肩关节前脱位AnteriorShoulderDislocation课件.ppt
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- 肩关节 脱位 AnteriorShoulderDislocation 课件
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1、Acute Shoulder Dislocation SurgeryEinoderAcute anterior dislocation of the shoulderAcute Shoulder Dislocation SurgeryEinoderAnatomy Stability:-ball&socket =compression in concavity effect Bone -big head small cup =unstable Menisci -labium =depth of cup by 20%Ligaments -glenohumeral&capsule Muscles -
2、rotator cuff&biceps =holds ball in cup Primary Movers-Deltoid,Pec.major&Lat.Dorsy=subluxing forces Dynamic -proprioceptive feedbackAcute Shoulder Dislocation SurgeryEinoderPathophysiology(Lazarus 1996)Chondro-labral defect causes a 65%reduction in stability in the direction of the defectDeficiency o
3、f the ant.inf.capsulolabral complex Fracture of ant.lip of glenoid=15%Detachment of labarum/capsule=15%Tear of glenohumeral ligaments=54%Avulsion of subscapularis and ligs of humerus(HAGL)To prevent the persistence of the defect it needs to be repairedArthroscopically Open Acute Shoulder Dislocation
4、 SurgeryEinoderAcute Injury Something breaks or tears and therefore can be repaired.Repair is better than reconstruct Repair is easier than reconstructChronic Instability has additional plastic deformation of the capsule and glenohumeral ligaments therefore needs to be shortened Restoring the normal
5、 functional anatomy is impossibleAcute Shoulder Dislocation SurgeryEinoderConservative TreatmentRowe JBJS,1957324 young patient with ant.dislocations 94%had recurrence if 20 years old 62%had recurrence if 40 years oldBurkhead&Rockwood(text book)40 patients with acute dislocation&vigorous rehabilitat
6、ion Only 16%had good or excellent result(1 in 6)Deny&Drew Injury,November 2002 21%of all patients presenting with shoulder dislocation had previous dislocation in 1 year 43%in patients 15-22 years had re-dislocationsAcute Shoulder Dislocation SurgeryEinoderNon operative treatment of shoulder disloca
7、tion in young athletes1.Arciera J Arthroscopy,19952.De Beardino J South Orthopaedic Ass,19963.Haelen J Arch Orthopaedic Trauma Surgery,19904.Hovelius J Orthopaedic Science,19995.Wheeler J Arthroscopy,19986.Kirkby J Arthroscopy,1999 all over 80%recurrence rateNon operative treatment is unacceptableAc
8、ute Shoulder Dislocation SurgeryEinoderProspective Randomised Study Bottani etc.Military Personnel Medicine Vol 30 No 4 2000First Time Acute Traumatic Shoulder DislocationStabilisation Vs Non Operative:Follow up in 36 months24 patients aged 18-26y.14 Non Operative rehab immobilised 4 weeks 9 of 12 n
9、on operative had instability(75%)(6 open Bankart repair)10 ASC Bankart repair with bioabsorbable tack 10 days 1 of 9 operated patients had instability(11%)Acute Shoulder Dislocation SurgeryEinoderComparison of Arthroscopic&Open StabilisationSample SizeFollow UpRecurrenceASCOpenASCOpenASCOpenSteinbec
10、k 199830323640175Field 19995050333080Cole 199937225255169Hayes etc 199944132929124ConclusionArthroscopic repair for chronic instability is inferior to open repair?Due to plastic deformationChronic anterior instabilityAcute Shoulder Dislocation SurgeryEinoderArthroscopic Techniques for Primary Disloc
11、ations1982 Johusa with staples1987 Morgen&Badenstab transglenoid sutures1991 Caspari-Cannulated bio-absorbable tacks 1993 Wolf&Snyder suture anchors=difficult1989 Wheller-ASC staple1993 Gohlke-Suture anchors1994 Arciera-ASC transglenoid1996 Speer-Bio-absorbable tack1999 Wintzell-ASC lavage2000 Intro
12、duction of a multitude of new gadgets&anchorsAcute Shoulder Dislocation SurgeryEinoderArthroscopic RepairsEinoder,1984 Knee Club Described Arthroscopic transglenoid sutures using:K wire with eye(ACL)introduced via anterior portal Sucking tube Sutures tied over infraspinatus fascia or spine of scapul
13、a Results 4 out 5 patients returned to the same level of sport with no re-dislocations Acute Shoulder Dislocation SurgeryEinoderArthroscopic RepairAcute Shoulder Dislocation SurgeryEinoderAcute Shoulder Dislocation SurgeryEinoderAcute Shoulder Dislocation SurgeryEinoderBoszotta&Helperstorfer Arthros
14、copy,July 2000 Transglenoid suture repair for initial Ant.dislocation 72 patients(1988-95)61 11 Aged 19-39 34%=Bankart lesion(6 with bone)66%=Avulsion of capsulolabral complexResults 7%=Redislocation all due to trauma(severe in 2 out of 5)85%=Returned to unrestricted pre injury sporting activitiesAc
15、ute Shoulder Dislocation SurgeryEinoderRandomised StudiesAsc.Stabilisation Vs Non OperativeArciera et.al.A.J.Sports Med.,1994 32 military men with acute 1st up dislocation,Average of 32 months follow up15 patients non operative 80%redislocated21 patients transglenoid suture 14%redislocatedBottony&Wi
16、lkings etc.A.J.Sports Medicine 2000 Patients with acute traumatic first time shoulder dislocation14 young patients non op,75%redislocation10 young patients Asc.Bankart repair,10%redislocationAcute Shoulder Dislocation SurgeryEinoderAsc.stabilisation Dara&Gerber Journal of Shoulder&Elbow,2000 20 shou
17、lders Av 3 year follow up Recurrences occurred in patients who were chronic dislocators i.e.30%Therefore now do open surgery for recurrent dislocationsAsc.surgery for acute dislocationsDe Beardino et al An J.Sports Med.,2000 49 1st up acute post traumatic Shoulders dislocation Average 37 months foll
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