肩关节镜临床应用PPT课件.ppt

1,肩关节技术的临床应用,2,镜下喙锁韧带重建治疗肩锁关节脱位,带袢纽扣钢板内固定同种异体/自体肌腱重建同种异体/自体肌腱重建+锁骨钩钢板/缝合锚,3,喙锁韧带重建治疗肩锁关节脱位,“关节镜下喙锁韧带增强术治疗肩锁关节脱位”皇甫小桥赵金忠，中华肩肘外科电子杂志2013年11月第1卷第1期,4,肩峰撞击症,肩峰成形术+射频消融技术将频消融刀头刺入肌腱问进行烧灼以刺激肌腱愈合。利用等离子介导的射频消融原理，在烧灼组织时，射频的能量在介质中激活电解质，离子液中被赋予能量的粒了足以切断分子间的关联，在相对较低的温度(标准为4070)切断或溶解软组织,低剂量的射频消融技术可在肌腱内促进血管生成因子的生长，对于肌腱愈合起到重要的作用，因此射频消融在理论上能够促进损伤肌腱的修复。MedlockVB，AmidDHarwoodFEtalAngiogenieresponsetobipolarradiofrequeneytreatmentofnormalrabbitachillestendonProceedingattheInternationalSceietyofArthroscopy,KneeSurgeryandOrthopaedicSportsMedicineCongressAuckland，NewZealand，March1014，2003,5,关节镜下微创治疗良性骨肿瘤,关节镜下治疗良性骨肿瘤时先采用C型透视定位克氏针钻入病灶，然后用空心钻沿克氏扩大通道，经C臂透视确定到达病灶无误后插入关节镜，直接观察病灶内情况，可取少量病变组织作病检，在关节镜直视下刮除肿瘤，用磨钻清理病灶关节镜检查病变刮除是否彻底，用等离子刀烧灼病灶。若空腔较大，则取自体或异体骨植骨,6,镜下缝合技术的改进,7,巨大肩袖损伤的治疗,将肱二头肌长头腱与损伤肩袖的前缘一起固定于大结节的肩袖止点部位优点：大大加强肩袖修补的固定强度，又可以在腱骨交界处形成一个相对更为广泛的愈合面积，更有利于肩袖组织的愈合边对边的缝合方法将撕裂肩袖的两端靠拢对合，缩小缺损，然后将残余肌腱用锚钉固定于肱骨头优点：巨大回缩型肩袖撕裂，松解肌腱仍无法将其拉至大结节，或者张力过大，该方法使肩袖能在盂肱关节的横断面和冠状面上保持力偶平衡，撕裂的肩袖仍能提供完好的功能,8,肩关节前方不稳定镜下测量,9,镜下治疗骨性Bankartlesion,10,Bankartlesion的双排固定,(A)TheCassiopeia(“W”)divergenttechniqueusesanasymmetricnumberofanchors(1morelaterallythanmedially),andthesuturelimbsdivergefromasinglepointinthecapsuleto2differentanchorsinthelateralrow.B)Theconvergent(“M”)techniqueusesasymmetricnumberofanchorsmediallyandlaterally,andthesuturelimbsconvergetoasinglemedialrowanchor,through2differentpointsinthecapsule,andconvergetoasinglelateral-rowanchor.Byuseofa1:1anchorconfiguration,suturemanagementandtensioningaremorepredictableandstraightforward.,CathalJ.Moran，ArthroscopicDouble-RowAnteriorStabilizationandBankartRepairforthe“High-Risk”Athlete.ArthroscopyTechniques,Vol3,No1(February),2014:ppe65-e71,11,ExtendedBankartlesion.Anteriorlabraltearextendstoinferiorandposteriorarea,肩关节后方不稳定,TypeI:Incompletedetachment.Theposteroinferiorlabrumisdetachedfromtheglenoidbutnotdisplaced.TypeII:MarginalcrackorKimslesion.Thelabrumhasmarginalcrackandretroversion.Deepportionisloose.TypeIII:Chondrolabralerosion.Thelabralsurfacehasfrayinganddeepportionisloose.TypeIV:Flaptear.Thelabrumhasflaptearormultiplebuckhandletea,12,肩关节后方不稳定的处理,13,冻结肩的诊治,BritishElbowandShoulderSociety(BESS)survey-definitionoffrozenshoulder,14,Clinicalpresentationisclassicallyinthreeoverlappingphases,15,arthroscopiccapsularrelease,Thecontractedstructuresoftherotatorinterval(coracohumeralligament,anteriorcapsule,superiorandmiddlegleno-humeralligaments)arethenreleased(divided)usuallyusingradiofrequencyablationSomecliniciansadvocateafurtherarthroscopicreleaseoftheposteriorandinferiorcapsuleora360-degreerelease,16,ComplicationsinShoulderArthroscopy,InfectionDAngeloandOgilvie-Harrisreportedaninfectionrateof0.23%VenousThrombosisandPulmonaryEmbolismOjikeetal.reviewed8articleswithatotalof40,000shouldersurgeriesincluding16,000arthroplastiesandfoundanov