Philipp Moroder, Marvin Minkus, Elisabeth Böhm, Victor Danzinger, Christian Gerhardt, Markus Scheibel
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引用次数: 21
摘要
背景:功能性肩关节不稳定(极性III型)是由肩袖和肩胛骨周围肌肉活动不足引起的，导致肩关节运动时半脱位或脱位。虽然手术治疗没有效果，但会加重疼痛，并经常进一步削弱功能，保守治疗也往往无效。目的:目的是研究“肩部起搏器”装置的有效性，该装置在肩部运动时刺激功能不稳定的患者活动不足的肌肉，以重建肩关节稳定性。患者和方法:本试点项目纳入3例因治疗失败导致疼痛、情绪紧张以及日常活动和运动参与受限的功能性肩部不稳定患者。该装置用于刺激肩部外旋器和肩胛骨牵开器。当设备打开和关闭时，比较疼痛水平、主观肩部不稳定性、活动范围、可见异常肌肉激活和脱位迹象。结果:当连接设备但关闭设备时，未观察到任何变化。当设备打开时，所有患者都能自由移动手臂，没有疼痛、不适或主观或客观的不稳定迹象。所有患者都认为这是一次很好的体验，并自愿使用该设备进行进一步的训练。无并发症发生。结论:应用肩起搏器电刺激功能低下的肩袖和肩胛周围肌，可成功地在应用期间重建功能性肩关节不稳定患者的稳定性。在线视频:本文的在线版本(doi: 10.1007/s11678-017-0399-z)包含视频:“肩部起搏器:病理性肌肉激活模式治疗功能性肩部不稳定”。视频由P. Moroder, M. Minkus, E. Böhm, V. Danzinger, C. Gerhardt和M. Scheibel提供，慈善机构Universitätsmedizin 2017，版权所有。
Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.
Background: Functional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffective as well.
Objectives: The aim was to investigate the effectiveness of a "shoulder pacemaker" device that stimulates underactive muscles in patients with functional instability during shoulder movement in order to re-establish glenohumeral stability.
Patients and methods: Three patients with unsuccessfully treated functional shoulder instability causing pain, emotional stress, as well as limitations during daily activities and sports participation were enrolled in this pilot project. The device was used to stimulate the external rotators of the shoulder and retractors of the scapula. Pain level, subjective shoulder instability, range of motion, visible aberrant muscle activation, and signs of dislocation were compared when the device was switched on and off.
Results: No changes were observed when the device was attached but switched off. When the device was switched on, all patients were able to move their arms freely without pain, discomfort, or subjective or objective signs of instability. All patients rated this as an excellent experience and volunteered to train further with the device. No complications were observed.
Conclusion: The electric stimulation of hypoactive rotator cuff and periscapular muscles by means of the shoulder pacemaker successfully re-establishes stability in patients with functional shoulder instability during the time of application.
Video online: The online version of this article (doi: 10.1007/s11678-017-0399-z) contains the video: "The Shoulder-Pacemaker: treatment of functional shoulder instability with pathological muscle activation pattern". Video by courtesy of P. Moroder, M. Minkus, E. Böhm, V. Danzinger, C. Gerhardt and M. Scheibel, Charité Universitätsmedizin Berlin 2017, all rights reserved.
期刊介绍：
Zielsetzung der Zeitschrift
Die Zeitschrift Obere Extremität widmet sich der Versorgung von Verletzungen, Verletzungsfolgen und Erkrankungen im Bereich des Schulter- und des Ellenbogengelenks.
Frei eingereichte Originalien präsentieren Forschungsergebnisse aktueller Studien im Bereich der Schulter- und Ellenbogenchirurgie und fördern den wissenschaftlichen Austausch. Vielversprechende Studien, die derzeit durchgeführt werden, sind ebenso willkommen, wie Langzeitstudien, die bewährte Verfahren auf den Prüfstand stellen. Fallberichte beleuchten seltene Indikationen und schildern ungewöhnliche Behandlungsverläufe.
Umfassende Übersichtsarbeiten zu einem aktuellen Schwerpunktthema sind das Kernstück jeder Ausgabe. Im Mittelpunkt steht gesichertes Wissen mit hoher Relevanz für die tägliche Arbeit in der Schulter- und Ellenbogenchirurgie. Zusätzlich wird in speziellen Rubriken über innovative Behandlungsmaßnahmen, Probleme in der Begutachtung, berufspolitische Entwicklungen und Kongressaktivitäten berichtet.
Als gemeinsames Kommunikations- und Weiterbildungsforum für alle Chirurg*innen und Orthopäd*innen mit entsprechender Spezialisierung ist die Zeitschrift Obere Extremität zukunftsorientiert und schließt eine wichtige Lücke im orthopädisch-unfallchirurgischen Informationsangebot.
Aims & scope
The journal Obere Extremität (Upper Extremity) is dedicated to the treatment of injuries, consequences of injuries and diseases in the area of the shoulder and elbow joint.
Freely submitted originals present research results of current studies in the field of shoulder and elbow surgery and promote scientific exchange. Promising studies that are currently being carried out are welcome, as are long-term studies that put proven procedures to the test. Case reports illuminate rare indications and describe unusual courses of treatment.
Comprehensive reviews on a current focus topic are the core of each issue. The focus is on secured knowledge with high relevance for the daily work in shoulder and elbow surgery. In addition, special sections report on innovative treatment measures, problems in assessment, professional policy developments and congress activities.
As a joint communication and further education forum for all surgeons and orthopaedic surgeons with appropriate specialisation, the journal Obere Extremität is future-oriented and closes an important gap in the orthopaedic trauma surgery information offer.
Begutachtung / Peer Review
Alle Beiträge, die bei der Zeitschrift Obere Extremität eingereicht werden (einschließlich der eingeladenen Manuskripte) durchlaufen ein Doppelblind-Peer-Review-Verfahren, an dem mindestens zwei unabhängige Experten beteiligt sind.---
All manuscripts submitted to the journal Obere Extremität (including invited manuscripts) undergo a double-blind peer review process involving at least two independent experts.
Ethische Richtlinien / Best Practice Guidelines and Publication Ethics
Die Zeitschrift Obere Extremität folgt den Richtlinien des Komitees für Publikationsethik (COPE). Autoren wird empfohlen, klinische Studien, die sie zur Veröffentlichung in Betracht ziehen, vor der Veröffentlichung in kostenlosen, öffentlichen Registern für klinische Studien (z.B. www.clinicaltrials.gov, http://clinicaltrials.ifpma.org, http://isrctn.org, www.germanctr.de/online-Register_de.html) zu registrieren. Die Register sind nach den Richtlinien des International Committee of Medical Journal Editors (ICMJE) zu genehmigen. Die Autor*innen sollten am Ende ihres Abstracts den Namen des Studienregisters und ihre Registriernummer für klinische Studien angeben.
The journal Obere Extremität (Upper Extremity) follows the Committee of Publications Ethics (COPE) - Guidelines. Authors are recommended to register clinical trials they consider for publication in free, public clinical trial registries (e.g., www.clinicaltrials.gov, http://clinicaltrials.ifpma.org, http://isrctn.org, www.germanctr.de/online-Register_de.html) before publication. The registries are to be approved by the guidelines of the International Committee of Medical Journal Editors (ICMJE). Authors should include the name of the trial register and their clinical trial registration number at the end of their abstract.
Deklaration von Helsinki / Declaration of Helsinki
Alle zur Veröffentlichung eingereichten Manuskripte, die Ergebnisse von Studien an Proband*innen oder Patient*innen präsentieren, müssen gemäß den Autorenrichtlinien für Originalarbeiten der Deklaration von Helsinki entsprechen.
All Manuscripts submitted for publication presenting results from studies on probands or patients must comply with the Declaration of Helsinki according to the author guidelines for original papers.
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