional assessment standard by Hand Surgery Branch of Chinese Medical Association.All patients accepted arthroscopic rotator cuff repairing,and 1 case received surgical neurolysis of brachial plexus. ResultsAll incisions healed by first intention without complication.All the 7 patients were followed up 18 to 25 months (mean,20.4 months).The function,muscle strength,and sensation of the shoulder were improved obviously.The shoulder ASES score was 84.71±8.06 and was significantly better than preoperative score (t=-8.194,P=0.000).The VAS score was 2.71±1.50 and was significantly better than preoperative score (t=7.750,P=0.000).The functional score of brachial plexus was 14.00±1.16 and was significantly better than preoperative score (t=-11.500,P=0.000). ConclusionIt is difficult to simultaneously diagnose lesions of the rotator cuff and the brachial plexus;orthopedists should pay attention to possible patients to avoid missed diagnosis and diagnostic errors.Nerve nutrition,physical therapy,and arthroscopic rotator cuff repair can achieve good effectiveness.