Recurrent anterior shoulder instability is a common problem we have to deal with in clinic. With the progress in shoulder and elbow surgery, there have appeared many new concepts about the etiology, diagnosis and treatment of this disease. About 2 decades ago, people realized the important role of glenohumeral ligaments. Now we believe that the stability of the glenohumeral joint relies heavily on the congruent articulating surfaces and surrounding soft tissues that act as static and dynamic stabilizers. Many new methods, such as MRI, physical examination under anesthesia and arthroscopy, can help us diagnose the disease accurately. Moreover, substantial progress has been made in the treatment of anterior shoulder instability. Open Bankart repair has become the golden standard for the treatment. With the advance of techniques, however, arthroscopic stabilization of anterior shoulder instability can now achieve good results comparable with those of open surgery.

Objective To evaluate the results of delayed proximal humeral fractures treated by open reduction and internal fixation. Methods From January 2005 to July 2008, 26 patients with delayed proximal humeral fractures were treated by open reduction and internal fixation. There were 11 males and 15 females. The patients ranged from sixteen to 22-81 years old, with an average age of 49.3 years. The interval from injury to operation ranged 22 to 510 days, with a mean of 88 months. There were two-part fractue in surgical neck in 12 cases, two part in lesser tubercles of in one case,two part in greater tubercles in seven cases, three part in greater tubercles in three cases, four part in 2 cases and the splitting fracture in the head of humerus in one ease.The range of motion, VAS for pain, ASES (American sboulder and elbow surgeon's form) score, Constant score, UCLA (University of California-Los Angels scoring system)score and SST(Sim-pie Shoulder Test) for function evaluation were all recorded. The results were evaluated according to sex,age, injury side, operation times and combined injury by ANOVA.The correlation analysis was performed between operative time and results. Results The average forward flexion was 137.3°±35.1°, average exter-nal rotation was 28.9°±24.1° and internal rotation was T_(10). The mean VAS score was 0.7±1.2, the mean Constant was 83.1±17.9, the mean UCLA was 28.9±6.0, the mean SST was 8.7. There were no difference re-gaming sex, age, injury side, operation time and combined injury, fracture type and complications groups. No correlation existed between operative time and results. Conclusion It is very hard to treat delayed proximal humeral fracture due to high complication and demanding experience. With appropriate surgical technique, satisfactory results can be expected by open reduction and internal fixation.

Objective To compare the results of locking intramedullar nail and Locking plate in treating proximal humerus fractures and discuss features of each instrument. Methods A total of 54 patients with fresh two-part surgical neck fracture of proximal humerus were divided into intramedullar nail fixation group(26 patients)and locking plate fixation group(128 patients).with no statistical difference upon age,gender and dominate hand involvement in two groups.At final follow-up,physical examination and X-ray films were used to evaluate fracture healing of shoulder ioint.In the meantime,VAS score,ASES score,Constant-Murley score,UCLA and SST questionnaire were used to evaluate the function of the shoulder in two groups. Results All fractures were healed basically within 8 weeks postoperative-ly.No infection or av&scular necrosis were fouml during follow-up.The incidence rate of complication in locking plate fixation group was higher than that in intramedullar nail fixation group.Both groups obtained satisfactory functional recovery of shoulder ioint.There was no statistieal difference in regard to active for-ward elevation,external rotation besides body,active height of internal rotation,Constant-Murley scores,and SST scores in both groups.The average ASES score and VAS score of locking plate fixation group was significantly better than those of intramedullar nail fixation group. Conclusions Both fixations can treat surgical neck fractures of proximal humerus well.Locking intramedullar nail causes less trauma to the patient while Locking plate has advantages in patients'final functional recovery.

Objective To study the best combination of respiratory parameters that can maintain good ventilation with a low airway pressure under general anesthesia and CO2 pneumoperitoneum (12 mm Hg) during laparoscopy, which is important for lung protections. Methods Basic respiratory parameters of anesthesia machine, respiratory frequency (f), tidal volume (VT), and respiration ratio (I∶E), were used as three factors A, B, and C. The there levels were set as f=15, 12, and 9 bpm; VT =8, 10, and 12 ml/kg body weight; and I∶E =1∶2.5, 1∶2.0, and 1∶1.5. L9(34) K=3 was adopted for repeated orthogonal experimental design. The effect of different combinations of respiratory parameters on peak inspiratory pressure (PIP), mean airway pressure (Pmean),and end-tidal carbon dioxide partial pressure (PETCO2), were analyzed statistically. Results During the laparoscopy, the vital signs of 27 patients were stable under general anesthesia with 9 combinations of the respiratory parameters, the SpO2 was maintained at 100%, and the PEEP was kept at 1 hPa. The effect of the three levels of VT (factor B) on PIP was not significant (P=0.074). While the effects of f (factor A) on PETCO2 and I∶E on Pmean were significantly different among the three levels (P=0.002 and P=0.017, respectively). Conclusion The best combination of three factors-levels respiratory parameters is not small tidal volume with fast frequency or large tidal volume with slow frequency, but is A2B2C2 (f=12 bpm, VT=10 ml/kg body weight, and I∶E=1∶2.0).

Objective To investigate and compare the biomechanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement model. Methods Eight pair (16) fresh-frozen shoulder cadavers were match-paired into 2 groups. Four-part fracture model was created in all cadavers. Standardized humeral head replacement procedure was carried out in all specimens, and anatomical and overlapping reconstruction of the greater tuberosity was applied to each group respectively. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion. A Binocular 3D Computer Vision metrical method was employed to measure the displacement of greater tuberosity relative to the humeral diaphysis. Results When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in anatomical reconstruction group was (1.81?1.75) mm,while the mean displacement was (3.23?2.91) mm in overlapping group. Statistical difference was found between the 2 groups. When the glenohumeral joint was elevated to 30? and 60? forward flexion, the mean displacement of greater tuberosity in anatomical group was (4.01?5.00) mm and (5.99?6.97) mm respectively, while the mean displacement was (3.02?5.27) mm and (6.97?7.00) mm respectively in overlapping group. No statistical difference was found between the 2 groups during forward flexion measurement. Conclusion In cadaveric humeral head replacement model, anatomic greater tuberosity reconstruction shows better mechanical stability compared with overlapping reconstruction during external rotation to neutral position. This result suggests that there may be some loss in mechanical stability in overlapping fixed greater tuberosity. Even though standardized postoperative rehabilitation protocol are strictly followed, evident displacement of the greater tuberosity was detected. Postpone of the postoperative rehabilitation program after humeral head replacement for a decent period of time may benefit tuberosity healing.

The shoulder is a complex joint which consists of sternoclavicular joint, clavicle, acromioclavicular joint, scapula, glenohumeral joint,proximal humerus and scapulothoracic joint. It is important for us to have a good knowledge of the normal biomechanics of the shoulder when we treat shoulder problems. So this article intends to help its readers to get familiar with the characteristics of functional anatomy, biomechanics and motion of the shoulder under physiological condition.

Objective To investigate the influence of nebulized Pulmieort respules inhalation after endoscopic sinus surgery (ESS)on the expression of epithelial Na~+ channel(ENaC)protein in nasal mucosa. Methods Forty-four patients with nasal polyps undergoing ESS were randomly divided into Pulmieort respules treatment group(n=21,nebulized Pulmieort respules inhalation for 10 d after ESS)and Rhinocort control group(n=23,Rhinoeort aqueous nasal spray for 10 d after ESS).All the patients were performed biopsy of membrane on the residual middle turbinate 14 d after ESS,eosinophils (Eos)and neutrophils(Neu)per hundred inflammation cells were counted under microscope during ESS and after ESS,and the expression of ENaC protein was detected by immunofluorescence assay. Results The percentages of Eos and Neu decreased in two groups after treatment,and the percentage of Neu in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.05).The expression of ENaC protein after treatment in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.01). Conclusion Application of pulmieort respules after ESS can decrease Neu infiltration and inhibit expression of ENaC protein,which can relieve acute inflammation and edema of nasal mucosa.

OBJECTIVE:To observe the clinical efficacy and safety of Shenfu injection combined with Danshen chuanxiongqin injection in the treatment of chronic pulmonary heart disease patients with heart failure. METHODS:Totally 100 chronic pulmonary heart disease patients with heart failure were randomly divided into observation group and control group. Patients in control group were given routine treatment,including antispasmodic asthma,low-flow oxygen therapy,anti-inflammatory,diuretic strong heart, maintaining the body water,electrolyte balance,vasoactive drugs and dopamine,etc. Patients in observation group were given Shenfu injection 50 ml and Danshen chuanxiongqin injection 10 ml adding into 5% glucose injection 250 ml based on the treatment of control group,iv,once a day. The course of both was 14 d. The clinical data was observed,including clinical efficacy,improve-ment time of signs and symptoms,p(O2),p(CO2),SV,LVEF,LVEDD,LVSD and the incidence of adverse reactions before and after treatment. RESULTS:The total effective rate in observation group was significantly higher than control group,the remission time of cyanosis,slowing time of heart rate and subsided time of swelling were significantly shorter than control group,with signif-icant differences(P<0.05). After treatment,the p(O2),p(CO2),SV,LVEF,LVEDD and LVSD in 2 groups were significantly bet-ter than before,and observation group was better than control group,with significant differences(P<0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Based on the treatment,Shenfu injection combined with Danshen chuanxion-gqin injection has better clinical efficacy than routine treatment in the treatment of chronic pulmonary heart disease patients with heart failure,with similar safety.

Objective To investigate the clinical efficacy of electroacupuncture in treating mild and moderate female stress incontinence.Methods One hundred and eighty female patients with mild or moderate stress incontinence were randomly allocated to treatment and control groups, 90 cases each. The treatment group received electroacupuncture and the control group took midodrine hydrochloride tablets. The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) score was recorded and 1-hour pad test leakage was measured in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Results There were statistically significant pre-/post-treatment differences in the ICIQ-UI SF score and pad test leakage in both groups (P<0.01). There were statistically significant post-treatment differences in the ICIQ-UI SF score and pad test leakage between the treatment and control groups (P<0.01). The total efficacy rate was 86.7% in the treatment group and 68.9% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusions Electroacupuncture is an effective way to treat mild and moderate female stress incontinence. It can improve urinary continence and reduce urine leakage in the patients.

Objective:To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures.Methods:From January 2013 to December 2014,8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were ret-rospectively reviewed after the final follow-up.There were 1 man and 7 women with a mean age of (58.5 ±6.4)years,of whom 3 left shoulders and 5 right shoulders were involved.There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures,and 6 patients with hu-meral head necrosis as well as implant-associated infection after open reduction internal fixation for proxi-mal humeral fractures with the locking plate.The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery.At the first-stage surgery,all the patients underwent a thorough debridement,and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate.During the second-stage surgery,the cement spacer was removed,and then a revision shoulder arthroplasty with the reverse shoul-der prosthesis was performed in all the patients who were routinely followed up after the second-stage sur-gery.The visual analogue score (VAS ),Constant score and University of California Los Angeles (UCLA)score were employed to evaluate the postoperative shoulder function.Results:The mean follow-up time was (19.9 ±8.0)months (range 12 to 35 months).At the end of the follow-up,the median forward elevation [100°(60°,140°)vs.25°(0°,90°),P=0.011],the median external rotation [15°(0°,50°)vs.5°(0°,20°),P=0.048],and the median internal rotation [L4 (buttock,T12) vs.buttock (buttock,L3 ),P =0.041 ]were all significantly improved postoperatively.The median Constant score [53.5 (32,74)vs.29.0 (10,57),P=0.012],the median UCLA score [20.5 (9, 26)vs.9.5 (5,15),P=0.012],and the median VAS score [1.5 (0,5)vs.5.0 (0,8),P=0.018]were all significantly improved after the surgery.No recurrence of infection,prosthetic loosening or neurovascular injury was noted by the last follow-up.Conclusion:Two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures.The shoulder function was postoperatively improved to a certain degree.