肩关节脱位的X线诊断

目的：探讨肩关节脱位的X线表现及诊断的相关问题。方法：回顾性分析24例肩关节脱位患者的X线表现,对肩关节正位及穿胸位X线片表现进行总结。结果：肩关节半脱位4例,喙突下脱位14例（其中合并肱骨大结节骨折4例、肱骨外科颈骨折4例、同时合并肱骨外科颈和大结节骨折2例）,盂下脱位4例,锁骨下脱位1例,肩关节后脱位1例。结论：多数肩关节脱位可通过X线平片诊断,但应注意与投照体位不恰当造成的假性脱位相鉴别。     

肩关节脱位的X线诊断

目的:探计肩关节脱位的x线表现及诊断的相关问题.方法:回顾性分析24例肩关节脱位患者的X线表现,对肩关节正位及穿胸位X线片表现进行总结.结果:肩关节半脱位4例,喙突下脱位14例(其中合并肱骨大结节骨折4例、肱骨外科颈骨折4例、同时合并肱骨外科颈和大结节骨折2例),孟下脱位4例,锁骨下脱位1例,肩关节后脱住1例.结论:多数肩关节脱住可通过X线平片诊断,但应注意与投照体位不恰当造成的假性脱位相鉴别.     

肩关节后脱位的CT诊断价值

近年来，本人收集了5例肩关节后脱位的CT检查结果，并与X线片对此分析诊断。 1 资料方法 1．1 临床资料 5例肩关节脱位患者中，男3例，女2例，最大年龄65岁，最小年龄20岁，CT检查前摄肩关节正位片，复位后进CT扫描，了解复位情况。     

介绍一种肩部外伤摄片方法

中国误诊学杂志社编辑部 :　　在肩外伤患者中 ,常规 X线摄片 ,肩锁关节半脱位易被漏诊 ,常不能明确诊断 ,我们通过下面的摄片方法 ,用于临床 ,效果良好。肩锁关节脱位多为暴力引起 ,此关节的稳定依赖肩锁和喙锁两条韧带 ,肩锁、喙锁两韧带都破裂时 ,肩锁关节全脱位 ,外部畸形明显 ,X线照片 ,肩峰与锁骨距离增大 ,诊断不难 ;当仅肩锁韧带破裂时 ,患者肩部症状不甚明显 ,急性期局部压痛 ,轻度肿胀 ,肩关节前后侧 X线片 ,肩峰与锁骨间距离增大不明显 ,常误诊为正常予以处理。我们在诊治肩部外伤患者时 ,对肩峰局部外伤疼痛 ,但外观畸形不明…     

加摄X线侧位片对手、足骨折和脱位的诊断价值

手、足部骨折、脱位是一种较常见的损伤,常用X线正、斜位摄片来作出诊断,但仍有部分骨折、脱位在常规X线正侧位难以显示．临床上常用CT检查来明确诊断,费用较为昂贵。本次研究采用加摄x线侧位,也能满足对手、足骨折、脱位的诊断需要,可部分替代CT检查的作用。报道如下。     

锁骨改良腋位DR摄片在锁骨中段骨折诊断中的应用价值

目的探讨锁骨改良腋位DR摄片在锁骨中段骨折诊断中的应用价值。方法对105例锁骨外伤高度疑似骨折的患者分别行锁骨正位、改良腋位DR摄片,统计锁骨内侧段、中段、外侧段骨折数目,对锁骨正位、改良腋位片与单纯的锁骨正位片间进行各段骨折检出率的对比分析。结果 105例锁骨外伤患者经X线DR摄影或CT检查发现证实锁骨骨折97例,其中锁骨正位发现骨折80例;锁骨正位加改良腋位摄片多发现锁骨骨折17例,其中锁骨中段的骨折16例。锁骨中段骨折检出率经χ2检验,P<0.05,差异有统计学意义。结论锁骨正位加摄锁骨改良腋位可明显提高锁骨中段骨折的检出率。     

肋骨骨折X线检查漏诊45例分析

目的 探讨胸部外伤后肋骨骨折漏诊的原因及避免漏诊的措施,旨在提高肋骨骨折的X线诊断准确率.方法 对45例128根肋骨骨折患者的X线检查(包括胸部正斜位片、患侧肋骨痛点切线位片,患侧肋骨多轴位透视下点片及3周后的复查)进行分析.结果 胸部正位片正确诊断89根肋骨骨折,检出率为69.5％;胸部正位片加患侧肋骨痛点切线位片正确诊断115根,检出率为89.8％;胸部正位片加患侧肋骨多轴位透视下点片正确诊断120根,检出率为93.7％;胸部正位、切线位片加患侧肋骨多轴位透视下点片正确诊断124根,检出率为96.8％.结论 单一胸部正位片诊断肋骨骨折漏诊率较高,诊断肋骨骨折一定要多体位摄片结合不同时间复查摄片加上认真负责的摄片及逐根的仔细观察,才能最大限度的减少肋骨骨折的漏诊.     

双手持重物双侧对比诊断肩锁关节脱位的价值

目的:研究双手持重物双侧对比摄片对肩锁关节脱位的诊断价值。材料与方法:对100例肩锁关节脱位病人均采取拍摄患侧肩关节正位片、双肩关节正位对比片和双手持重物双肩关节对比片,对比、分析其影像特征。结果:双手持重物双侧对比对肩锁关节脱位诊断准确率高,特异性强,明显优于其它两种方法,能为临床提供有价值的诊断治疗依据。     

一种新型肩关节半脱位矫形器的设计及其3D打印成品的应用

摘要 目的：为脑损伤后肩关节半脱位的防治设计一款新型矫形器。 方法：利用3D打印技术设计和打印一套防治肩关节半脱位的新型矫形器——肘前臂托,并将此肘前臂托与传统的肩吊带应用于脑卒中后伴有肩关节半脱位的患者。采用自身对照的设计方法,对患者分别佩戴肘前臂托与传统的肩吊带,并分别在佩戴前、佩戴后即刻以及佩戴后30min拍摄半脱位肩关节坐位下的正位X线片,测量X片肩峰下缘至肱骨头中心的垂直距离和水平距离,比较这2种矫形器对肩关节半脱位的复位效果。 结果：对于脑卒中后出现肩关节半脱位患者,佩戴这2种矫形器后的即刻均可以达到复位目的,30min后传统肩吊带的复位作用明显减弱,佩戴肘前臂托的复位仍然有效。肘前臂托支撑稳定,持续时间长,佩戴舒适。 结论：基于3D打印技术研制的此款肘前臂托设计可行,测试效果好,为脑卒中后肩关节半脱位的临床治疗提供了新的思路。     

肋骨骨折的诊断流程和方法

目的总结肋骨骨折的影像诊断方法及流程,以减少漏诊。方法对我院2007年10月至2009年5月100例肋骨骨折患者进行回顾性分析,利用胸部转位透视、胸部X线摄片检查及胸部CT检查。结果单纯行胸部正位检查发现肋骨骨折40例,胸部转位透视加摄片明确肋骨骨折诊断90例,对临床症状明显而X线检查阴性者进一步做CT检查,明确肋骨骨折4例,但发现肺部挫裂伤5例,气胸3例,液气胸3例,胸腔积液5例。结论胸部外伤肋骨骨折诊断要结合临床体征,采取胸部转位透视加摄片,必要时做胸部CT的规范影像检查流程以减少肋骨骨折的漏诊。     

肩关节后脱位反Hill-Sachs损伤X线片、多层螺旋CT诊断

目的:回顾性分析反Hill-Sachs损伤X线、多层螺旋CT(MSCT)表现。材料与方法:20例因外伤致肩关节后脱位患者,19例行X线检查,11例行MSCT检查。测量X线片、MSCT肱骨头压缩性骨折塌陷深度。结果:18例(90%)肩关节后脱位病例出现肱骨头反Hill-Sachs损伤。X线片测量18例肱骨头压缩性骨折平均塌陷深度为(9.00±6.75)mm。同时行X线和MSCT病例组10例X线正位测量肱骨头压缩性骨折平均塌陷深度为(9.64±7.99)mm;MSCT测量肱骨头压缩性骨折塌陷深度为(17.18±10.50)mm,CT测量反Hill-Sachs损伤肱骨头关节面塌陷深度更为准确。反Hill-Sachs损伤和年龄不存在相关关系。"槽线征"出现12例(63.2%),关节面局部凹陷出现4例(21.1%)。CT显示反Hill-Sachs损伤轻度3例,中度5例,重度3例。3例反Bankart骨性病变。结论:肱骨头内侧"槽线征"及关节面凹陷是诊断肩关节后脱位及反Hill-Sachs损伤的重要征象,MSCT能够全面观察肩关节后脱位中肱骨反Hill-Sachs损伤、反Bankart骨性病变及骨性关节炎,对指导临床制定...     

Bilateral posterior shoulder dislocations

Bilateral posterior shoulder dislocation is an uncommon complication of seizure activity. It may initially present in a manner that suggests other clinical entities. A case is reported of a man with blood pressure differences in his upper extremities after his first seizure who was found to have bilateral posterior dislocations of the shoulders.     

漏诊肩关节后脱位的治疗探讨

目的 探讨肩关节后脱位的相关诊断方法的意义和治疗效果。方法 对7例漏诊的肩关节后脱位进行创伤系列X线和CT扫描检查，根据伤后延误时间，临床症状和影像学检查结果选择治疗方法，行早期闭合复位4例；陈旧性脱位的3位显示3例肩关节后脱位；CT和腋窝位X线检查同时显示伴随骨折，随访3-6年，闭合复位者，UCLA评分32-35分，切开复位者，UCLA评分14分；未予复位者，UCLA评分22分，结论 临床对该症认识不足是造成漏诊的主要原因，早期闭合复位可取得肩关节功能恢复的良好效果。     

Injury to the anteroinferior glenohumeral capsule during anterior dislocation

Background

Glenohumeral dislocation commonly results in permanent deformation of the glenohumeral capsule. Knowing the location and extent of tissue damage may aid in improving diagnostic and repair procedures for shoulder dislocations. Therefore, the objectives of this study were to determine: (1) the strain in the anteroinferior capsule at dislocation and (2) the location and extent of injury to the anteroinferior capsule due to dislocation by quantifying the resulting non-recoverable strain.

Methods

A robotic/universal force–moment sensor testing system was used to anteriorly dislocate six cadaveric shoulders. The magnitude of the maximum principle strain at dislocation and the resulting non-recoverable strain due to dislocation in the anteroinferior capsule were measured by tracking the change in the location of a grid of strain markers from a reference position.

Findings

The glenoid side of the capsule experienced higher strains at dislocation than the humeral side. The greatest strains at dislocation were found on the glenoid side of the anterior band (strain ratio of 0.60), but the greatest non-recoverable strains were found in the posterior axillary pouch (strain ratio of 0.34 on the glenoid side and 0.31 on the humeral side).

Interpretation

These findings suggest that even though the glenoid side of the anterior band undergoes more deformation during anterior dislocation, the most permanent deformation occurs in the posterior axillary pouch, and surgeons should consider also plicating the posterior axillary pouch when performing repair procedures following anterior dislocation. In the future, the mechanical properties of the normal and injured glenohumeral capsules will be compared.     

Schulterinstabilität bei Epilepsie

Glenohumeral instability due to epilepsy is usually considered to be of the posterior type. In the literature, however, inconsistent data on the predominant direction of instability caused by epilepsy is provided. The largest reported series of 34 shoulders in 26 patients with primary dislocation caused by epileptic seizures showed a comparable incidence of anterior and posterior instability. We report the case of a 26-year-old woman with epilepsy and instability including hyperlaxity of both shoulders known since childhood who presented with a recurrent dislocation of the right shoulder after a fall downstairs. Clinical and radiological evaluation revealed unidirectional anteroinferior shoulder instability with hyperlaxity (type B3 according to Gerber). Thus, arthroscopic stabilization had to be considered. As pharmacological treatment of epilepsy was insufficient so far, conservative treatment was recommended including optimizing anticonvulsive medication and scapulothoracic dyskinesia. Four months later, symptoms of anterior instability had only slightly improved, and arthroscopic anteroinferior and posteroinferior stabilization was performed. Intraoperatively, a partial lesion of the anteroinferior labrum, a superficial Hill-Sachs lesion and extensive enlargement of the anterior and posterior capsular volume were found. In patients with shoulder instability due to epilepsy, recognition of unidirectional anterior instability with hyperlaxity is of importance regarding the high risk of recurrent instability.     

Manubriosternal Joint Dislocation: An Unusual Risk of Trampolining

Background: Manubriosternal joint (MSJ) dislocation is a rare but potentially serious injury that can be associated with concurrent injuries to ribs, lungs, or myocardium. Two distinct types of MSJ dislocation have been described in the literature: type I, involving posterior dislocation of the sternum due solely to direct trauma; and type II, involving the sternum being pushed anteriorly as a result of indirect trauma. Until now, the relationship between the nature of the forces acting on the sternum and the type of MSJ dislocation that results has been absolute, whereby indirect forces never cause a type I dislocation, and direct forces never result in a type II dislocation. Objectives: To describe a case demonstrating that type I MSJ dislocation can occur without direct trauma. Case Report: A 14-year-old boy developed sternal pain accompanied by an audible crack while executing a maneuver on a trampoline that required hyperflexion of the thorax. A lateral chest radiograph demonstrated a type I manubriosternal dislocation normally associated with direct trauma, as opposed to the more typical type II dislocation pattern one would expect to find in a hyperflexion injury. Conclusion: MSJ dislocations are classified into two groups, depending on the position of the sternum in relation to the manubrium. Each type of dislocation has been ascribed to either direct forces (for type I dislocation) or indirect forces (for type II dislocation). This case highlights that it is possible to have a type I dislocation in the absence of any direct sternal trauma.     

四钉头架在颈椎后路手术中的应用

目的探讨四钉头架在颈椎后路手术中的应用价值与护理体会。方法应用四钉头架作术中体位颈椎后路手术15例,观察其体位固定的确切性,操作与护理的灵活性,手术时间,出血量,术中并发症的发生率。结果15例手术中体位固定确切,操作灵活,护理方便,手术时间2～4.5h,出血量230～650ml,术中无并发症的发生。结论四钉头架在颈椎后路手术体位固定中固定确切,操作灵活,护理方便,安全可靠,值得推广。     

Bilateral anterior dislocation of the shoulder following a grand-mal convulsion

Bilateral dislocation of the shoulders is an uncommon event. The majority are posterior and occur during a seizure, electrical shock or electroconvulsive therapy, and in patients with neuromuscular disorders and psychiatric disturbances. The literature contains only eight cases of traumatic bilateral anterior dislocations. This report describes only the second case sustained during a grand-mal convulsion.     

Analyzing shoulder translation with navigation technology

Purpose

Asymmetric stress imposed on the shoulder can lead to anterior shoulder instability in young athletes who perform repetitive overhead motions. A common treatment, surgical anterior capsule tightening, assumes that the instability is caused by abnormal anterior laxity. This study investigated the possibility that one element of overall imbalance, posterior capsular tightness, could be an underlying reason for shoulder instability. Surgical navigation technology, which is more accurate than whole-body motion-capture systems, was used to study anterior translational motions.

Method

The study was used four cadaver shoulders, with the scapula and rotator cuff muscles intact. Opto-electronic surgical navigation localization devices were mounted on the scapula and humerus to accurately capture positions and orientations. The shoulders were passively moved through 7 motions, 5 of simple angulation and 2 combinations of clinical interest. Each motion was repeated in 4 different soft-tissue states: rotator cuff intact, capsule intact, and surgically induced capsular tightnesses of 5 and 10mm.

Results

The shoulders had significantly greater anterior translation when the posterior capsule was artificially tightened (p?<?0.05); this was particularly in movements that combined abduction with internal or external rotation, which are typical overhead sports motions. Overall translation was indifferent to whether the shoulders were intact or dissected down to the capsule, as was translation during flexion was indifferent to dissection state (p?>?0.95).

Conclusion

Surgical navigation technology can easily be used to analyze cadaveric shoulder motion, with opportunities for adaptation to anesthetized patients. Results suggest that the inverse of artificial tightening, such as surgical release of the posterior capsule, may be an effective minimally invasive treatment of chronic shoulder dislocation subsequent to sports motions.     

Is the anteroposterior cervical spine radiograph necessary in initial trauma screening?

The usefulness of the anteroposterior (AP) radiograph of the cervical spine in contributing to the diagnosis of cervical spine injuries in the acute trauma patient was examined in a retrospective study. All cases of cervical spine fracture or dislocation seen at a level I trauma center over a 3-year period and at a rehabilitation center over a 10-year period were reviewed. The lateral radiograph, open-mouth odontoid radiograph, and AP radiograph of each case were sequentially examined by a neuroradiologist (blinded to the original diagnosis) to determine the contribution of each view in making a diagnosis of cervical spine injury. Results of these reviews showed that there were no cases of cervical spine injury evident on the AP view without an obvious corresponding abnormality on the lateral or open-mouth view. It was concluded that the AP view could be dropped from the initial screening radiographic study of the cervical spine in the trauma patient. Only an adequate lateral view and open-mouth odontoid view would then be necessary to initially evaluate the cervical spine in the trauma patient, and decisions to obtain further studies could be based safely on only the lateral and open-mouth views.