单人结肠镜操作中俯卧位的防袢作用

目的探讨单人结肠镜操作中俯卧位防袢的效果。方法结肠镜单人操作，判断镜身成袢后首先解袢，之后将患者体位改变为俯卧位，再继续进镜。结果共200例次单人结肠镜检查采用解袢后改为俯卧位的方法，镜身未再次成袢，均顺利到达回肠末段，耗时3-10min，进镜长度70～90cm，术中、术后患者无明显痛苦及并发症发生。结论结肠镜单人操作时，遇到成袢后首先解袢，之后将患者体位改变为俯卧位可有效防止再次成袢，从而顺利无痛苦地完成结肠镜检查及治疗。     

结肠镜单人操作技术临床应用的探讨

目的探讨结肠镜单人操作技术的临床应用。方法对2004年11月至2008年12月笔者采用结肠镜单人操作技术施行全结肠检查与治疗的618例患者的资料进行回顾性分析。结果结肠镜单人操作检查治疗成功609例,成功率98．5％,回盲部到达率96．9％,末端回肠到达率55．5Voo;到达回盲部时间为5～50min,平均13min;进镜长度一般为50～80cm,少数为80～100cm,个别在100cm以上;行肠镜下息肉切除（EMR—L）80例,肠镜下行乙状结肠套叠伴扭转复位成功1例,无1例并发症发生。结论结肠镜单人操作技术安全、简便、成功率高,患者痛苦小,值得临床推广。     

非牵引手法整复肩关节脱位

肩关节脱位临床较常见 ,一般普遍采用足蹬拔伸等对抗牵引的手法治疗 ,而我们近年来应用非牵引的手法整复 ,取得满意疗效 ,现总结报道如下。1　临床资料本组收集了 1996～ 1999年 ,我们门诊采取非牵引方法处理的肩关节脱位病人 42例 ,年龄 17～ 76岁 ,男 2 4例 ,女 18例 ;全部病例均摄Ｘ线片明确诊断。2　治疗方法患者正坐位 ,以右侧脱位为例 ,术者单人操作 ,站于患者右侧前斜方 ,在与患者交谈的同时 ,以轻一指弹手法放松肩关节周围韧带肌肉约一分钟之后 ,左手置于患者腋窝处 ,触到肱骨头向外托住 ,右手握住患者腕部使其屈肘 90° ,以上 2、…     

零度复位治疗肩关节前脱位

我们采用零度复位法治疗肩关节前脱位9例（其中男5例，女4例），取得满意效果，现将具体方法介绍如下。复位方法卫．单人复位法：患者平卧在复位床上。术者站在其患侧，先将辅手按压于肩前部，术手紧握其肘上部，行持续向下牵引，缓慢地将上肢外展；上举至零度（上肢外展与肩肿冈呈一直线时称零度），术手作轻度内旋，辅手推挤肽骨头，此时即可听到肽骨头入臼“喀略”’之声，表示复位已成功。2．双人复位法：患者平卧于复位床上，助手双手掌按压患肩前部，术者一手紧握腕部，另一手抓握时上部，行拔伸、牵引，同时将患肢外展，＿［举至零度…     

搭肩牵引法整复肩关节脱位

搭肩牵引法整复肩关节脱位石庭芬１９８７年５月起，作者创用搭肩牵引法整复新鲜外伤性肩关节前脱位，方法简单，疗效满意。整复方法：患者仰卧于诊察台上，关节腔内注入１％利多卡因１５ｍｌ。术者坐于患者伤侧。以右肩关节脱位为例，则患者右手搭于术者左肩上，健侧手把...     

过肩折顶复位法治疗肩关节脱位33例

作者近年来采用过肩折顶单人复位法，整复肩关节前脱位33例，取得很好效果，报告如下。临床资料本组33例中男20例，女13例；年龄19～96岁；左侧15例，右侧19例（双侧1例）；锁骨下型4例，喙突下型16例，盂下型14例；习惯性脱位6例，合并肱骨大结节骨折13例，肱骨干骨折1例，多发骨折2例。33例全部是新鲜脱位。治疗方法一般情况下，不用任何麻醉。把复位的优点向病人说明，取得患者配合，使伤肢松弛是复位的重要步骤。以左肩为例，患者取仰卧位。把患肢前上臂对向搁置术者右前上臂，术者握住伤肢时关节上端，缓缓持患肢外展、外旋，过肩上举…     

带肩峰骨瓣喙肩韧带转移修复喙锁韧带治疗Ⅲ度肩锁关节脱位

目的：探讨手术治疗Ⅲ度肩锁关节脱位的新方法。方法：2000年8月-2004年3月收治TossyⅢ度肩锁关节脱位14例，男10例，女4例；年龄17～54岁，平均42．5岁；新鲜脱位9例，陈旧脱位5例。采用带肩峰骨瓣喙肩韧带转移修复喙锁韧带加内固定治疗，其中采用锁骨钩钢板固定6例，骨片钉固定8例。结果：所有患者经过3个月～3年（平均2．4年）随访，根据Karlsson评定标准：A级9例，B级5例。结论：喙肩韧带替代喙锁韧带确保肩锁关节的稳定，骨瓣与锁骨固定愈合较韧带与骨愈合更可靠，手术操作简单，功能恢复快。     

利用加压骨片针治疗RockwoodⅡ型肩锁关节脱位

目的采用加压骨片针治疗RockwoodⅡ型肩锁关节脱位，评价其治疗效果。方法采用加压骨片针治疗RockwoodⅡ型肩锁关节脱位12例，按Karlsson标准进行疗效评价。结果肩关节功能评价A级11例，B级1例，无再脱位发生，患者均恢复正常生活和工作。结论加压骨片针治疗RockwoodⅡ型肩锁关节脱位具有操作简单、复位好、固定可靠、内固定物取出便捷等优点，是治疗RockwoodⅡ型肩锁关节脱位的一种有效方法。     

闭合复位经皮穿针治疗新鲜Bennett骨折58例

目的报道闭合复位经皮穿针治疗新鲜Bennett骨折的经验。方法2004年8月-2010年8月,我科采用闭合复位经皮克氏针治疗Bennett骨折58例,手术在桡骨茎突周围局部阻滞麻醉下操作,利用术者与患者虎口相扣牵引复位．经皮钻入两枚克氏针完成固定,无需外固定。4周后复查,视骨折愈合情况拔除克氏针．开始功能锻炼。结果58例患者均获得随访,平均18个月,无骨折不愈合及延期愈合。功能恢复满意。优良率94．8％。结论闭合复位经皮穿针治疗新鲜Bennett骨折手术操作简单、复位准确、固定可靠,无特殊情况时。术者一人即可单独完成局麻及手术操作,适合基层医院开展。     

急性肩锁关节脱位手术治疗体会

目的探讨急性肩锁关节脱位的治疗方法及临床效果。方法2003-2006年，应用三种不同术式治疗急性肩锁关节脱位89例，其中钩钢板29例，Dewar改良术治疗33例，Dewar改进术治疗27例。结果85例获得随访，随访时间6～12个月，平均10．5个月。采用VAS视觉模拟疼痛评分评定主观疼痛；UCLA评分和美国肩肘协会肩关节评分（ASES评分）进行关节功能评定，并测量肩关节活动范围，钩钢板与Dewar的术后效果有显著差异（P〈0．05），Dewar改良与改进型之间无显著性差异（P〉0．05），但改进Dewar的手术病例肩锁关节复位可靠。结论对于急性肩锁关节脱位的手术治疗，各种方法均有优缺点，但改进Dewar的手术方式具有手术简单、有效、恢复快、费用低、痛苦小及肩锁关节完全复位等优点，是疗效可靠的治疗方法。     

闭合复位老年肩关节前脱位过程中发生医源性肱骨颈骨折的成因分析和对策

目的分析在闭合复位老年肩关节前脱位的过程中发生医源性肱骨颈骨折的原因并探索避免的方法。 方法对上海市第一人民医院2012年1月至2017年1月在肩关节前脱位复位过程中发生肱骨颈骨折患者的临床资料和影像学特点进行回顾性分析。 结果共5例患者在闭合复位过程中发生肱骨颈骨折,导致肱骨头、颈分离。这些患者的特征：（1）老年女性,低能量损伤,初次肩关节脱位;（2）复位前肩关节正位片：肩关节前脱位伴大结节骨折;（3）肱骨头内移至喙突下方或内侧;（4）均为无麻醉下采取Hippocrates足蹬法复位。 结论闭合复位肩关节前脱位过程中发生肱骨颈骨折的原因与复位前遗漏盂肱关节脱位时伴随的肱骨颈骨折有关。老年肩关节前脱位有其特点,在治疗上应与年轻患者加以区别。对老年初次肩关节前脱位伴大结节骨折的患者应加以特别重视,复位前规范的影像学检查以除外肱骨颈骨折是避免此类医源性并发症的关键。     

Eine neue Repositionstechnik für die verhakte hintere Schulterluxation

The case of a 61-year-old male with posterior dislocation of the right shoulder joint is presented and a new technique for closed reduction of posterior locked shoulder dislocation is described. The technique involves four steps: in step 1 a constant traction is applied on the injured arm, in step 2 the arm is internally rotated and in steps 3 and 4 the second arm of the physician is used as a lever arm to lateralize and ventralize the shoulder. Lateralization and ventralization of the humeral head are essential to engage the humeral head and to pass it around the glenoid during reduction. Steps 3 and 4 are performed simultaneously. In the presented case the patient suffered a traumatic shoulder dislocation with a rim fracture of the glenoid. After reduction the shoulder was stable and conservative treatment was performed. A 2 year follow-up examination revealed a pain-free and stable shoulder with free range of motion and an Oxford instability score of 48 points. The described reduction technique for posterior locked shoulder dislocation is a simple and gentle technique, which can be performed easily by one person.Presentation of a reduction technique for locked posterior shoulder dislocation. Constant traction and internal rotation is performed for engaging the locked humeral head. After disengaging the humeral head the reduction is performed by using the arm of the physician as a lever arm.     

应用缝合锚钉解剖重建肩锁关节的临床效果

目的评估应用缝合锚钉重建喙锁韧带,治疗急性肩锁关节脱位的临床结果。 方法自2014年2月至2015年6月接受手术治疗的急性肩锁关节脱位患者13例,其中男性8例、女性5例;平均年龄为（40.0±15.6）岁。应用缝合锚钉重建喙锁韧带,复位固定肩锁关节。术后应用三维CT评估喙突上缝合锚钉的位置情况;通过肩关节正位片评估肩锁关节复位保持情况,并测量喙锁间距;记录肩关节的活动范围、视觉模拟评分（visual analogue scale,VAS）和Constant-Merly评分。 结果所有患者均顺利康复。术后肩关节前屈上举平均为171.5°,体侧外旋为70.8°,体侧内旋为T8。VAS评分为（0.3±0.6）分,Constant-Merly评分为92.4分。术后术侧的喙锁间距平均为（8.9±3.0）mm,健侧的喙锁间距平均为（7.7±1.7）mm,两者之间差异无统计学意义（P=0.119）。26枚锚钉中有23枚位置良好,1枚锚钉刺穿了喙突的下表面,2枚锚钉位置偏向内侧。1例患者肩锁关节复位完全丢失,1例患者肩锁关节复位部分丢失,其Constant-Merly评分分别为74分和84分。 结论通过在喙突基底部准确地置入缝合锚钉,可以解剖重建喙锁韧带,恢复肩锁关节的垂直和水平稳定性。该技术创伤小,可以取得较为满意的临床结果。     

Base of coracoid process fracture with acromioclavicular dislocation in a child

Fracture of the coracoid process is a rare injury. It can be easily missed when associated with other injuries to the shoulder girdle, for instance, acromioclavicular joint (ACJ) dislocation. Clinical attention is easily drawn to the more obvious ACJ dislocation, hence, the need for further radiological evaluation. We report an unusual case of fracture of the base of coracoid process associated with a true acromioclavicular joint dislocation in a 12 year old boy, with no separation of the epiphyseal plate, as one might expect. Treatment also remains controversial. Our patient underwent open reduction internal fixation of the acromioclavicular joint and coracoid process. He subsequently made an uneventful progress with pain free full range of shoulder movement at 5 months, and was discharged at 9 months.     

Anterior dislocation of shoulder in eclampsia: a case report

This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia.This is an unusual mechanism of injury,but simila...     

A case of acromioclavicular dislocation without coracoclavicular ligament rupture accompanied by coracoid process fracture

Acromioclavicular joint dislocation with intact coracoclavicular ligaments accompanied by fracture of the coracoid process is a rare injury. The patients are treated with conservative and/or surgical methods. A 30-year-old male patient developed type 3 acromioclavicular dislocation and coracoid process fracture due to a fall in the right shoulder. Both injuries were treated surgically. Following open reduction, the acromioclavicular joint was fixed with a Knowles pin, and the coracoid process was fixed with a 4.0-mm malleolar screw. Active-assisted rehabilitation of the shoulder was initiated a week after surgery. The patient returned to office work with a long arm splint at three weeks. Pain-free, active, and complete shoulder movements were seen in the fifth week. The Knowles pin in the acromioclavicular joint was removed under local anesthesia seven months postoperatively. A year after surgery, he resumed full shoulder functions without pain and there were no signs of complications such as heterotopic ossification.     

关节镜辅助下三束重建治疗急性Rockwood Ⅲ型肩锁关节脱位

目的探讨关节镜辅助下三束重建治疗急性Rockwood Ⅲ型肩锁关节脱位的临床疗效。 方法回顾性分析上海交通大学医学院附属新华医院骨科采用关节镜辅助下三束重建治疗21例急性Rockwood Ⅲ型肩锁关节脱位患者的资料,均为闭合性损伤。术后3、6、12个月对所有患者进行术后临床效果和影像学评价。根据术后影像学资料评估复位再丢失情况,采用Constant评分和上肢功能（disabilities of arm,shoulder and hand,DASH）评分评估患者肩关节功能。探讨术中关节镜辅助治疗的意义和价值。 结果术中关节镜探查发现4例合并软组织损伤,并进行一期镜下修复。所有患者术后均未发生喙突骨折和襻断裂。影像学评估提示术后6~12个月有6例患者（28.6%）出现轻度复位丢失,但与Constant评分和DASH评分无显著相关性,没有患者要求取出内固定。 结论关节镜辅助下三束重建治疗急性Rockwood Ⅲ型肩锁关节脱位是一种创伤小、安全、临床效果确切的手术方法。急性肩锁关节脱位通常由高能量损伤造成,在手术中关节镜探查肩关节能发现合并的软组织损伤,并进行一期修复,有利于肩关节功能的恢复,避免二次手术。     

Locked posterior dislocation of the shoulder joint: Report of two cases

Posterior dislocation of the shoulder joint is very rare. Most cases are missed initially because it is difficult to diagnose using conventional radiographic images. Computed tomography (CT) is the best tool for diagnosis. We report two cases of posterior dislocation of the shoulder joint that were missed initially at another hospital. The patients presented with painful disability of the shoulder joint. Posterior dislocation of the shoulder joint was suspected after physical examination. Anteroposterior radiography was unable to confirm the diagnosis because an abnormal posterior relationship of humeral head to glenoid fossa could not be clearly identified. An axillary view was unobtainable because of severe pain and the limited joint motion available. CT showed posterior dislocation of the humeral head. The bony defect of the humeral head was incarcerated by the posterior rim of the glenoid process. Open reduction via an anterior approach was performed on both patients, who recovered with good shoulder function after rehabilitation (the Constant score of Case 1 was 85 and that of Case 2 was 75). We concluded that “Mouzopoulos sign” obtained via an anteroposterior view is helpful for the diagnosis of posterior dislocation of the shoulder joint and that CT is required for a definitive diagnosis. If the dislocation is locked and closed reduction fails, then open reduction should be carried out.     

三种手术方法在肩关节脱位合并肱骨大结节撕脱骨折中的应用

目的观察肩关节脱位并肱骨大结节撕脱骨折三种手术方法的疗效。方法对89例肩关节脱位并肱骨大结节撕脱骨折分别采用传统肩前三角肌和胸大肌间隙入路并肱骨近端解剖型钢板螺钉内固定、肩前外侧经三角肌入路并可吸收螺钉内固定、肩前外侧经三角肌入路并微型钢板螺钉内固定。结果本组获随访13～118个月,上述三种手术方法术后肩关节功能优良率分别为:57.57%、81.08%、84.21%;肩根部周径增加程度:术后第1、3、7天肩前外侧经三角肌入路组肩根部周径增加程度明显小于传统肩前三角肌、胸大肌入路组(P<0.05);肩峰下撞击综合征:以肩前外侧经三角肌入路并可吸收钉及微型钢板螺钉组均明显少于传统经三角肌、胸大肌入路并肱骨近端解剖型钢板螺钉组(P<0.05)。结论肩前外侧经三角肌入路较传统肩前三角肌、胸大肌入路具有创伤小、操作简单的优点;可吸收螺钉及微型钢板螺钉可有效固定肱骨大结节撕脱骨折,并减少肩峰下撞击的并发症;肩关节脱位合并肱骨大结节撕脱骨折应根据肱骨大结节骨折形态、肩关节是否已闭合复位及是否合并肱骨近端其他骨折的情况来选择合适的手术入路与内固定物。     

Resection arthroplasty of the infected shoulder: a salvage procedure for the elderly patient

Infection of the shoulder joint is a challenging problem for the orthopaedic surgeon. Several treatment options have been proposed. Here, we evaluate the results achieved following resection arthroplasty of the shoulder in seven patients. We performed resection arthroplasty in seven cases to treat a chronic uncontrollable infection of the shoulder. Three patients had an infected shoulder arthroplasty, one had an infected non-united arthrodesis, one was treated for an infected osteosynthesis, one had an infected rotator cuff repair and one patient had a septic arthritis of the shoulder joint. All patients were reviewed after a mean of 252 days. The functional outcome was evaluated using the Constant and DASH score. C-Reactive Protein levels were determined to evaluate the presence of residual infection. Except for one doubtful result, all our patients remained free of infection and there was excellent pain relief after the resection. Nevertheless, the functional outcome was poor: the mean Constant score was 25.7 and the mean DASH score was 69.3. Resection arthroplasty of the shoulder is a valuable treatment option for infection of the shoulder, especially in older patients with a poor mental and physical condition who suffer intolerable pain.