subscapularis

肩胛骨下
  • 文章类型: Journal Article
    肩胛骨下的肌内脓肿是一种罕见的现象,但对于外科医生来说是重要的病理,因为临床恶化可能会迅速且诊断困难。该表现通常模仿具有亚急性肩痛和僵硬的其他常见肩关节病变。早期诊断,抗生素和外科引流对减少关节的传播和破坏至关重要。
    对PubMed和GoogleScholar数据库的搜索确定了肩胛骨下肌内脓肿的病例。收集到的每个病例的数据包括患者的人口统计学,介绍,病理学,手术治疗和结果。作者报告了另一例肩胛骨下脓肿病例。
    我们发现了17例肩胛骨下脓肿,文献中的16个和作者描述的一个案例。17例中有16例(94.1%)在就诊前平均6.7天内出现肩痛和活动范围恶化。使用的手术方法包括后下入路,三角肌胸肌入路和后下外侧入路。
    从有关肩胛骨下肌内脓肿的有限数据,作者提出了以下建议:(1)经验性抗生素涵盖金黄色葡萄球菌+/-耐甲氧西林金黄色葡萄球菌,(2)在所有情况下都应引流;(3)保留肌腱的方法可以在肩胛骨下间隙的大多数位置进入脓肿。
    UNASSIGNED: An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction.
    UNASSIGNED: A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case.
    UNASSIGNED: Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach.
    UNASSIGNED: From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering Staphylococcus aureus +/- methicillin-resistant Staphylococcus aureus, (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.
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  • 文章类型: Journal Article
    对于肩胛骨下肌腱撕裂(SCT),已经提出了几种分类;然而,骨科医生在这些病变的诊断和治疗方面仍未达成一致.区分各种泪液模式并将其分类具有一定的预后意义可能有助于手术外科医生计划适当的治疗。
    本研究的目的是概述有关SCT分类和治疗的现有文献,并在肩和肘外科医生中进行调查,以确定有关这些损伤的手术决策的方法。
    在这篇系统综述中,我们分析了12篇有关肩胛骨下肌腱撕裂分类的文章,以及对治疗计划和结局的影响.此外,4名肩胛骨下修复手术的国际专家参与了问卷形式的开发,该问卷形式分发给1161名ASES成员。一百六十五名外科医生参加并选择他们是否同意,不同意,或对包括适应症/禁忌症在内的4个部分中的32个陈述中的每个陈述都弃权,治疗计划,以及影响调查结果的因素。
    分类标准变化很大,对泪液形态的建议和描述不同;大多数基于泪液大小,相关肩部病理学,或较小的结节足迹暴露。考虑到多种分类系统和关于SCT管理的总体协议较差,我们的研究发现,最广泛认同(超过80%)的陈述包括早期手术建议用于创伤性SCT,与急性冈上肌撕裂相关的慢性退行性SCT(无脂肪浸润)是修复的候选人,肩袖关节病是SCT修复的禁忌证。
    我们的研究能够确定患者和泪液的特征,这些特征在外科医生的治疗中得到了很好的认同。Lafosse分类通常被广泛接受;然而,它需要通过一些补充来改进。需要外科医生之间继续合作,以建立可接受且广泛适用的分类系统来管理这些损伤。
    UNASSIGNED: Several classifications have been proposed for subscapularis tendon tearing (SCTs); however, there remains a poor agreement between orthopedic surgeons regarding the diagnosis and management of these lesions. Distinguishing the various tear patterns and classifying them with some prognostic significance may aid the operating surgeon in planning appropriate treatment.
    UNASSIGNED: The purpose of this study was to outline the current literature regarding SCT classification and treatment and conduct a survey among shoulder and elbow surgeons to identify the approaches regarding surgical decision-making for these injuries.
    UNASSIGNED: In this systematic review, we analyzed 12 articles regarding the subscapularis tendon tear classification and implications regarding treatment plans and outcomes. In addition, 4 international experts in subscapularis repair surgery participated in the development of a questionnaire form that was distributed to 1161 ASES members. One hundred sixty five surgeons participated and chose whether they agree, disagree, or abstain for each of the 32 statements in 4 parts including indications/contraindications, treatment plan, and the factors affecting outcomes in the survey.
    UNASSIGNED: Classification criteria were extremely variable with differing recommendations and descriptions of tear morphology; most were based on tear size, associated shoulder pathology, or lesser tuberosity footprint exposure. Considering the multiple classification systems and the overall poor agreement regarding SCT management, our study found that the most widely agreed upon (more than 80%) statements included early surgery is advised for traumatic SCT, chronic degenerative SCT (without fatty infiltration) associated with acute supraspinatus tear is a candidate for repair, and rotator cuff arthropathy is a contraindication for SCT repair.
    UNASSIGNED: Our study was able to identify both patient and tear characteristics that are well agreed upon among surgeons in the treatment of these injuries. Lafosse classification is generally widely accepted; however, it needs to be improved by some additions. Continued collaboration among surgeons is needed to establish an acceptable and broadly applicable classification system for the management of these injuries.
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  • 文章类型: Journal Article
    解剖全肩关节置换术是完整的肩袖和足够的关节盂骨以适应假体关节盂植入物的患者的金标准肩关节置换手术,并提供可靠的患者满意度。优异的植入物寿命,并发症发生率低。有关解剖全肩关节置换术后康复策略的文献存在差异。本文介绍了解剖全肩关节置换术后康复领域专家的共识声明。该共识声明的目标是提供当前基于证据的基础,以告知解剖全肩关节置换术后的康复过程。这些指南适用于解剖全肩关节置换术(替换肱骨头和关节盂),半髋关节置换术(仅替换肱骨头),和关节盂扩孔或表面置换术。共识声明整合了广泛的文献综述,以及美国肩肘治疗师协会和美国肩肘外科医生的实践模式的调查结果。提出了三个恢复阶段,最初保护,然后逐渐加载受外科手术影响的软组织,比如肩胛骨下,以获得最佳的患者结果。建议的指南应与外科医生的偏好和患者特定因素合作使用。
    Anatomic total shoulder arthroplasty is the gold standard shoulder replacement procedure for patients with an intact rotator cuff and sufficient glenoid bone to accommodate prosthetic glenoid implant and offers reliable patient satisfaction, excellent implant longevity, and a low incidence of complications. Disparity exists in the literature regarding rehabilitation strategies following anatomic total shoulder arthroplasty. This article presents a consensus statement from experts in the field on rehabilitation following anatomic total shoulder arthroplasty. The goal of this consensus statement is to provide a current evidence-based foundation to inform the rehabilitation process after anatomic total shoulder arthroplasty. These guidelines apply to anatomic total shoulder arthroplasty (replacement of the humeral head and glenoid), hemiarthroplasty (replacing only the humeral head), and hemiarthroplasty with glenoid reaming or resurfacing. The consensus statement integrates an extensive literature review, as well as survey results of the practice patterns of members of the American Society of Shoulder and Elbow Therapists and the American Shoulder and Elbow Surgeons. Three stages of recovery are proposed, which initially protect and then gradually load soft tissue affected by the surgical procedure, such as the subscapularis, for optimal patient outcomes. The proposed guidelines should be used in collaboration with surgeon preferences and patient-specific factors.
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