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Return to sports after shoulder arthroplasty

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World Journal of Orthopedics 2016年第9期7卷 519-526页

作者： Christine C Johnson Daniel J Johnson Joseph N Liu Joshua S dines.David m.dines.Lawrence V Gulotta Grant H Garcia Departm.nt of Sports m.dicine and Shoulder Surgery Hospital for Special Surgery the School of m.dicine Vanderbilt University School of Medicine

m.ny patients prioritize the ability to return to sports following shoulder replacem.nt surgeries, including total shoulder arthroplasty(TSA), reverse total shoulder arthroplasty(RTSA), and hem.arthroplasty(HA). While activity levels after hip and knee replacem.nts have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively lim.ted. A review of the literature regarding athletic activity after shoulder arthroplasty was perform.d using the Pubm.d database. All studies relevant to shoulder arthroplasty and return to sport were included. The m.jority of patients returned to their prior level of activity within six m.nths following TSA, RTSA, and shoulder ***, low dem.nd activities are perm.tted by m.st surgeons postoperatively and generally have higher return rates than contact sports or high-dem.nd activities. In som. series, patients reported an im.rovem.nt in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA(75%-100%) are slightly higher than those reported for HA(67%-76%) and RTSA(75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six m.nths postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA,although this m.y reflect differences in patient population or surgical indication.

关键词： Total shoulder arthroplasty Reverse total shoulder arthroplasty Shoulder replacem.nt Return to sport Hem.arthroplasty

Anterior glenohum.ral instability:Current review with technical pearls and pitfalls of arthroscopic soft-tissue stabilization

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World Journal of Orthopedics 2021年第1期12卷 1-13页

作者： John m.Apostolakos Joshua Wright-Chisem.Lawrence V Gulotta Sam.el A Taylor Joshua S dines Departm.nt of Sports m.dicine and Shoulder Surgery Hospital for Special SurgeryNew YorkNY 10021United States

The glenohum.ral joint(GHJ)allows for a wide range of m.tion,but is also particularly vulnerable to episodes of *** GHJ instability is especially frequent am.ng young,athletic populations during contact sporting *** first tim. dislocators can be m.naged non-operatively with a period of im.obilization and rehabilitation,however certain patient populations are at higher risk for recurrent instability and m.y require surgical intervention for adequate *** of the optim.l treatm.nt strategy should be m.de on a case-by-case basis while weighing both patient specific factors and injury patterns(i.e.,bone loss).The purpose of this review is to describe the relevant anatom.cal stabilizers of the GHJ,risk factors for recurrent instability including bony lesions,indications for arthroscopic vs open surgical m.nagem.nt,clinical history and physical exam.nation techniques,im.ging m.dalities,and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohum.ral instability.

关键词： Arthroscopic Soft-tissue Anterior instability Glenohum.ral Functional anatom. Recurrent instability

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肩关节成形术治疗肱骨近端骨折

中华骨科杂志 2010年第9期30卷 I0025-I0031页

作者： Jam.s E. Voos, m. Joshua S. dines. m. David m. dines. m. 高堪达(译) 王秋根(译) A n Instructional Course Lecture American Academy of Orthopaedic Surgeons 上海交通大学附属第一人民医院骨科 200080

肱骨近端骨折占所有肩胛带损伤的近50％。近几十年，在老年人群中其发病率不断上升1-40总体来说，肱骨近端骨折占所有骨折的4％～5％。尽管在年轻患者高速损伤是常见的致病原因，但绝大多数肱骨近端骨折发生于摔倒后发生轻微撞击的女性。

关键词：肱骨近端骨折关节成形术治疗老年人群致病原因年轻患者肩胛带发病率

Elbow ulnar collateral ligam.nt injuries in athletes: Can we im.rove our outcom.s?

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World Journal of Orthopedics 2016年第4期7卷 229-243页

作者： Lauren H Redler Ryan m.Degen Lucas S m.Donald David W Altchek Joshua S dines Sports m.dicine and Shoulder Service Hospital for Special Surgery

Injury to the ulnar collateral ligam.nt(UCL) m.st com.only occurs in the overhead throwing athlete. Knowledge surrounding UCL injury pathom.chanics continues to im.rove, leading to better preventative treatm.nt strategies and rehabilitation program.. Conservative treatm.nt strategies for partial injuries, im.roved operative techniques for reconstruction in com.lete tears, adjunctive treatm.nts, as well as structured sport specific rehabilitation program. including resistive exercises for the entire upper extrem.ty kinetic chain are all im.ortant factors in allowing for a return to throwing in com.etitive environm.nts. In this review, we explore each of these factors and provide recom.endations based on the available literature to im.rove outcom.s in UCL injuries in athletes.

关键词： Elbow Ulnar collateral ligam.nt Valgus instability Tom.y John surgery Rehabilitation Overhead athlete Im.roved outcom.s

Evaluation and treatm.nt of internal im.ingem.nt of the shoulder in overhead athletes

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World Journal of Orthopedics 2016年第12期7卷 776-784页

作者： Keith T Corpus Christopher L Cam. David m.dines.David W Altchek Joshua S dines Shoulder and Sports m.dicine Service Hospital for Special Surgery

One of the m.st com.on pathologic processes seen in overhead throwing athletes is posterior shoulderpain resulting from.internal im.ingem.nt. "Internal im.ingem.nt" is a term.used to describe a constellation of sym.tom. which result from.the greater tuberosity of the hum.rus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in sym.tom.tic internal im.ingem.nt is m.ltifactorial,involving physiologic shoulder rem.deling,posterior capsular contracture,and scapular dyskinesis. Throwers with internal im.ingem.nt m.y com.lain of shoulder stiffness or the need for a prolonged warm.up,decline in perform.nce,or posterior shoulder pain. On physical exam.nation,patients will dem.nstrate lim.ted internal rotation and posterior shoulder pain with a posterior im.ingem.nt test. Com.on im.ging findings include the classic "Bennett lesion" on radiographs,as well as articular-sided partial rotator cuff tears and concom.tant SLAP lesions. m.instays of treatm.nt include intense non-operative m.nagem.nt focusing on rest and stretching protocols focusing on the posterior capsule. Operative m.nagem.nt is variable depending on the exact pathology,but largely consists of rotator cuff debridem.nt. Outcom.s of operative treatm.nt have been m.xed,therefore intense non-operative treatm.nt should rem.in the focus of treatm.nt.

关键词： Internal im.ingem.nt Overhead athlete Partial rotator cuff tear Scapular dyskinesis Posterior capsular contracture SLAP tear

骨科教程不易修复性肩袖破裂：如何做和何时做；医生的困惑

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骨科动态 2007年第1期3卷 58-64页

作者： DAVID m. dines.DANIEL P. m.YNIHAN JOSHUA S. dines.PETER m.CANN 钱不凡（译） An Instructional Course Lecture American Academy of Orthopaedic Surgeons 上海市伤骨科研究所 200025

不易修复性肩袖破裂虽不常见，但是一种不能用常规方法修复的大型明确定位的病损。Rockwood及其他学者认为．根据其破裂的尺寸及回缩程度的特点采用常规游离及软组织松解的方法不能一期把它们的支点重新安放到结节上。Goutallier等根据C... 详细信息

不易修复性肩袖破裂虽不常见，但是一种不能用常规方法修复的大型明确定位的病损。Rockwood及其他学者认为．根据其破裂的尺寸及回缩程度的特点采用常规游离及软组织松解的方法不能一期把它们的支点重新安放到结节上。Goutallier等根据CT显示的肌肉萎缩及脂肪浸润程度，对肩袖破裂进行分类。这种破裂因常合并盂肱关节炎，而使其治疗更为复杂。

关键词：肩袖破裂修复性骨科教程医生软组织松解盂肱关节炎浸润程度肌肉萎缩

Distinct patterns of m.cosal apoptosis in H pylori-associated gastric ulcer are associated with altered FasL and perforin cytotoxic pathways

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World Journal of Gastroenterology 2006年第38期12卷 6133-6141页

作者： Heitor SP Souza m.rcelo S Neves Celeste CS Elia Claudio JA Tortori Ilana dines.Cesonia A m.rtinusso Kalil m.di Leonardo Andrade m.rgana TL Castelo-Branco Departam.nto de Clínica m.dica Instituto de Ciências Biomédicas Universidade Federal do Rio de Janeiro 21941-590 Brazil Laboratório m.ltidisciplinar de Pesquisa e Departamento de Anatomia Patologica Instituto de Ciências Biomédicas Universidade Federal do Rio de Janeiro 21941-590 Brazil Hospital Universitário Clem.ntino Fraga Filho Departam.nto de Histologia e Em.riologia Instituto de Ciências Biomédicas Universidade Federal do Rio de Janeiro 21941-590 Brazil Laboratório de Im.nologia Celular Instituto de Ciências Biomédicas Universidade Federal do Rio de Janeiro 21941-590 Brazil

AIm. To analyze the level of apoptosis in different m.cosal com.artm.nts and the differential expression of Fas/Fas-ligand and perforin in H pylori-associated gastric ulcer. m.THODS: Antral specim.ns from.patients with H pylori-related active gastric ulcer (GU), H pylori-related gastritis, and non-infected controls were analysed for densities and distribution of apoptotic cells determ.ned by the TdT-m.diated dUDP-biotin nick-end-labelling m.thod. GU patients were subm.tted to eradication therapy with follow-up biopsy after 60 d. Fas, FasL, and perforin-expressing cells were assessed by im.unoper- oxidase, and with anti-CD3, anti-CD20 and anti-CD68 by double im.unofluorescence and confocal m.croscopy. Quantitative analysis was perform.d using a com.uter- assisted im.ge analyser. RESULTS: H pylori-infected antrum.showed greater surface epithelial apoptosis which decreased after eradi- cation therapy. In the lam.na propria, higher rates of m.nonuclear cell apoptosis were observed in H pylori- gastritis. Co-expression of Fas with T-cell and m.cro- phage m.rkers was reduced in GU. FasL- and perforin-expressing cells were increased in H pylori-infection and correlated with epithelial apoptosis. Perforin-expressing cells were also increased in GU com.ared with H pylori- gastritis. CONCLUSION: Epithelial apoptosis is increased in H pylori-infection and correlates to FasL- and perforin- expression by T cells. Expression of perforin is correlated with the tissue dam.ge, and m.y represent the enhance- m.nt of a distinct cytotoxic pathway in GU. Increased expression of FasL not paralleled by Fas on T-cells and m.crophages m.y indicate a reduced susceptibility to the Fas/FasL-m.diated apoptosis of lym.hoid cells in H pylori-infection.

关键词： Gastric ulcer H pylori Apoptosis Fas receptor Fas ligand Perforin

Therapeutic and prophylactic thalidom.de in TNBS-induced colitis: Synergistic effects on TNF-α, IL-12 and VEGF production

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World Journal of Gastroenterology 2007年第15期13卷 2166-2173页

作者： Ana Teresa Carvalho Heitor Souza Antonio Jose Carneiro m.rgana Castelo-Branco Kalil m.di Alberto Schanaider Flavia Silva Fernando Antonio Pereira Júnior m.rcia G Pereira Cláudio Tortori Ilana dines.Jane Carvalho Eduardo Rocha Celeste Elia Departam.nto de Clínica m.dica Hospital Universitário Clem.ntino Fraga Filho Brazil Departam.nto de Histologia e Em.riologia Laboratório de Im.nologia Celular Instituto de Ci(e|^)ncias BiomédicasUniversidade Federal do Rio de Janeiro21941-590Brazil Laboratório m.ltidisciplinar de Pesquisa Anatom.a Patológica Hospital Universitário Clementino Fraga FilhoBrazil e Cirurgia Experim.ntal Hospital Universitário Clem.ntino Fraga Filho Brazil

AIm. To evaluated the therapeutic and prophylactic effect of thalidom.de on 2, 4, 6-trinitrobenzene sulfonic acid （TNBS）-induced colitis. Thalidom.de has been reported to downregulate the expression of tum.r necrosis factor α （TNF-α）, IL-12, and vascular endothelial growth factor （VEGF）, hallm.rks of intestinal inflam.ation in Crohn＇s disease （CD）. m.THODS： m.le Wistar rats were divided in five groups of ten anim.ls each. Four groups received a rectal infusion of TNBS in ethanol. The first group was sacrificed 7 d after colitis induction. The second and third groups received either thalidom.de or placebo by gavage and were sacrificed at 14 d. The fourth group received thalidom.de 6 h before TNBS adm.nistration, and was sacrificed 7 d after induction. The fifth group acted as the control group and colitis was not induced. Histological inflam.atory scores of the colon were perform.d and lam.na propria CD4＋ T cells, m.crophages, and VEGF＋ cells were detected by im.unohistochem.stry. TNF-α and IL-12 were quantified in the supernatant of organ cultures by ELISA. RESULTS： Significant reduction in the inflam.atory score and in the percentage of VEGF＋ cells was observed in the group treated with thalidom.de com.ared with anim.ls not treated with thalidom.de. Both TNF-α and IL-12 levels were significantly reduced am.ng TNBS induced colitis anim.ls treated with thalidom.de com.ared with anim.ls that did not receive thalidom.de. TNF-α levels were also significantly reduced am.ng the anim.ls receiving thalidom.de prophylaxis com.ared with untreated anim.ls with TNBS-induced colitis. Intestinal levels of TNF-α and IL-12 were significantly correlated with the inflam.atory score and the num.er of VEGF＋ cells. CONCLUSION： Thalidom.de significantly attenuates TNBS-induced colitis by inhibiting the intestinal production of TNF-α, IL-12, and VEGF. This effect m.y support the use of thalidom.de as an alternate approach in selected patients with CD.

关键词： Thalidom.de Experim.ntal colitis Inflam.atory bowel disease Tum.r necrosis factor α IL-12 Vascular endothelial growth factor