肩關(guān)節(jié)鏡臨床應(yīng)用解析

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，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)，在相對較低的溫度(標準為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(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大通道，經(jīng)C臂透視確定到達病灶無誤后插入關(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,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

5、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(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