肩關(guān)節(jié)鏡臨床應(yīng)用

1、肩關(guān)節(jié)技術(shù)的臨床應(yīng)用,D_THCh,鏡下喙鎖韌帶重建治療肩鎖關(guān)節(jié)脫位,帶袢紐扣鋼板內(nèi)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,喙鎖韌帶重建治療肩鎖關(guān)節(jié)脫位,“關(guān)節(jié)鏡下喙鎖韌帶增強(qiáng)術(shù)治療肩鎖關(guān)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,肩峰撞擊癥,肩峰成形術(shù)+射頻消融技術(shù)將頻消融刀頭刺入肌腱問進(jìn)行燒灼以刺激肌腱愈合。利用等離子介導(dǎo)的射頻消融原理，在燒

2、灼組織時(shí)，射頻的能量在介質(zhì)中激活電解質(zhì)，離子液中被賦予能量的粒了足以切斷分子間的關(guān)聯(lián)，在相對(duì)較低的溫度(標(biāo)準(zhǔn)為40℃~70℃)切斷或溶解軟組織,低劑量的射頻消融技術(shù)可在肌腱內(nèi)促進(jìn)血管生成因子的生長，對(duì)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(jìn)損傷肌腱的修復(fù)。Medlock VB，Amid D．Harwood F．Et al．Angiogenie response to bipolar radiofrequeney trea

3、tment of normal rabbit achilles tendon．Proceeding at the International Sceiety of Arthroscopy,Knee Surgery and Orthopaedic Sports Medicine Congress．Auckland，New Zealand，March 10．14，2003．,關(guān)節(jié)鏡下微創(chuàng)治療良性骨腫瘤,關(guān)節(jié)鏡下治療良性骨腫瘤時(shí)先采用C型透視

4、定位克氏針鉆入病灶，然后用空心鉆沿克氏擴(kuò)大通道，經(jīng)C臂透視確定到達(dá)病灶無誤后插入關(guān)節(jié)鏡，直接觀察病灶內(nèi)情況，可取少量病變組織作病檢，在關(guān)節(jié)鏡直視下刮除腫瘤，用磨鉆清理病灶關(guān)節(jié)鏡檢查病變刮除是否徹底，用等離子刀燒灼病灶。若空腔較大，則取自體或異體骨植骨,鏡下縫合技術(shù)的改進(jìn),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(jié)節(jié)的肩袖止點(diǎn)部位優(yōu)點(diǎn)：大大加強(qiáng)肩袖修補(bǔ)的固定強(qiáng)度，又可以在腱骨交界處形成一個(gè)相對(duì)更為廣泛的愈合面

5、積，更有利于肩袖組織的愈合邊對(duì)邊的縫合方法將撕裂肩袖的兩端靠攏對(duì)合，縮小缺損，然后將殘余肌腱用錨釘固定于肱骨頭優(yōu)點(diǎn)：巨大回縮型肩袖撕裂，松解肌腱仍無法將其拉至大結(jié)節(jié)，或者張力過大，該方法使肩袖能在盂肱關(guān)節(jié)的橫斷面和冠狀面上保持力偶平衡，撕裂的肩袖仍能提供完好的功能,肩關(guān)節(jié)前方不穩(wěn)定鏡下測量,鏡下治療骨性Bankart lesion,Bankart lesion的雙排固定,(A) The Cassiopeia (“W”)diverge

6、nt technique uses an asymmetric number of anchors (1 more laterally than medially), and the suture limbs diverge from a single point in the capsule to 2 different anchors in the lateral row. B) The convergent (“M”) tec

7、hnique 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 converge to a single lateral-row anchor. By us

8、e 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. Art

9、hroscopy Techniques, Vol 3, No 1 (February), 2014: pp e65-e71,Extended Bankart lesion. Anterior labral tear extends to inferior and posterior area,肩關(guān)節(jié)后方不穩(wěn)定,Type I: Incomplete detachment. The posteroinferior labrum is d

10、etached from the glenoid but not displaced. Type II: Marginal crack or Kim’s lesion. The labrum has marginal crack and retroversion. Deep portion is loose. Type III: Chondrolabral erosion. The labral surface has fr

11、aying and deep portion is loose. Type IV: Flap tear. The labrum has flap tear or multiple buck handle tea,,肩關(guān)節(jié)后方不穩(wěn)定的處理,凍結(jié)肩的診治,British Elbow and Shoulder Society (BESS) survey-definition of frozen shoulder,Clini

12、cal presentation is classically in three overlapping phases,arthroscopic capsular release,The contracted structures of the rotator interval (coracohumeral ligament, anterior capsule,superior and middl

13、e 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-deg

14、ree’ release,Complications in Shoulder Arthroscopy,Infection D’Angelo and Ogilvie-Harris reported an infection rate of 0.23 %Venous Thrombosis and Pulmonary Embolism Ojike et al. reviewed 8 articles with a total o

15、f 40,000 shoulder surgeries including 16,000 arthroplasties and found an overall incidence of 0.24 % for DVT and 0.11 % for PEPain and Chronic Regional PainSyndrome (CRPS),,Fractures StiffnessChondrolysis （軟骨溶解）Impl