dislocation isakos肩关节脱位 课件

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1、AcuteanteriordislocationoftheshoulderAnatomyStability:-ball&socket=compressioninconcavityeffectBone-bighead–smallcup=unstableMenisci-labium=↑depthofcupby20%Ligaments-glenohumeral&capsuleMuscles-rotatorcuff&biceps=holdsballincupPrimaryMovers-Deltoid,Pec.major&Lat

2、.Dorsy=subluxingforcesDynamic-proprioceptivefeedbackPathophysiology(Lazarus1996)Chondro-labraldefectcausesa65%reductioninstabilityinthedirectionofthedefectDeficiencyoftheant.inf.capsulolabralcomplexFractureofant.lipofglenoid=15%Detachmentoflabarum/capsule=15%Tea

3、rofglenohumeralligaments=54%Avulsionofsubscapularisandligsofhumerus(HAGL)TopreventthepersistenceofthedefectitneedstoberepairedArthroscopicallyOpenAcuteInjurySomethingbreaksortearsandthereforecanberepaired.RepairisbetterthanreconstructRepairiseasierthanreconstru

4、ctChronicInstabilityhasadditionalplasticdeformationofthecapsuleandglenohumeralligamentsthereforeneedstobeshortenedRestoringthenormalfunctionalanatomyisimpossibleConservativeTreatmentRowe–JBJS,1957324youngpatientwithant.dislocations94%hadrecurrenceif<20yearsold62

5、%hadrecurrenceif<30yearsold14%hadrecurrenceif>40yearsoldBurkhead&Rockwood(textbook)40patientswithacutedislocation&vigorousrehabilitationOnly16%hadgoodorexcellentresult(1in6)Deny&Drew–Injury,November200221%ofallpatientspresentingwithshoulderdislocationhadprevious

6、dislocationin1year43%inpatients15-22yearshadre-dislocationsNonoperativetreatmentofshoulderdislocationinyoungathletesArciera–JArthroscopy,1995DeBeardino–JSouthOrthopaedicAss,1996Haelen–JArchOrthopaedicTraumaSurgery,1990Hovelius–JOrthopaedicScience,1999Wheeler–JAr

7、throscopy,1998Kirkby–JArthroscopy,1999allover80%recurrencerateNonoperativetreatmentisunacceptableProspectiveRandomisedStudyBottanietc.–MilitaryPersonnelMedicineVol30No42000FirstTimeAcuteTraumaticShoulderDislocationStabilisationV’sNonOperative:Followupin36months2

8、4patientsaged18-26y.14NonOperative–rehabimmobilised4weeks9of12nonoperativehadinstability(75%)(6openBankartrepair)10ASCBankartrepairwithbioabsorbabletack<10days1of9ope