【Abstract】 Objective To review the progress in pathoanatomy, diagnosis, and treatment of posterolateral rotatory instability (PLRI) of the elbow. Methods Related literature concerning PLRI of the elbow was extensively reviewed, comprehensive analysis was done. Results The lateral collateral ligament complex (LCLC), radial head, capitellum, and coronoid process are important constraints to PLRI. Muscle groups that cross the lateral elbow are secondary constraints to PLRI. Clinical examination includes lateral pivot-shift test, lateral pivot-shift apprehension test, chair sign, active floor push-up sign, tabletop relocation test, and posterolateral rotatory drawer test. Radiology, arthroscopy, and ultrasound can help diagnosis of PLRI. Reconstruction of bony fixation or soft tissue fixation can be used for treatment of injured LCLC. Conclusion The primary constraints to PLRI is LCLC. Ultrasound imaging is accurate for identification and measurement of normal LCLC. Therefore, ultrasound may prove valuable in assessment of abnormal lateral ulnar collateral ligaments. Reconstruction of soft tissue fixation, which can avoid iatrogenic fracture, is a selective treatment method.
Objective To review the progress in the cl inical treatment of Kienbouml;ck’s disease. Methods Related l iterature concerning the treatment of Kienbouml;ck’s disease was reviewed, and comprehensive analysis was done. Results The treatment methods of Kienbouml;ck’s disease include non-surgical treatment and surgical treatment, which are primarily guided bythe anatomic factor and Lichtman stage. Non-surgical treatment methods should be selected in patients of children and at stage I. Surgical treatment methods include vascularized bone graft transfer into the cored-out lunate, radial shortening osteotomy, radial lateral wedge osteotomy, etc. All surgical treatment methods have advantages and disadvantages. Conclusion For the treatment of Kienbouml;ck’s disease, none of procedure is superior to another. In short, choosing different treatment strategies based on different patients can achieve the desired outcome.
Objective To evaluate the role of glenoid osseous structure on anterior stabil ity of shoulder so as to provide the biomechanical basis for cl inical treatment. Methods Ten fresh shoulder joint-bone specimens were collected from10 adult males cadavers donated voluntarily, including 4 left sides and 6 right sides. The displacements of the specimens were measured at 0° and 90° abduction of shoulder joint by giving 50 N posterior-anterior load under the conditions as follows: intact shoulder joint, glenoid l ip defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect. Results For intact shoulder joint, glenoid l i p defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect, the displacements were (10.73 ± 2.93), (11.43 ± 3.98), (13.58 ± 4.86), (18.53 ± 3.07), and (12.77 ± 3.13) mm, respectively at 0° abduction of shoulder joint; the displacements were (8.41 ± 2.10), (8.55 ± 2.28), (9.06 ± 2.67), (12.49 ± 2.32), and (8.55 ± 2.15) mm, respectively at 90° abduction of shoulder joint. There was no significant difference between intact shoulder joint and others (P gt; 0.05) except between intact shoulder joint and 20% of osseous defect (P lt; 0.05). Conclusion When shoulder glenoid l ip defects or the glenoid osseous defect is less than 20%, the shoulder stabil ity does not decrease obviously, indicating articular l igament complex is not damaged or is repaired. When glenoid osseous defect is more than 20% , the shoulder stabil ity decreases obviously even if articular l igament complex is not damaged or is repaired. Simultaneous repair of glenoid osseous defect andarticular l igament complex can recover the anterior stabil ity of the shoulder.
Objective To review the progress in influence of bony structure of glenohumeral joint on the shoulder joint stabil ity. Methods Recent l iterature, concerning the influence factors of the shoulder joint stabil ity and the action of bony structure of the glenohumeral joint in the stabil ity of shoulder joint, was extensively reviewed and summarized. Results The specific factors which the bony structure of the glenohumeral joint influences the stabil ity of the shoulder joint are the conformity index, the shape of the glenohumeral joint, version angle, incl ination angle, and head shaft angle, etc. Conclusion Although the predecessor’s research experience and cl inical reports have prel iminarily determined therelationship between the bony structure of the glenohumeral joint and the stabil ity of the shoulder joint, it is necessary to further study in various aspects (including anatomy, biomechanics, and cl inical practice).
Objective To determine the change in humeral head anterosuperior migration after releasing the coracoacromial l igament in shoulders from cadavers with simulated intact or irreparable teared rotator cuff, to provide biomechanical basis for preserving the coracoacromial l igament or not during hemiarthroplasty. Methods Twelve freshfrozen cadaveric glenohumeral joints of adult preserving the scapula, upper 2/3 of the humerus, articular capsule and the coracoacromial l igament, were divided into 2 groups. The suprascapularis was preserved in group A (6 shoulders) and excised in group B (6 shoulders). Positioning the joint in a combination of 30° extension, 0° abduction and 30° external rotation, and imposing a 50 N axial compressive load to the humeral shaft, the anterosuperior displacement of the humeral head weremeasured before and after excising the coracoacromial l igament. Results In group A, the displacement of the humeral head was (5.96 ± 0.77）mm with intact coracoacromial l igament and (6.83 ± 0.84）mm after transecting the l igament. In group B, the displacement of the humeral head was (8.07 ± 2.46）mm with intact coracoacromial l igament and (9.92 ± 3.29）mm after transecting the coracoacromial l igament. So the mean increase of anterosuperior migration of the humeral head was (0.88 ± 0.34) mm (P lt; 0.01) in group A, and (1.85 ± 0.99) mm (P lt; 0.01) in group B, which was greater than the former (P lt; 0.05). Conclusion The coracoacromial l igament restrained anterosuperior translation of the humeral head, especially for patients with rotator cuff deficiency, so it should be preserved as far as possible during hemiarthroplasty.
ObjectiveTo investigate the effect of glenohumeral ligament(GHL） in static stabilizing structure of shoulder joint. Methods Fifteen upper limbs specimen from fresh adult corpse were made shoulder jointbone ligament specimen and divided in 5 groups (n=3). The loadshift curve of the following specimen was measured respectively at the shoulder joint in abductive angles of 0°,45° and 90°,influenced by 50 N posterioranterior load to evaluate anterior stability of shoulder joint. According to different selectivecutting test, 5 groups were divided subgroups:group A (A1-A4), respectively normal group, superior GHL (SGHL) injury group；SGHL/middle GHL (MGHL) injury group and SGHL/MGHL/inferior GHL (IGHL） injury group； group B（B1-B3），respectively normal group，MGHL injury group，MGHL/IGHL injury group； group C（C1-C2），respectively normal group,IGHL-anterior band(IGHL-AB) injury group； group D（D1-D2），respectively normal group, IGHL-posterior band(IGHL-PB) injury group; and group E（E1-E2），respectively normal group, IGHL injury group. Results For complete shoulder joint(A1 group), there was verysmall average shift (15.00±4.99 mm), for A4 group, there was the worst stability of shoulder joint，the average shift was 22.34±5.70 mm. For B2 group，the stability of shoulder joint had no obvious decrease. For B3 group, the stability of shoulder joint was worst at abduction angleof 45° and 90°. For C2 group, the stability of shoulder joint at abduction angle of 45° (23.19±4.58 mm) and 90°(15.32±1.30 mm) was worse than that of A1 group （P＜0.05）; halfdislocation or dislocation could be seen. For D2 group(17.30±4.93 mm), there was less effect on anterior stability of shoulder joint than that of A1 group(P＜0.05).For E2 group(20.26±4.75 mm), the effect on anterior stability was similar toC2 group. Conclusion GHL is a key static stabilizing structure of shoulder joint. SGHL has no obvious effect on anterior stability of shoulder joint. MGHL and IGHL together holds anterior stability of shoulder joint, and IGHL plays the most important role.
Objective To review the research progress in transplantation of the skeletal muscle myoblast. Methods The recentlypublished articles concernedwith the myoblast transplantation were reviewed, including myoblast culture, modified transplant methods, preparation of the recipient, scaffold choice, and aninfluence of the recipient’s immunity on the transplantation. How to improve the efficiency of the myoblast transplantation was also discussed. Results The techniques of the myoblast transplantation were improved and transplantation efficiency was increased. 〖WTHZ〗Conclusion The transplantation of the skeletal muscle myoblast has a great potential value in clinical practice and a promising future in its clinical application.
Objective To investigate the initiation of fracture repair and regulation on molecular level.Methods Literature concernedfracture repair and effects of correlative factors in the process in recent years was reviewed. The initiation in the process of fracture repair and the effects of the correlative factor were summarized to probe into effective methods to intervene. Results During fracture repair, the initiation had particular character and the correlative factors were concerned with the process. Conclusion The correlative factors regulate the initiation of fracture repair on molecular level.
ObjectiveTo review the research progress of the biomechanics of proximal row carpal instability (IPRC). MethodsThe related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. ResultsThe muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. ConclusionSome strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.