RESUMEN
INTRODUCTION: arthroscopic surgical treatment of rotator cuff tendon injuries has replaced open surgery as the first treatment option. Different surgical techniques have been described for massive or irreparable ruptures, and recently, a new device that consists of a biodegradable subacromial spacer between the humeral head and the acromion has been used. The present study aims to analyse the results of this implant in our experience. MATERIAL AND METHODS: we conducted an observational and retrospective study of all patients undergoing subacromial spacer implantation at our centre from 2017 to 2019. Patients were assessed pre- and postoperatively using the Constant, DASH and VAS scales. RESULTS: a total of 43 patients met the inclusion criteria and the minimum follow-up of 24 months. The mean DASH scale score went from 53.6 at preoperative assessment to 27.9 at postoperative assessment (p = 0.026). There was also a significant improvement in the Constant scale from a mean of 37.9 to 61.8 (p = 0.037). In terms of pain assessment, the mean VAS went from a mean of 7.44 to 3.38 (p = 0.916). In 90% of patients no complications or need for further interventions were objectified. CONCLUSIONS: the subacromial balloon has shown favorable results in our series of patients, so it could be a valid treatment option in patients with non-repairable rotator cuff tears.
INTRODUCCIÓN: el tratamiento mediante cirugía artroscópica de las lesiones del manguito rotador ha desplazado a la cirugía abierta como primera opción de tratamiento. Existen diferentes técnicas quirúrgicas descritas para tratar las roturas masivas o no reparables. Desde hace unos años se viene utilizando un nuevo dispositivo que consiste en un balón subacromial biodegradable que actúa como espaciador entre la cabeza humeral y el acromion. Este trabajo pretende analizar los resultados de este implante. MATERIAL Y MÉTODOS: realizamos un estudio observacional y retrospectivo de todos los pacientes a los que se les implantó un balón subacromial en nuestro centro entre 2017 y 2019. Se evaluó a los pacientes pre y postoperatoriamente mediante las escalas de Constant, DASH y EVA. RESULTADOS: un total de 43 pacientes cumplieron los criterios de inclusión y el seguimiento mínimo de 24 meses. La puntuación media de la escala DASH pasó de 53.6 en la evaluación preoperatoria a 27.9 en la postoperatoria (p = 0.026). También se obtuvo una mejoría significativa en la escala de Constant, que pasó de una media de 37.9 a 61.8 (p = 0.037). En cuanto a la evaluación del dolor, la EVA media pasó de 7.44 a 3.38 (p = 0.916). En 90% de los pacientes no se objetivaron complicaciones ni necesidad de nuevas intervenciones. CONCLUSIONES: el balón subacromial ha mostrado resultados favorables en nuestra serie de pacientes, por lo que podría suponer una opción válida de tratamiento en pacientes con roturas no reparables del manguito rotador.
Asunto(s)
Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Manguito de los Rotadores/cirugía , Estudios Retrospectivos , Artroscopía , Rotura/cirugía , Resultado del Tratamiento , Rango del Movimiento ArticularRESUMEN
O efeito metabólico do contraceptivo mensal injetável contendo acetofenido de dihidroxiprogesterona (DHPA) 150 mg + enantato de estradiol (Een) 10 mg foi comparado ao de outros métodos anticoncepcionais comumente utilizados (pílulas contendo: etinilestradiol (EEn) 0,050 mg + levonogestrel (LNG) 0,250 mg, EE 0,030 + LNG 0,150 mg; e EE 0,030/0,040/0,030mmg + LNG 0,050/0,075/0,0125 mg; enantato de noretisterona (NEE) 200 mg via i.m.; e métodos nao-hormonais. Foram determinados os triglicerídeos séricos, colesterol HDL/LDL, cobre, ceruloplasmina, cortisol total e livre, CBG e testosterona total e livre e SHBG de usu rios crônicas. Este estudo contou com a participaçäo do total de 237 mulheres. As usuárias de métodos nao-hormonais utilizadas como controle apresentaram níveis mais altos de triglicerídeos. Os níveis de testosterona total e livre foram mais baixos em mulheres que utilizavam DHPA 150 mg + Een 10 mg e nas que tomavam pílulas anticoncepcionais (p<0,05 - 0,01). Tais alteraçöes foram levemente menores no grupo que utilizou o injetável. Os efeitos do DHPA 150 mg + EEn 10 mg sobre o colesterol HDL/LDL, cobre, ceruloplasmina, CBG, cortisol total e livre e SHBG foram raros ou inexistentes. Entretanto, com as pílulas anticoncepcionais (mesmo as de formulaçäo de baixa dosagem) ocorreram alteraçöes em todas essas vari eis, que foram altamente significativas na comparaçäo com o método injetável (p< 0,01) e com os métodos nao-hormonais (p<0,01); näo houve diferenças entre estes dois últimos métodos. Os resultados sugerem que o efeito metabólico da injeçäo mensal i.m. de DHPA 150 mg + Een 10 mg näo é superior aos dos anticoncepcionais orais comumente utilizados. Estes resultados também nao sugerem que a dose contida nesse injetável seja excessiva. Nao há qualquer evidência de que ele produza efeito cumulativo no organismo. Esses achados devem ser levados em consideraçäo com relaçäo à segurança do uso a longo prazo desse injetável.
Asunto(s)
Humanos , Femenino , Algestona/metabolismo , Anticonceptivos Femeninos/metabolismo , Estradiol/metabolismo , Heptanoatos/metabolismo , Ceruloplasmina/análisis , Colesterol/sangre , Anticonceptivos Orales/metabolismo , Cobre/sangre , Hidrocortisona/sangre , Inyecciones , Globulina de Unión a Hormona Sexual/análisis , Testosterona/sangre , Transcortina/análisis , Triglicéridos/sangreRESUMEN
The metabolic effect of the monthly injectable contraceptive containing dihydroxyprogesterone acetophenide (DHPA) 150 mg + estradiol enanthate (EEn) 10 mg was compared to that of other regularly used contraceptive methods (pills containing: ethinylestradiol (EE) 0.050 mg + levonorgestrel (LNG) 0.250 mg, EE 0.030 mg + LNG 0.150 mg; EE 0.030/0.040/0.030 mg + LNG 0.050/0.075/0.0125 mg; norethisterone enanthate (NEE) 200 mg i.m.; non-hormonal methods). Serum triglycerides, HDL/LDL-cholesterol, copper, ceruloplasmin, total and free cortisol, CBG, total and free testosterone and SHBG in chronic users were determined. A total of 237 women took part in this study. Taking users of non-hormonal methods as control, triglyceride levels were higher, and total and free testosterone levels were lower in women using DHPA 150 mg + EEn 10 mg and in those taking contraceptive pills (p less than 0.05 - 0.01). Such modifications were slightly less in the group using the injectable. The effects of DHPA 150 mg + EEn 10 mg on HDL/LDL-cholesterol copper, ceruloplasmin, CBG, total and free cortisol and SHBG were rare or non-existent. Nevertheless, the contraceptive pills (even the low-dose formulations) correlate with modifications of all those variables, which were highly significant in comparison with the injectable (p less than 0.01) and with non-hormonal methods (p less than 0.01); there were no differences between the last two methods. The results suggest that the metabolic effect of DHPA 150 mg + EEn 10 mg is not higher than that of the commonly used oral contraceptives. On the other hand, they do not suggest that the dose contained in this injectable is exaggerated. There is no evidence that it produces accumulation of effects in the organism. These findings should be taken into account when referring to the long-term safety of this injectable.