肩關節(jié)鏡臨床應用解析課件

1、肩關節(jié)鏡臨床應用解析肩關節(jié)鏡臨床應用解析肩關節(jié)鏡臨床應用解析肩關節(jié)鏡臨床應用解析肩關節(jié)鏡臨床應用解析肩關節(jié)鏡臨床應用解析鏡下喙鎖韌帶重建治療肩鎖關節(jié)脫位帶袢紐扣鋼板內固定同種異體/自體肌腱重建同種異體/自體肌腱重建+鎖骨鉤鋼板/縫合錨2021/1/122鏡下喙鎖韌帶重建治療肩鎖關節(jié)脫位帶袢紐扣鋼板內固定2021/喙鎖韌帶重建治療肩鎖關節(jié)脫位“關節(jié)鏡下喙鎖韌帶增強術治療肩鎖關節(jié)脫位”皇甫小橋 趙金忠，中華肩肘外科電子雜志 20 1 3 年 1 1 月第 1 卷第 1 期2021/1/123喙鎖韌帶重建治療肩鎖關節(jié)脫位“關節(jié)鏡下喙鎖韌帶增強術治療肩鎖肩峰撞擊癥肩峰成形術+射頻消融技術將頻消融刀頭刺

2、入肌腱問進行燒灼以刺激肌腱愈合。利用等離子介導的射頻消融原理，在燒灼組織時，射頻的能量在介質中激活電解質，離子液中被賦予能量的粒了足以切斷分子間的關聯(lián)，在相對較低的溫度(標準為4070)切斷或溶解軟組織低劑量的射頻消融技術可在肌腱內促進血管生成因子的生長，對于肌腱愈合起到重要的作用，因此射頻消融在理論上能夠促進損傷肌腱的修復。Medlock VB，Amid DHarwood FEt alAngiogenie response to bipolar radiofrequeney treatment of normal rabbit achilles tendonProceeding at the

3、 International Sceiety of Arthroscopy,Knee Surgery and Orthopaedic Sports Medicine CongressAuckland，New Zealand，March 1014，20032021/1/124肩峰撞擊癥肩峰成形術+射頻消融技術低劑量的射頻消融技術可在肌關節(jié)鏡下微創(chuàng)治療良性骨腫瘤關節(jié)鏡下治療良性骨腫瘤時先采用C型透視定位克氏針鉆入病灶，然后用空心鉆沿克氏擴大通道，經(jīng)C臂透視確定到達病灶無誤后插入關節(jié)鏡，直接觀察病灶內情況，可取少量病變組織作病檢，在關節(jié)鏡直視下刮除腫瘤，用磨鉆清理病灶關節(jié)鏡檢查病變刮除是否徹底，用等

4、離子刀燒灼病灶。若空腔較大，則取自體或異體骨植骨2021/1/125關節(jié)鏡下微創(chuàng)治療良性骨腫瘤關節(jié)鏡下治療良性骨腫瘤時先采用C型鏡下縫合技術的改進2021/1/126鏡下縫合技術的改進2021/1/126巨大肩袖損傷的治療將肱二頭肌長頭腱與損傷肩袖的前緣一起固定于大結節(jié)的肩袖止點部位優(yōu)點：大大加強肩袖修補的固定強度，又可以在腱骨交界處形成一個相對更為廣泛的愈合面積，更有利于肩袖組織的愈合邊對邊的縫合方法將撕裂肩袖的兩端靠攏對合，縮小缺損，然后將殘余肌腱用錨釘固定于肱骨頭優(yōu)點：巨大回縮型肩袖撕裂，松解肌腱仍無法將其拉至大結節(jié)，或者張力過大，該方法使肩袖能在盂肱關節(jié)的橫斷面和冠狀面上保持力偶平衡，

5、撕裂的肩袖仍能提供完好的功能2021/1/127巨大肩袖損傷的治療將肱二頭肌長頭腱與損傷肩袖的前緣一起固定于肩關節(jié)前方不穩(wěn)定鏡下測量2021/1/128肩關節(jié)前方不穩(wěn)定鏡下測量2021/1/128鏡下治療骨性Bankart lesion2021/1/129鏡下治療骨性Bankart lesion2021/1/129Bankart lesion的雙排固定(A) The Cassiopeia (“W”)divergent technique uses an asymmetric number of anchors (1 more laterally than medially), and the

6、suture limbs diverge from a single point in the capsule to 2 different anchors in the lateral row. B) The convergent (“M”) technique uses a symmetric number of anchors medially and laterally, and the suture limbs converge to a single medial row anchor, through 2 different points in the capsule, and

7、converge to a single lateral-row anchor. By use of a 1:1 anchor configuration, suture management and tensioning are more predictable and straightforward.Cathal J. Moran，Arthroscopic Double-Row Anterior Stabilization and Bankart Repair for the“High-Risk”Athlete. Arthroscopy Techniques, Vol 3, No 1 (F

8、ebruary), 2014: pp e65-e712021/1/1210Bankart lesion的雙排固定(A) The CasExtended Bankart lesion. Anterior labral tear extends to inferior and posterior area肩關節(jié)后方不穩(wěn)定Type I: Incomplete detachment. The posteroinferior labrum is detached from the glenoid but not displaced. Type II: Marginal crack or Kims les

9、ion. The labrum has marginal crack and retroversion. Deep portion is loose. Type III: Chondrolabral erosion. The labral surface has fraying and deep portion is loose. Type IV: Flap tear. The labrum has flap tear or multiple buck handle tea2021/1/1211Extended Bankart lesion. Anter肩關節(jié)后方不穩(wěn)定的處理2021/1/12

10、12肩關節(jié)后方不穩(wěn)定的處理2021/1/1212凍結肩的診治British Elbow and Shoulder Society (BESS) survey-definition of frozen shoulder2021/1/1213凍結肩的診治British Elbow and ShoClinical presentation is classically in three overlapping phases2021/1/1214Clinical presentation is clarthroscopic capsular releaseThe contracted structur

11、es of the rotator interval (coracohumeral ligament, anterior capsule,superior and middle gleno-humeral ligaments) are then released(divided) usually using radiofrequency ablationSome clinicians advocate a further arthroscopic release of the posterior and inferior capsule or a 360-degree release2021/

12、1/1215arthroscopic capsular releasComplications in Shoulder ArthroscopyInfection DAngelo and Ogilvie-Harris reported an infection rate of 0.23 %Venous Thrombosis and Pulmonary Embolism Ojike et al. reviewed 8 articles with a total of 40,000 shoulder surgeries including 16,000 arthroplasties and found an overall incidence of 0.24 % for DVT and 0.11 % for P