肩关节镜临床应用解析课件.ppt

1、肩关节镜临床应用解析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2021/1/122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2021/1/123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

2、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 Zea

3、land，March 1014，20032021/1/124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2021/1/125镜下缝合技术的改进2021/1/126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

4、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：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2021/1/127肩关节前方不稳定镜下测量2021/1/128镜下治疗骨性Bankart lesion2021/1/129Bankart lesion的双排固定(A)The Cassiopeia(“W”)divergent technique uses an asymmetric number of anchors(1

5、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”)technique uses a symmetric number of anchors medially and laterally,and the suture limbs converge to a single medial row anchor,through 2 diffe

6、rent points in the capsule,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

7、 Techniques,Vol 3,No 1(February),2014:pp e65-e712021/1/1210Extended 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 labru

8、m 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 tea2021/1/1211肩关节后方不稳定的处理2021/1/1212冻结肩的诊治British Elbow and Shoulder Society (BESS)su

9、rvey-definition of frozen shoulder2021/1/1213Clinical presentation is classically in three overlapping phases2021/1/1214arthroscopic capsular release The contracted structures of the rotator interval (coracohumeral ligament,anterior capsule,superior and middle gleno-humeral ligaments)are then releas

10、ed(divided)usually using radiofrequency ablation Some clinicians advocate a further arthroscopic release of the posterior and inferior capsule or a 360-degree release2021/1/1215Complications in Shoulder Arthroscopy Infection DAngelo and Ogilvie-Harris reported an infection rate of 0.23%Venous Thromb

11、osis 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 PE Pain and Chronic Regional PainSyndrome(CRPS)2021/1/1216 Fractures Stiffness Chondrolysis（软骨溶解）Implants looseness/failure 2021/1/1217谢谢大家！