肩关节镜临床应用

1、肩关节技术的临床应用 D_THCh 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 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 20 1 3 年 1 1 月第 1 卷第 1 期 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

2、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。 Medlock VB，Amid DHarwood FEt alAngiogenie response to bipolar radiofrequeney treatment of normal rabbit achilles tendonProceeding at the International Sceiety of Arthroscopy,Knee Surgery and Orthopaedic Sports Medicine CongressAuckland，New

3、 Zealand，March 1014，2003 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 镜下缝合技术的改进 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

4、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：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 肩关节前方不稳定镜下测量 镜下治疗骨性Bankart lesion Bankart lesion的双排固定 (A) The Cassiopeia (“W”)divergent technique uses an asymmetric number of anchors (1 more laterally than medially), a

5、nd the 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 capsul

6、e, and 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

7、, No 1 (February), 2014: pp e65- e71 Extended Bankart lesion. Anterior labral tear extends to inferior and posterior area 肩关节后方不稳定 Type I: Incomplete detachment. The posteroinferior labrum is detached from the glenoid but not displaced. Type II: Marginal crack or Kims lesion. The labrum has marginal

8、 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 tea 肩关节后方不稳定的处理 冻结肩的诊治 British Elbow and Shoulder Society (BESS) survey-definition of frozen

9、 shoulder Clinical presentation is classically in three overlapping phases arthroscopic capsular release The contracted structures of the rotator interval (coracohumeral ligament, anterior capsule,superior and middle gleno-humeral ligaments) are then released(divided) usually using radiofrequency ab

10、lation Some clinicians advocate a further arthroscopic release of the posterior and inferior capsule or a 360-degree release Complications in Shoulder Arthroscopy Infection 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 over