BACKGROUND Acinic cell carcinoma(ACC)is a malignant epithelial neoplasm that commonly occurs in the parotid gland.It is known to have a high recurrence rate and the potential to metastasize to the lung or cervical lym...BACKGROUND Acinic cell carcinoma(ACC)is a malignant epithelial neoplasm that commonly occurs in the parotid gland.It is known to have a high recurrence rate and the potential to metastasize to the lung or cervical lymph nodes.However,few cases of ACC with bone metastasis have been reported in the medical literature.CASE SUMMARY The clinical significance of this case report lies in the unique site of occurrence of the metastasis:To the best of our knowledge,this report is the only literature documenting ACC arising in a shoulder mass.CONCLUSION Unusual presentations of uncommon malignancies can present diagnostic challenges for both surgeons and histopathologists.It is important to be aware of these rare occurrences in order to provide the best possible treatment for patients.展开更多
BACKGROUND Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of allfractures, and scapular neck fractures are extremely rare, comprisingapproximately 7%-25% of all scapular fractures. Scapular neck ...BACKGROUND Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of allfractures, and scapular neck fractures are extremely rare, comprisingapproximately 7%-25% of all scapular fractures. Scapular neck fractures are oftenstudied as case reports mostly accompanied by other injuries, thus leading toconfusion. All previous cases of scapular neck fractures are not associated withrotator cuff injuries.CASE SUMMARY A 62-year-old man was admitted to our emergency department 6 h after his rightshoulder and back were impacted by heavy objects. The patient presented chesttightness and shortness of breath. Chest computed tomography (CT) showedpneumohemothorax, multiple rib fractures, and right scapula fractures. ThreedimensionalCT reconstruction of the right shoulder joint showed a trans-spinousscapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injurywas suspected because the patient had a glenohumeral joint dislocation and wasthen confirmed by shoulder magnetic resonance imaging. A staged surgery wasperformed, including open reduction and internal fixation of the right scapulafracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mofollow-up, the fracture line was blurred and the shoulder joint function was good.CONCLUSION Fracture of the scapular neck combined with rotator cuff tear is rare and therotator cuff injury should not be ignored in clinical work. Stable internal fixationcombined with secondary arthroscopic repair of rotator cuff tear can achieve goodresults.展开更多
BACKGROUND No dynamic technique, such as tendon transfer, has been described for scapular winging due to levator scapulae or rhomboid major and minor palsies resulting from an isolated dorsal scapular nerve injury. Th...BACKGROUND No dynamic technique, such as tendon transfer, has been described for scapular winging due to levator scapulae or rhomboid major and minor palsies resulting from an isolated dorsal scapular nerve injury. Thus, we evaluated how the contralateral trapezius compound osteomuscular flap transfer would work in stabilizing lateral scapular winging, and the case is reported here. A literature review was also conducted, and articles relevant to the case are presented.CASE SUMMARY A 37-year-old male patient who had sustained an isolated dorsal scapular nerve injury underwent reconstructive surgery using the contralateral trapezius compound osteomuscular flap transfer technique to treat scapular winging and the consequent pain, and to restore function from the shoulder impairment. As a result, the involved shoulder showed an improved Constant-Murley score, from19.5% to 81.88%.CONCLUSION Contralateral trapezius osteomuscular flap transfer succeeded in stabilizing scapular winging in this case, improving shoulder function and affording pain relief.展开更多
Fractures of the scapula are rare and have been reported to account for only 1% of all fractures and 3%-5% of upper extremity fractures. Several studies have reported successful outcomes with non-operative treatment o...Fractures of the scapula are rare and have been reported to account for only 1% of all fractures and 3%-5% of upper extremity fractures. Several studies have reported successful outcomes with non-operative treatment of scapula fractures. Although non-operative treatments are successful in a very high percentage of patients, very few cases of non-union of scapular body fractures have been reported. In our review of the literature, we found two case reports of scapular body fractures developed into non-unions. In both of these cases, open reduction and internal fixation with reconstruction plates and bone graft was successful at eliminating pain and restoring function. This is a case report of a patient with a symptomatic, extra-articular scapular body defect from a non-union that was treated successfully with an acellular dermal extracellular matrix and bone graft using a novel展开更多
AIM To evaluate whether implant design, glenoid positioning, and other factors influenced instability and scapular notching in reverse total shoulder arthroplasty.METHODS We retrospectively reviewed records of patient...AIM To evaluate whether implant design, glenoid positioning, and other factors influenced instability and scapular notching in reverse total shoulder arthroplasty.METHODS We retrospectively reviewed records of patients who had undergone reverse total shoulder arthroplasty by the senior author from July 2004 through October 2011 and who had at least 24 mo of follow-up. The 58 patients who met the criteria had 65 arthroplasties: 18 with a Grammont-type prosthesis(Grammont group) and 47 with a lateral-based prosthesis(lateral-design group). We compared the groups by rates of scapular notching and instability and by radiographic markers of glenoid position and tilt. We also compared glenoid sphere sizes and the number of subscapularis tendon repairs between the groups. Rates were compared using the Fisher exact test. Notching severity distribution was compared using the χ2 test of association. Significance was set at P < 0.05.RESULTS The Grammont group had a higher incidence of scapular notching(13 of 18; 72%) than the lateral-design group(11 of 47; 23%)(P < 0.001) and a higher incidence of instability(3 of 18; 17%) than the lateral-design group(0 of 47; 0%)(P = 0.019). Glenoid position, glenoid sphere size, and subscapularis tendon repair were not predictive of scapular notching or instability, independent of implantdesign. With the lateral-based prosthesis, each degree of inferior tilt of the baseplate was associated with a 7.3% reduction in the odds of developing notching(odds ratio 0.937, 95%CI: 0.894-0.983). CONCLUSION The lateral-based prosthesis was associated with less instability and notching compared with the Grammonttype prosthesis. Prosthesis design appears to be more important than glenoid positioning.展开更多
BACKGROUND Frozen shoulder(FS)is a familiar disorder.Diabetics with FS have more severe symptoms and a worse prognosis.Thus,this study investigated the influence of enhancing dynamic scapular recognition on shoulder d...BACKGROUND Frozen shoulder(FS)is a familiar disorder.Diabetics with FS have more severe symptoms and a worse prognosis.Thus,this study investigated the influence of enhancing dynamic scapular recognition on shoulder disability and pain in diabetics with FS.CASE SUMMARY A Forty-five years-old male person with diabetes mellitus and a unilateral FS(stage II)for at least 3 mo with shoulder pain and limitation in both passive and active ranges of motion(ROMs)of the glenohumeral joint of≥25%in 2 directions participated in this study.This person received dynamic scapular recognition exercise was applied to a diabetic person with a unilateral FS(stage II).The main outcome measures were upward rotation of the scapula,shoulder pain and disability index,and shoulder range of motion of flexion,abduction,and external rotation.The dynamic scapular exercise was performed for 15 min/session and 3 sessions/wk lasted for 4 wk.After 4 wk of intervention,there were improvements between pre-treatment and post-treatment in shoulder pain,shoulder pain and disability index,shoulder ROM,and upward rotation of the scapula.CONCLUSION This case report suggested that enhancing dynamic scapular recognition may improve shoulder pain and disability;upward rotation of the scapula;and shoulder ROM of shoulder abduction,flexion,and external rotation after 4 wk.展开更多
Objective:To observe the clinical effect of"scapular heat penetration"technique of acupuncture in treatment of scapulohumeral periarthritis.Design:It was a single-central randomized controlled trial,the part...Objective:To observe the clinical effect of"scapular heat penetration"technique of acupuncture in treatment of scapulohumeral periarthritis.Design:It was a single-central randomized controlled trial,the participants,outcome assessors and statisticians were blinded.Setting:The trial was undertaken in Department of Acupuncture and Moxibustion,Yueyang Hospital of Integrated Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,from June 2021 to January 2022.Participants:Sixty-seven patients with scalpulohumeral periarthritis were participated.Interventions:In the control group,the routine acupuncture was given,while in the trial group,the"scapular heat penetration"technique of acupuncture was adopted.The intervention was delivered once every two days,3 treatments a week;and one course included 9 treatments.Before the 1st treatment and after the 9th treatment,the symptoms and physical signs were observed and recorded in each group.Outcomes:Primary outcome:the score of visual analogy scale(VAS)before treatment and after treatment completion.Secondary outcomes:the range of movement(ROM)of shoulder joint,the score of Japanese Orthopaedic Association(JOA)of shoulder joint and the infrared thermal imaging temperature around the shoulder.Results:A total of 102 cases were collected,72 cases of them were eligible and 5 cases were withdrawn.Sixty-seven cases were included in analysis.In the within-group comparison,VAS score,ROM and JOA score as well as the shoulder temperature were all ameliorated after 9 treatments in either the trial group or the control group,compared with those before treatment(P<0.05).In the comparison between two groups,after 9 treatments,VAS score in the trial group was lower than that of the control group(P<0.05);and the improvements in ROM and shoulder temperature in the trial group were better than those of the control group(P<0.05).No adverse reactions were found in the two groups.Conclusion:Both the"scapular heat penetration"technique of acupuncture and the conventional acupuncture are effective on scapulohumeral periarthritis.But,regarding the improvements in pain,ROM of shoulder joint,the activity of daily life and shoulder temperature,the"scapular heat penetration"technique of acupuncture is superior to the conventional acupuncture.展开更多
BACKGROUND Squamous cell carcinoma(SCC)of bone is usually caused by metastasis from the lungs,bladder,or other sites.Primary SCC of bone most frequently involves the skull bones,and primary involvement of other sites ...BACKGROUND Squamous cell carcinoma(SCC)of bone is usually caused by metastasis from the lungs,bladder,or other sites.Primary SCC of bone most frequently involves the skull bones,and primary involvement of other sites in the skeletal system is extremely rare.To date,only three such cases have been reported,which makes the diagnosis,treatment,and prognosis of this disease a challenge.CASE SUMMARY A 76-year-old Chinese man presented to our hospital with nonspecific pain and limited mobility in the right shoulder for 4 mo.He underwent three-dimensional computed tomography reconstruction and magnetic resonance imaging of the right shoulder,which revealed an osteolytic destructive lesion in the right scapula with invasion into the surrounding muscles and soft tissues.Ultrasound-guided core needle biopsy detected a malignant tumor,and immunohistochemical analysis revealed a poorly differentiated SCC.Wide excision of the right scapular bone was performed,and pathological examination of the surgical specimen confirmed the diagnosis.At the last follow-up examination within 2 years,the patient was doing well with the pain significantly relieved in the right shoulder.CONCLUSION Primary SCC of bone is extremely rare at sites other than the skull.Clinicians must exhaust all available means for the diagnosis of primary SCC of the bone,so greater attention can be paid to its timely and effective management.Regular and adequate follow-up is essential to help rule out metastasis and judge the prognosis.展开更多
BACKGROUND Severe bony Bankart lesions are a difficult challenge in clinical treatment and research.The current treatment methods consist mostly of Latarjet-Bristow surgery and its modified procedures.While good resul...BACKGROUND Severe bony Bankart lesions are a difficult challenge in clinical treatment and research.The current treatment methods consist mostly of Latarjet-Bristow surgery and its modified procedures.While good results have been achieved,there are also complications such as coracoid fracture,bone graft displacement,and vascular and nerve injury.AIM To analyze the techniques and biomechanical properties of transversely fixing a bone block from the scapular spine using bone allograft pins with suture threads to repair bony Bankart lesions.METHODS Fresh human shoulder joint specimens and a cadaver specimen model for scapular bone grafting with allograft pin fixation for repair of bony Bankart lesions were used.When the humeral rotation angles were 0°,30°,60°and 90°,and the axial loads were 30 N,40 N,and 50 N,the humerus displacement was studied by biomechanical experiments.RESULTS When the angle of external rotation of the humerus was 0°,30°,60°,and 90°,with axial loads of 30 N,40 N,and 50 N,the data of the normal control group,allograft pin repair group,and titanium alloy hollow screw repair group were compared with each other by the q-test,which showed that there were no statistically differences among the three groups(P>0.05).CONCLUSION The joints repaired with bone block from the scapular spine transversely fixed with allograft bony pins to repair bony Bankart lesions show good mechanical stability.The bone block has similar properties to normal glenohumeral joints in terms of biomechanical stability.展开更多
Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local ...Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient’s pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.展开更多
To explore the treatment methods for scapular fractures associated with clavicle fractures.Methods Of 23 cases with scapular fractures associated with clavicle fractures,13 treated conservatively took the function exe...To explore the treatment methods for scapular fractures associated with clavicle fractures.Methods Of 23 cases with scapular fractures associated with clavicle fractures,13 treated conservatively took the function exercise of shoulder joint after two months and 10 treated with open reduction and plate fixation reconstruction began the function exercise of shoulder joint four weeks after operation.The follow up averaged 12 months.Results All patients were healed up.18 cases were followed up,of them 8 cases were treated surgically,10 cases,conservatively.Of eight cases treated surgically,seven got excellent functional recovery of the shoulder joint and one satisfactory.In the meantime,of 10 cases treated conservatively,the recovery of shoulder joint was excellent in six,good in three and poor in one.Conclusion As for scapular fractures with associated clavicle fractures,open reduction and plate fixation reconstruction is a good treatment method for it can keep the stability and the balance of shoulder joint and is helpful for early functional exercise and recovery of the shoulder joint.7 refs,5 figs.展开更多
The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruct...The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruction of the mandible.The subscapular system can serve as an alternative to the fibula free flap in the presence of significant atherosclerotic disease or other contraindications.The flexibility and abundance of its soft tissue components make this system particularly advantageous for complex composite defects.Avoiding a fibula free flap for osseous reconstruction of the mandible permits early patient mobilization and may prevent adverse postoperative complications.A long pedicle can be harvested with subscapular flaps,which may prove useful in the face of limited available recipient vessels.Critics of the subscapular system cite longer operative times due to the need for patient repositioning and concerns over the integrity of the bone stock.Positioning modifications may permit a two-team approach to subscapular reconstruction,thus limiting operative times.Subscapular harvest does incur shoulder morbidity;however,this does not appear to affect the quality of life significantly.The flap is reliable and can support endosseous implants if properly planned,though it may be more susceptible to bone resorption when compared to the fibula.Overall,the subscapular system remains a versatile donor that can achieve ideal reconstructive outcomes with minimal morbidity.展开更多
Reverse shoulder arthroplasty(RSA)can treat severe rotator cuff deficiency,but its medialized design of the shoulder's center of rotation(CoR)has been associated with scapular notching.Although lateralization of C...Reverse shoulder arthroplasty(RSA)can treat severe rotator cuff deficiency,but its medialized design of the shoulder's center of rotation(CoR)has been associated with scapular notching.Although lateralization of CoR provides a larger impingement-free range of motion,the changes in component positioning alter the biomechanics and may cause unforeseen complications.This work quantified the muscle forces and predicted the scapula fracture risk by coupling dynamic simulation analysis with finite element modeling.To identify bone failure patterns,the results were analyzed using three common failure measures.A parametric study showed greater lateralization produced higher strain/stress concentrations in the scapular spine(Levy Region Type II),with approximately a 10%increase for the 12 mm lateralized scenario,compared to a neutral configuration.Significant differences in fracture risk patterns were found between the maximum principal stress/strain results and the von Mises stress results.The lateralized configurations could increase the muscle and joint reaction forces during abduction and induce scapular fracture.Studying the effects of RSA lateralization on scapular fracture risk can help guide the continued optimization of RSA performance and surgical techniques.The findings of relationships between the loading style and bone failure measures can provide valuable insight into the investigation of bone failure criteria.展开更多
Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects di...Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects disrupting two or more of the following facial axes:orbital,nasofacial,and palatal axes.Patients underwent primary reconstruction using an angular artery-based scapular tip-free flap with an osteotomy to fold the flap.Harvest techniques,including placement of osteotomies,folding and plating,surgical esthetic,and functional outcomes,are presented.Results:Osteotomies placed in the scapular tip-free flap allowed folding of the osseous flap and improved restoration of all three facial axes with a single flap.In one patient,the tip of the scapula was used to reconstruct the nasofacial axis,while the body and lateral border were used to reconstruct the palate.In four patients,the tip of the scapula was used to reconstruct the orbital axis,while the body and lateral border were used to reconstruct the nasofacial axis.Patients had successful oronasal separation,healed wounds withstanding adjuvant therapy,satisfactory orbital positioning and facial projection,preserved masticatory surfaces and opportunity for dental implants.Conclusion:The midface is geometrically complex and is one of the most challenging head and neck sites to reconstruct.Ablative defects in this area can disrupt facial axes resulting in poor esthetic and functional outcomes.This study demonstrates the reconstructive advantages of a novel osteotomized folded scapular tip-free flap.展开更多
目的观察苍龟探穴针刺法与肩胛带稳定性训练治疗肩袖损伤的临床疗效及对肩外旋角的影响。方法将100例肩袖损伤患者随机分为单一组和联合组,每组50例。单一组采用肩胛带稳定性训练干预方案,联合组在单一组的基础上采用苍龟探穴针刺法。...目的观察苍龟探穴针刺法与肩胛带稳定性训练治疗肩袖损伤的临床疗效及对肩外旋角的影响。方法将100例肩袖损伤患者随机分为单一组和联合组,每组50例。单一组采用肩胛带稳定性训练干预方案,联合组在单一组的基础上采用苍龟探穴针刺法。观察两组治疗前后美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、疼痛视觉模拟量表(visual analog scale,VAS)评分、肩周激痛点(myofascial trigger point,MTrP)数量、肩关节活动度及健康调查简表(MOS 36-item short-form health survey,SF-36)评分的变化,并比较两组临床疗效。结果联合组的总有效率为92.0%,高于单一组的70.0%(P<0.05)。两组治疗后ASES评分均升高(P<0.05),且联合组高于单一组(P<0.05)。两组治疗后VAS评分均降低(P<0.05),且联合组低于单一组(P<0.05)。两组治疗后MTrPs数量均减少(P<0.05),且联合组少于单一组(P<0.05)。两组治疗后肩关节活动度均增大(P<0.05),且联合组大于单一组(P<0.05)。两组治疗后SF-36评分均升高(P<0.05),且联合组高于单一组(P<0.05)。结论针刺联合肩胛带稳定性训练可有效缓解肩袖损伤患者肩部疼痛,促进肩关节功能恢复。展开更多
文摘BACKGROUND Acinic cell carcinoma(ACC)is a malignant epithelial neoplasm that commonly occurs in the parotid gland.It is known to have a high recurrence rate and the potential to metastasize to the lung or cervical lymph nodes.However,few cases of ACC with bone metastasis have been reported in the medical literature.CASE SUMMARY The clinical significance of this case report lies in the unique site of occurrence of the metastasis:To the best of our knowledge,this report is the only literature documenting ACC arising in a shoulder mass.CONCLUSION Unusual presentations of uncommon malignancies can present diagnostic challenges for both surgeons and histopathologists.It is important to be aware of these rare occurrences in order to provide the best possible treatment for patients.
文摘BACKGROUND Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of allfractures, and scapular neck fractures are extremely rare, comprisingapproximately 7%-25% of all scapular fractures. Scapular neck fractures are oftenstudied as case reports mostly accompanied by other injuries, thus leading toconfusion. All previous cases of scapular neck fractures are not associated withrotator cuff injuries.CASE SUMMARY A 62-year-old man was admitted to our emergency department 6 h after his rightshoulder and back were impacted by heavy objects. The patient presented chesttightness and shortness of breath. Chest computed tomography (CT) showedpneumohemothorax, multiple rib fractures, and right scapula fractures. ThreedimensionalCT reconstruction of the right shoulder joint showed a trans-spinousscapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injurywas suspected because the patient had a glenohumeral joint dislocation and wasthen confirmed by shoulder magnetic resonance imaging. A staged surgery wasperformed, including open reduction and internal fixation of the right scapulafracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mofollow-up, the fracture line was blurred and the shoulder joint function was good.CONCLUSION Fracture of the scapular neck combined with rotator cuff tear is rare and therotator cuff injury should not be ignored in clinical work. Stable internal fixationcombined with secondary arthroscopic repair of rotator cuff tear can achieve goodresults.
基金Fundación Pública Andaluza para la Gestión de la investigación en Salud de Sevilla"FISEVI"
文摘BACKGROUND No dynamic technique, such as tendon transfer, has been described for scapular winging due to levator scapulae or rhomboid major and minor palsies resulting from an isolated dorsal scapular nerve injury. Thus, we evaluated how the contralateral trapezius compound osteomuscular flap transfer would work in stabilizing lateral scapular winging, and the case is reported here. A literature review was also conducted, and articles relevant to the case are presented.CASE SUMMARY A 37-year-old male patient who had sustained an isolated dorsal scapular nerve injury underwent reconstructive surgery using the contralateral trapezius compound osteomuscular flap transfer technique to treat scapular winging and the consequent pain, and to restore function from the shoulder impairment. As a result, the involved shoulder showed an improved Constant-Murley score, from19.5% to 81.88%.CONCLUSION Contralateral trapezius osteomuscular flap transfer succeeded in stabilizing scapular winging in this case, improving shoulder function and affording pain relief.
文摘Fractures of the scapula are rare and have been reported to account for only 1% of all fractures and 3%-5% of upper extremity fractures. Several studies have reported successful outcomes with non-operative treatment of scapula fractures. Although non-operative treatments are successful in a very high percentage of patients, very few cases of non-union of scapular body fractures have been reported. In our review of the literature, we found two case reports of scapular body fractures developed into non-unions. In both of these cases, open reduction and internal fixation with reconstruction plates and bone graft was successful at eliminating pain and restoring function. This is a case report of a patient with a symptomatic, extra-articular scapular body defect from a non-union that was treated successfully with an acellular dermal extracellular matrix and bone graft using a novel
文摘AIM To evaluate whether implant design, glenoid positioning, and other factors influenced instability and scapular notching in reverse total shoulder arthroplasty.METHODS We retrospectively reviewed records of patients who had undergone reverse total shoulder arthroplasty by the senior author from July 2004 through October 2011 and who had at least 24 mo of follow-up. The 58 patients who met the criteria had 65 arthroplasties: 18 with a Grammont-type prosthesis(Grammont group) and 47 with a lateral-based prosthesis(lateral-design group). We compared the groups by rates of scapular notching and instability and by radiographic markers of glenoid position and tilt. We also compared glenoid sphere sizes and the number of subscapularis tendon repairs between the groups. Rates were compared using the Fisher exact test. Notching severity distribution was compared using the χ2 test of association. Significance was set at P < 0.05.RESULTS The Grammont group had a higher incidence of scapular notching(13 of 18; 72%) than the lateral-design group(11 of 47; 23%)(P < 0.001) and a higher incidence of instability(3 of 18; 17%) than the lateral-design group(0 of 47; 0%)(P = 0.019). Glenoid position, glenoid sphere size, and subscapularis tendon repair were not predictive of scapular notching or instability, independent of implantdesign. With the lateral-based prosthesis, each degree of inferior tilt of the baseplate was associated with a 7.3% reduction in the odds of developing notching(odds ratio 0.937, 95%CI: 0.894-0.983). CONCLUSION The lateral-based prosthesis was associated with less instability and notching compared with the Grammonttype prosthesis. Prosthesis design appears to be more important than glenoid positioning.
文摘BACKGROUND Frozen shoulder(FS)is a familiar disorder.Diabetics with FS have more severe symptoms and a worse prognosis.Thus,this study investigated the influence of enhancing dynamic scapular recognition on shoulder disability and pain in diabetics with FS.CASE SUMMARY A Forty-five years-old male person with diabetes mellitus and a unilateral FS(stage II)for at least 3 mo with shoulder pain and limitation in both passive and active ranges of motion(ROMs)of the glenohumeral joint of≥25%in 2 directions participated in this study.This person received dynamic scapular recognition exercise was applied to a diabetic person with a unilateral FS(stage II).The main outcome measures were upward rotation of the scapula,shoulder pain and disability index,and shoulder range of motion of flexion,abduction,and external rotation.The dynamic scapular exercise was performed for 15 min/session and 3 sessions/wk lasted for 4 wk.After 4 wk of intervention,there were improvements between pre-treatment and post-treatment in shoulder pain,shoulder pain and disability index,shoulder ROM,and upward rotation of the scapula.CONCLUSION This case report suggested that enhancing dynamic scapular recognition may improve shoulder pain and disability;upward rotation of the scapula;and shoulder ROM of shoulder abduction,flexion,and external rotation after 4 wk.
基金Supported by Shanghai three-year action plan for accelerating the development of Traditional Chinese Medicine(2018-2020):ZY(2018-2020)-ZYJS-07Research project o Yueyang Hospital of Integrated Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine(2019-2020):2018YJ12.
文摘Objective:To observe the clinical effect of"scapular heat penetration"technique of acupuncture in treatment of scapulohumeral periarthritis.Design:It was a single-central randomized controlled trial,the participants,outcome assessors and statisticians were blinded.Setting:The trial was undertaken in Department of Acupuncture and Moxibustion,Yueyang Hospital of Integrated Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,from June 2021 to January 2022.Participants:Sixty-seven patients with scalpulohumeral periarthritis were participated.Interventions:In the control group,the routine acupuncture was given,while in the trial group,the"scapular heat penetration"technique of acupuncture was adopted.The intervention was delivered once every two days,3 treatments a week;and one course included 9 treatments.Before the 1st treatment and after the 9th treatment,the symptoms and physical signs were observed and recorded in each group.Outcomes:Primary outcome:the score of visual analogy scale(VAS)before treatment and after treatment completion.Secondary outcomes:the range of movement(ROM)of shoulder joint,the score of Japanese Orthopaedic Association(JOA)of shoulder joint and the infrared thermal imaging temperature around the shoulder.Results:A total of 102 cases were collected,72 cases of them were eligible and 5 cases were withdrawn.Sixty-seven cases were included in analysis.In the within-group comparison,VAS score,ROM and JOA score as well as the shoulder temperature were all ameliorated after 9 treatments in either the trial group or the control group,compared with those before treatment(P<0.05).In the comparison between two groups,after 9 treatments,VAS score in the trial group was lower than that of the control group(P<0.05);and the improvements in ROM and shoulder temperature in the trial group were better than those of the control group(P<0.05).No adverse reactions were found in the two groups.Conclusion:Both the"scapular heat penetration"technique of acupuncture and the conventional acupuncture are effective on scapulohumeral periarthritis.But,regarding the improvements in pain,ROM of shoulder joint,the activity of daily life and shoulder temperature,the"scapular heat penetration"technique of acupuncture is superior to the conventional acupuncture.
文摘BACKGROUND Squamous cell carcinoma(SCC)of bone is usually caused by metastasis from the lungs,bladder,or other sites.Primary SCC of bone most frequently involves the skull bones,and primary involvement of other sites in the skeletal system is extremely rare.To date,only three such cases have been reported,which makes the diagnosis,treatment,and prognosis of this disease a challenge.CASE SUMMARY A 76-year-old Chinese man presented to our hospital with nonspecific pain and limited mobility in the right shoulder for 4 mo.He underwent three-dimensional computed tomography reconstruction and magnetic resonance imaging of the right shoulder,which revealed an osteolytic destructive lesion in the right scapula with invasion into the surrounding muscles and soft tissues.Ultrasound-guided core needle biopsy detected a malignant tumor,and immunohistochemical analysis revealed a poorly differentiated SCC.Wide excision of the right scapular bone was performed,and pathological examination of the surgical specimen confirmed the diagnosis.At the last follow-up examination within 2 years,the patient was doing well with the pain significantly relieved in the right shoulder.CONCLUSION Primary SCC of bone is extremely rare at sites other than the skull.Clinicians must exhaust all available means for the diagnosis of primary SCC of the bone,so greater attention can be paid to its timely and effective management.Regular and adequate follow-up is essential to help rule out metastasis and judge the prognosis.
基金by PLA General Logistics Department,No.CWS14J067.
文摘BACKGROUND Severe bony Bankart lesions are a difficult challenge in clinical treatment and research.The current treatment methods consist mostly of Latarjet-Bristow surgery and its modified procedures.While good results have been achieved,there are also complications such as coracoid fracture,bone graft displacement,and vascular and nerve injury.AIM To analyze the techniques and biomechanical properties of transversely fixing a bone block from the scapular spine using bone allograft pins with suture threads to repair bony Bankart lesions.METHODS Fresh human shoulder joint specimens and a cadaver specimen model for scapular bone grafting with allograft pin fixation for repair of bony Bankart lesions were used.When the humeral rotation angles were 0°,30°,60°and 90°,and the axial loads were 30 N,40 N,and 50 N,the humerus displacement was studied by biomechanical experiments.RESULTS When the angle of external rotation of the humerus was 0°,30°,60°,and 90°,with axial loads of 30 N,40 N,and 50 N,the data of the normal control group,allograft pin repair group,and titanium alloy hollow screw repair group were compared with each other by the q-test,which showed that there were no statistically differences among the three groups(P>0.05).CONCLUSION The joints repaired with bone block from the scapular spine transversely fixed with allograft bony pins to repair bony Bankart lesions show good mechanical stability.The bone block has similar properties to normal glenohumeral joints in terms of biomechanical stability.
文摘Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient’s pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.
文摘To explore the treatment methods for scapular fractures associated with clavicle fractures.Methods Of 23 cases with scapular fractures associated with clavicle fractures,13 treated conservatively took the function exercise of shoulder joint after two months and 10 treated with open reduction and plate fixation reconstruction began the function exercise of shoulder joint four weeks after operation.The follow up averaged 12 months.Results All patients were healed up.18 cases were followed up,of them 8 cases were treated surgically,10 cases,conservatively.Of eight cases treated surgically,seven got excellent functional recovery of the shoulder joint and one satisfactory.In the meantime,of 10 cases treated conservatively,the recovery of shoulder joint was excellent in six,good in three and poor in one.Conclusion As for scapular fractures with associated clavicle fractures,open reduction and plate fixation reconstruction is a good treatment method for it can keep the stability and the balance of shoulder joint and is helpful for early functional exercise and recovery of the shoulder joint.7 refs,5 figs.
文摘The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects.This chapter aims to review the indications,advantages,and anatomy of subscapular system flaps in the reconstruction of the mandible.The subscapular system can serve as an alternative to the fibula free flap in the presence of significant atherosclerotic disease or other contraindications.The flexibility and abundance of its soft tissue components make this system particularly advantageous for complex composite defects.Avoiding a fibula free flap for osseous reconstruction of the mandible permits early patient mobilization and may prevent adverse postoperative complications.A long pedicle can be harvested with subscapular flaps,which may prove useful in the face of limited available recipient vessels.Critics of the subscapular system cite longer operative times due to the need for patient repositioning and concerns over the integrity of the bone stock.Positioning modifications may permit a two-team approach to subscapular reconstruction,thus limiting operative times.Subscapular harvest does incur shoulder morbidity;however,this does not appear to affect the quality of life significantly.The flap is reliable and can support endosseous implants if properly planned,though it may be more susceptible to bone resorption when compared to the fibula.Overall,the subscapular system remains a versatile donor that can achieve ideal reconstructive outcomes with minimal morbidity.
文摘Reverse shoulder arthroplasty(RSA)can treat severe rotator cuff deficiency,but its medialized design of the shoulder's center of rotation(CoR)has been associated with scapular notching.Although lateralization of CoR provides a larger impingement-free range of motion,the changes in component positioning alter the biomechanics and may cause unforeseen complications.This work quantified the muscle forces and predicted the scapula fracture risk by coupling dynamic simulation analysis with finite element modeling.To identify bone failure patterns,the results were analyzed using three common failure measures.A parametric study showed greater lateralization produced higher strain/stress concentrations in the scapular spine(Levy Region Type II),with approximately a 10%increase for the 12 mm lateralized scenario,compared to a neutral configuration.Significant differences in fracture risk patterns were found between the maximum principal stress/strain results and the von Mises stress results.The lateralized configurations could increase the muscle and joint reaction forces during abduction and induce scapular fracture.Studying the effects of RSA lateralization on scapular fracture risk can help guide the continued optimization of RSA performance and surgical techniques.The findings of relationships between the loading style and bone failure measures can provide valuable insight into the investigation of bone failure criteria.
文摘Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects disrupting two or more of the following facial axes:orbital,nasofacial,and palatal axes.Patients underwent primary reconstruction using an angular artery-based scapular tip-free flap with an osteotomy to fold the flap.Harvest techniques,including placement of osteotomies,folding and plating,surgical esthetic,and functional outcomes,are presented.Results:Osteotomies placed in the scapular tip-free flap allowed folding of the osseous flap and improved restoration of all three facial axes with a single flap.In one patient,the tip of the scapula was used to reconstruct the nasofacial axis,while the body and lateral border were used to reconstruct the palate.In four patients,the tip of the scapula was used to reconstruct the orbital axis,while the body and lateral border were used to reconstruct the nasofacial axis.Patients had successful oronasal separation,healed wounds withstanding adjuvant therapy,satisfactory orbital positioning and facial projection,preserved masticatory surfaces and opportunity for dental implants.Conclusion:The midface is geometrically complex and is one of the most challenging head and neck sites to reconstruct.Ablative defects in this area can disrupt facial axes resulting in poor esthetic and functional outcomes.This study demonstrates the reconstructive advantages of a novel osteotomized folded scapular tip-free flap.
文摘目的观察苍龟探穴针刺法与肩胛带稳定性训练治疗肩袖损伤的临床疗效及对肩外旋角的影响。方法将100例肩袖损伤患者随机分为单一组和联合组,每组50例。单一组采用肩胛带稳定性训练干预方案,联合组在单一组的基础上采用苍龟探穴针刺法。观察两组治疗前后美国肩肘外科协会(American Shoulder and Elbow Surgeons,ASES)评分、疼痛视觉模拟量表(visual analog scale,VAS)评分、肩周激痛点(myofascial trigger point,MTrP)数量、肩关节活动度及健康调查简表(MOS 36-item short-form health survey,SF-36)评分的变化,并比较两组临床疗效。结果联合组的总有效率为92.0%,高于单一组的70.0%(P<0.05)。两组治疗后ASES评分均升高(P<0.05),且联合组高于单一组(P<0.05)。两组治疗后VAS评分均降低(P<0.05),且联合组低于单一组(P<0.05)。两组治疗后MTrPs数量均减少(P<0.05),且联合组少于单一组(P<0.05)。两组治疗后肩关节活动度均增大(P<0.05),且联合组大于单一组(P<0.05)。两组治疗后SF-36评分均升高(P<0.05),且联合组高于单一组(P<0.05)。结论针刺联合肩胛带稳定性训练可有效缓解肩袖损伤患者肩部疼痛,促进肩关节功能恢复。
