scholarly journals Optimization of the Algorithm for Choosing the Surgical Treatment of Anterior Recurrent Instability of the Shoulder Joint

2021 ◽  
Vol 6 (2) ◽  
pp. 176-183
Author(s):  
N. N. Chirkov ◽  
N. S. Nikolaev ◽  
Y. A. Pashentsev ◽  
A. V. Alekseeva ◽  
V. N. Yakovlev
Keyword(s):  
Surgical Treatment ◽  
Shoulder Joint ◽  
Joint Instability ◽  
Axillary Nerve ◽  
Entire Group ◽  
Recurrent Instability ◽  
Incorrect Choice ◽  
Stabilization Technique ◽  
Bankart Operation ◽  
Preoperative Examination

Introduction. Chronic recurrent instability of the shoulder joint is a frequent outcome of conservative treatment oftraumatic dislocation of the shoulder (2.8–30 % of cases). Preoperative examination largely determines the outcome of surgical treatment of this pathology.The aim of the study was to provide a clinical assessment of the developed algorithm for the surgical treatment of patients with recurrent anterior shoulder joint instability. Materials and methods. The results of treatment of 98 patients with recurrent anterior shoulder joint instability were studied. Preoperative examination included clinical tests, MRI or CT with calculation of bone loss. Fifty-six patients (57.1 %) underwent Bankart operation, 14 patients (14.3 %) – Latarjet operation. Twenty-three patients (23.5 %) underwent Bankart + Remplissage surgery, and 5 (5.1 %) – Latarjet + remplissage. The result was assessed on the ROWE scale.Results. Bone defects significant in the formation of instability (“glenoid off track”) were found in 19.4 % of patients, and “glenoid on track” – in 80.6 %. According to the proposed algorithm for treating patients with anterior recurrent instability of the shoulder joint, the “glenoid off track” state was an indication for Latarjet surgery. When “glenoid on track” was used, indications for Bankart operation were displayed. The remplissage procedure was indicated in case of the presence of a Hill-Sachs grade 3 defect or the presence of hyperelasticity of the tissues of the shoulder joint. The mean ROWE score for the entire group of patients before surgery was 41.5 ± 12.8 points, and 15 months after sur gery – 94.9 ± 3.4 points. Two recurrent dislocations were revealed, one of which was associated with repeated trauma, and the other – with an incorrect choice of stabilization technique. One complication (axillary nerve neuropathy) was observed, which was arrested conservatively.Conclusions. The proposed algorithm allowed us to obtain positive results in 97.9 % of cases. 

scholarly journals The effectiveness of current methods of surgical treatment of anterior recurrent instability of the shoulder joint, depending on anatomical and functional changes

2021 ◽  
Vol 27 (3) ◽  
pp. 337-344
Author(s):  
N.N. Chirkov1 ◽  
◽  
N.S. Nikolaev ◽  
A.V. Alekseeva ◽  
V.N. Yakovlev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bone Defect ◽  
Shoulder Joint ◽  
Rating Scales ◽  
Bone Defects ◽  
Anterior Dislocation ◽  
Functional Disorders ◽  
Recurrent Instability ◽  
The Mean ◽  
Grade 3

Introduction Traumatic anterior dislocation of the shoulder usually results in chronic recurrent shoulder instability, especially in young adults. To reduce the rate of recurrent dislocations, various options of osteoplastic operations have been proposed. The purpose of our study is to determine the significance of anatomical and functional disorders in patients with anterior shoulder joint instability; to evaluate the results of the methods for surgical treatment of patients with anterior recurrent instability of the shoulder joint, depending on the anatomical and functional disorders. Materials and methods The results of diagnostic examination and treatment of 169 patients with recurrent post-traumatic dislocation of the shoulder who were operated on at the Federal State Budgetary Organization “Federal Center for Traumatology, Orthopedics and Arthroplasty” (Cheboksary) were analyzed. The average age of patients was 31.1 ± 13.1 years; the average period of postoperative follow-up was 49.5 ± 24.0 months. Clinical data were assessed by angulometry, using the ROWE, ASES, UCLA, VAS scales. The size of bone defects was determined using radiological methods. 99 patients (58.6 %) underwent arthroscopic Bankart repair, 24 patients (14.2 %) with more than 15 % anterior glenoid bone defect underwent Latarjet operation. Bankart + Remplissage surgery was performed in 39 patients (23.1 %), Latarjet + Remplissage in 7 (4.1 %) patients. Results Bone defect of the glenoid of more than 15 % of the area was detected in 32 patients. Hill-Sachs grade 3 injury was reported in 24 patients. Most of these patients had a history of more than 20 dislocation episodes. Hyperelasticity of the shoulder joint was found in 34 patients. In the postoperative period, there was a slight improvement in the mean indicators of flexion and abduction in the shoulder joint from 174.2 ± 15.9° and 170.6 ± 17.8° to 175.6 ± 9.3° and 173.0 ± 12.3°, respectively. The mean external rotation worsened from 61.6 ± 25.7° to 55.9 ± 14.4°. Indicators of the ROWE, ASES, UCLA rating scales improved significantly from 38.5 ± 8.5, 76.0 ± 13.2 and 20.8 ± 3.0 to 89.9 ± 17.5, 94.0 ± 7.1 and 32.7 ± 3.7 points, respectively. Poor results were observed in 7 patients (4.1 %), of which three had a relapse. Conclusions Critically significant anatomical and functional disorders in patients with anterior instability of the shoulder joint are the defect of the anterior rim of the articular process of the scapula more than 15 %, the defect of the posterior surface of the humeral head (Hill-Sachs defect) of grade 3, hyperelasticity of the soft tissues of the shoulder joint. The severity of bone defects is directly proportional to the total number of dislocations. The effectiveness of surgical techniques for stabilizing the shoulder joint, depending on the above anatomical and functional disorders, was 95.9 %.

scholarly journals Cadaveric evaluation of the feasibility of glenohumeral joint denervation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Amr M. Aly
Keyword(s):  
Muscle Weakness ◽  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Axillary Nerve ◽  
Low Risk ◽  
Dorsal Approach ◽  
Articular Branch ◽  
Pectoral Nerve ◽  
Teres Minor

Abstract Purpose To assess the feasibility of total shoulder denervation through two proposed incisions. Methods Total shoulder denervation was performed through an extended delta-pectoral approach and a transverse dorsal approach at the spine of the scapula. The study involved six cadavers. Course and number of articular branches from the lateral pectoral, axillary and supra-scapular nerve were documented. Results All shoulder joint articular branches were accessible through the proposed anterior and posterior approaches. The articular branch of the lateral pectoral nerve and supra scapular nerve were present in all the specimen. Axillary nerve articular branches were variable in number but when present anteriorly were proximal to the deltoid muscular branches and posteriorly proximal to the muscular branches to the teres minor. Conclusion Total glenohumeral denervation was feasible through our proposed anterior and posterior approaches. Enhanced knowledge of articular nerve branches could provide interventional targets for joint and ligament pain, with low risk of muscle weakness.

Surgical treatment of soft tissue sarcomas

1980 ◽  
Vol 61 (6) ◽  
pp. 4-6
Author(s):  
M. Z. Sigal ◽  
G. F. Fatuhova
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Skin Defect ◽  
Skin Grafts ◽  
Preoperative Examination

In 46 patients with sarcomas, extensive soft tissue resections were performed using free skin defect plasty. The limits of resection were determined on the basis of preoperative examination, examination and palpation of various tissue layers during the operation. Defects were replaced with free skin grafts ranging in size from 40 to 300 cm2.

scholarly journals Recommendations for diagnosis and treatment Shoulder joint replacement in rheumatoid arthritis – surgical treatment and physiotherapy

2013 ◽  
Vol 2 ◽  
pp. 108-112
Author(s):  
Agnieszka Prusinowska ◽  
Piotr Turski ◽  
Emil Przepiórski ◽  
Paweł Małdyk ◽  
Krystyna Księżopolska-Orłowska
Keyword(s):  
Rheumatoid Arthritis ◽  
Surgical Treatment ◽  
Joint Replacement ◽  
Shoulder Joint ◽  
Diagnosis And Treatment

scholarly journals Ultrasonographic and MR diagnosis of rotator cuff disorders & shoulder joint instability

2013 ◽  
Vol 44 (4) ◽  
pp. 835-844
Author(s):  
Mohamed Ahmed Youssef ◽  
Atef Hammad Teima ◽  
Yaser Elsayed Abduo ◽  
Logain Nabeel Salem
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Joint Instability

Surgical methods of treatment of intestinal passage disturbances with the characteristics of constipation in patients with intestinal stoma based on own experience

2015 ◽  
Vol 87 (4) ◽  
Author(s):  
Łukasz Krokowicz ◽  
Sylwia Sławek ◽  
Witold Ledwosiński ◽  
Adam Bobkiewicz ◽  
Maciej Borejsza-Wysocki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Parastomal Hernia ◽  
Surgical Intervention ◽  
Intestinal Fistula ◽  
Entire Group ◽  
Stomal Prolapse ◽  
Surgical Methods ◽  
Intestinal Stoma ◽  
Inflammatory Bowel ◽  
Methods Of Treatment

AbstractStoma is an intestinal fistula created in emergency or by elective indications, and it is done to drain out the digestive tract content. In some patients there is a disturbance passage of gastric contents through the stoma, which may take the form of chronic constipation or even periodic subileus that will sooner or later require surgical treatment.The aim of the study was the assessment of the causes and method of treatment of constipation in patients with intestinal stoma.Material and methods. A total of 331 patients with stoma followed by Ostomy and Proctology Outpatient Clinic were included in the study in the years 2011-2014. The study included 146 women and 185 men and the average age was 61.3 ± 12.7 years. Within the entire froup, 273 patients had the end stoma performed whereas in 58 patients the loop stoma was created. The highest percentage of patients were the ones with diverticulosis and colorectal cancer, i.e. 132 and 114 patients respectively. A stoma was created in 35 patients due to inflammatory bowel disease (IBD), in 23 patients because of cancer, in 14 as a result of injuries and in 13 due to rectovaginal fistula.Results. Out of the entire group subject to study (331 patients) 93 patients (28.1%) suffered from constipation. 50 patients with constipation required surgical intervention. The most common indication for surgical treatment was the parastomal hernia (36 patients, 72%), other indications were the narrowing of the stoma (5 patients, 10%), its collapse (6 patients, 12%) or prolapse (3 patients, 6%). Parastomal hernia was responsible for 84% of constipation within the stoma and 86.1% were treated with laparotomy (31 out of 36 patients). Other causes of constipation were the stomal stenoses (5 patients), collapse of the stoma (6 patients) and stomal prolapse (3 patients). All patients were treated surgically with a good final result.Conclusions. Constipation associated with dysfunction of the stoma in most cases should be treated surgically. Parastomal hernia is the most common cause of constipation in the stoma. Treatment should be performed in due time because of the possibility of developing complications, especially dangerous one is a strangulated parastomal hernia and ischemia of stoma.

scholarly journals Prognostic value of the Tokuhashi scale when choosing a method of surgical treatment of metastatic lesions of the spine

2021 ◽  
Vol 13 (3) ◽  
pp. 63-75
Author(s):  
M. A. Kosimshoev ◽  
A. V. Evsyukov ◽  
Yu. E. Kubetskiy ◽  
E. K. Uzhakova ◽  
E. V. Amelina ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Life Expectancy ◽  
Cox Model ◽  
Prognostic Significance ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Study Objective ◽  
Spinal Lesion ◽  
Preoperative Examination

Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

scholarly journals Evaluation of the effectiveness of the use of low-traumatic surgical access in the reverse shoulder arthroplasty

2021 ◽  
Vol 28 (2) ◽  
pp. 21-28
Author(s):  
Gurgen A. Kesyan ◽  
Grigoriy S. Karapetyan ◽  
Artem A. Shuyskiy ◽  
Rashid Z. Urazgil'deev ◽  
Igor' G. Arsen'ev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Shoulder Arthroplasty ◽  
Shoulder Joint ◽  
Subcutaneous Tissue ◽  
Reverse Shoulder Arthroplasty ◽  
Main Group ◽  
Control Group ◽  
Surgical Interventions ◽  
Surgical Access

BACKGROUND: The number of reversible shoulder joint endoprostheses installed in the world at the present stage is several times greater than the number of hemiarthroplasty performed. Nevertheless shoulder arthroplasty is considered a traumatic operation and can be accompanied by a number of complications, both from the side of implants and due to the traumatic nature of the surgical technique. During surgical interventions on the shoulder joint with a wide dissection of the skin and subcutaneous tissue, iatrogenic damage to structures such as the axillary nerve, posterior and anterior arteries and veins surrounding the humerus can often be detected, which triggers a whole cascade of pathophysiological and regulatory processes in which Interventions immediately release inflammatory mediators. Therefore, orthopedic traumatologists strive to reduce the risk of intra- and postoperative complications, and it is necessary to improve the surgical technique of surgical interventions towards their less traumatic performance. AIM: Development and evaluation of the effectiveness of the use of low-traumatic surgical access when performing reverse shoulder arthroplasty. MATERIALS AND METHODS: In the period 20172020, 169 patients with various diseases, injuries of the shoulder joint and their consequences were operated on in the Department of Adult Orthopedics of the N.N. Priorov National Research Medical Center of the Russian Federation, who underwent reverse shoulder arthroplasty according to generally accepted indications. In the main group (84 patients), surgical treatment was performed using a low-traumatic surgical approach, while the control group (85 patients) underwent standard procedures. Functional, clinical and radiological results of surgical treatment of patients of the main and control groups were evaluated and compared after 3, 6 and 12 months. RESULTS: In the main group, excellent results (25 points on DASH) were observed in 73 patients, good results (2650 points) in 10 patients. In 1 patient, the results were assessed as satisfactory (5175 points). In the control group of observation, the clinical result was worse (68 excellent, 16 good and 1 satisfactory result). CONCLUSION: On the basis of the performed study, taking into account the better results in the main group of patients, the technique of low-traumatic surgical access for reverse shoulder arthroplasty can be recommended for wide use in clinical practice.

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