肩周炎1次臂丛麻醉下多次手法松解临床研究

目的研究1次臂丛麻醉下3次手法松解治疗肩周炎的疗效。方法将120例肩周炎住院患者随机分为治疗组和对照组,治疗组为1次臂丛麻醉下,在麻醉药有效期内,实施3次手法松解术加功能锻炼治疗;对照组为臂丛麻醉下,1次手法松解术加功能锻炼治疗。采用疼痛视觉模拟评分法（VAS）,观察两组治疗前后疼痛程度变化;采用肩关节功能活动Melle评分,对两组治疗前后肩关节动作进行量化评分对比。结果治疗组治愈率为68.33%,对照组为48.33%,临床治愈率显著提高（P〈0.01）;治疗组治疗后的疼痛VAS评分比对照组均显著降低（P〈0.01）,其关节活动度改善的Melle评分比对照组均显著增高（P〈0.01）。结论 1次臂丛麻醉下不同时间3次手法松解术治疗肩周炎,比1次松解手法治疗治愈率明显提高,且疼痛VAS评分及功能Melle评分均有更多的改善。     

不同神经阻滞法用于锁骨骨折内固定麻醉效果观察

目的：观察颈丛神经阻滞、臂丛神经阻滞及颈丛臂丛神经联合阻滞麻醉用于锁骨骨折内固定术的麻醉效果。方法：选择行锁骨骨折内固定术60例,根据手术部位不同分为3组各20例。A组锁骨内1／z骨折,采用颈丛神经阻滞麻醉;B组锁骨外1／2骨折,采用臂丛神经阻滞麻醉;C组锁骨内外1／2骨折,采用颈丛臂丛神经联合阻滞麻醉。观察比较3组的麻醉效果及不良反应发生情况。结果：A组和c组麻醉优良率显著高于B组（P〈0．05）;A、C两组比较,差异均不显著（P〉0．05）。3组不良反应发生率比较,差异不显著（P〉0．05）。结论：锁骨内1／z骨折采用单纯颈丛神经阻滞,锁骨外1／z采用颈丛臂丛神经联合阻滞麻醉效果较好。     

颈浅丛联合肌间沟臂丛阻治疗锁骨骨折分析

目的：对锁骨骨折采用颈浅丛联合肌间沟臂丛阻治疗进行回顾性分析。方法：将我院收治的120例肩部及锁骨手术患者随机分为A、B两组,即肌间沟进路臂丛神经阻滞组（A组）、肌间沟进路臂丛颈丛神经阻滞组（B组）。采用1％利多卡因＋0．25％罗哌卡因复合液25～30mL行神经阻滞治疗。对术中的镇痛效果作对比分析。结果：B组术中56例镇痛效果显著,好于A组的38例（P〈0．05）。麻醉并发症比较无差异（P〉0．05）。结论：臂颈浅丛联合肌间沟臂丛阻用于肩部锁骨手术较单纯臂丛神经阻滞麻醉镇痛疗效显著,无并发症增加。     

复合麻醉下肩关节松解术联合玻璃酸钠治疗肩周炎的观察

肩周炎是肩部最常见的疾病,部分患者肩关节粘连严重,功能明显受限。以往在传统治疗方法上配合臂丛神经阻滞下行肩关节粘连松解术,除常因阻滞不全术中疼痛而影响松解效果外,还因肩部疼痛,功能锻炼受限,短期内2次粘连,治疗效果不够理想。我们采用异丙酚静脉麻醉复合臂丛神经阻滞     

改良锁骨上臂丛神经阻滞用于上肢骨科手术的临床观察

目的探讨改良锁骨上臂丛神经阻滞用于上肢骨科手术的可行性。方法120例ASAⅠ～Ⅱ级择期行上肢骨科手术（肩关节及肩关节以下手术）的患者,随机分为改良锁骨上臂丛麻醉组（A组）和肌间沟臂丛麻醉组（B组）,观察不同的臂丛神经阻滞法的麻醉效果、阻滞范围、对止血带的耐受及麻醉并发症的发生情况,比较两组间的入针深度、止血带痛发生率、麻醉操作时间以及感觉运动的阻滞成功率。结果A组止血带痛的发生率明显少于B组（P〈0.05）,A组正中神经、桡神经、尺神经、肌皮神经的感觉阻滞成功率明显高于B组（P〈0.05）,A组运动阻滞的成功率也明显高于B组,B组有尺神经阻滞不全的例数,而A组则没有1例阻滞不全的情况,两组均无气胸和局麻药中毒。结论改良锁骨上入路臂丛神经阻滞成功率高,麻醉效果好,可以安全有效地应用于上肢手术的临床麻醉。     

中西医结合疗法在肩周炎治疗中的疗效分析

目的探讨中西医结合疗法在肩周炎治疗中的临床疗效。方法选取2012年4月-2013年4月收治的肩周炎患者100例,随机分为观察组和对照组,每组各50例。对照组患者给予西医治疗,观察组患者给予中西医结合治疗,治疗4周后比较两组的临床疗效。结果治疗4周后,所有患者的肩关节各活动度、VAS评分均显著优于治疗前（P〈0．05）,且观察组改善程度显著优于对照组（P〈0．05）。观察组治疗总有效率显著优于对照组,差异有统计学意义（P〈0．05）。结论中医西结合疗法治疗肩周炎较单纯西医疗法更为有效,可有效改善肩周炎患者肩关节疼痛及活动障碍,值得临床推广。     

颈5加颈7肌间沟臂丛神经阻滞效果观察

目的：观察C5＋C7肌间沟臂丛神经阻滞的效果。方法：选择上肢手术180例，ASAⅠ或Ⅱ级，随机分为Ⅰ、Ⅱ、Ⅲ三组，每组各60例。术前均肌注阿托品0．5mg，咪达唑仑0．15mg／kg体重。局麻药均为2%利多卡因10ml＋0．75％布比卡因10ml＋0．9％氯化钠注射液10ml。Ⅰ组（C6水平）、Ⅱ组（C7水平）分别注入局麻药30ml，Ⅲ组（C5和C7水平）在每个穿刺点注入局麻药15ml，阻滞结束后按压两点间部位5min。比较三组麻醉效果、生命体征和不良反应发生率。结果：Ⅰ、Ⅱ、Ⅲ组麻醉优良率分别为66．7％、75．0％和94．6％，Ⅲ组麻醉效果优良率明显高于Ⅰ组和Ⅱ组（P〈0．01）。三组均未发生严重并发症，Horner综合征发生率三组比较，差异不显著（P〉0．05）。结论：与传统C6、C7水平肌间沟臂丛神经阻滞相比，C5＋C7肌间沟臂丛神经阻滞麻醉效果更为安全、有效。     

不同浓度罗哌卡因用于肌间沟臂丛阻滞的临床对比研究

目的：观察3种浓度罗哌卡因肌间沟臂丛阻滞的效果和不良反应。方法：84例择期行上肢手术患者，随机分为A、B、C、D4组，每组21例。分别采用0．25％、0．375％、0．5％浓度罗派卡因和0．25％布比卡因行肌间沟臂丛神经阻滞。观察感觉神经、运动阻滞时间及阻滞程度、镇痛持续时间、不良反应。结果：B、C组感觉神经阻滞、运动阻滞和镇痛持续时间明显较A组延长（P〈0．05），B、C组运动阻滞程度明显较A组增强（P〈0．01）。结论：3种浓度罗哌卡因肌间沟臂丛阻滞均可满足手术要求，但0．375％罗派卡因更适合于肌间沟臂丛阻滞。     

神经妥乐平联合常规治疗对神经根型颈椎病疗效观察

目的：观察静脉推注神经妥乐平联合常规治疗对神经根型颈椎病的疗效。方法：选择神经根型颈椎病73例，随机分为观察组50例及对照组23例。对照组采用牵引、手法松动疗法等传统治疗；观察组在对照组治疗基础上加用静脉推注神经妥乐平治疗。以视觉模拟评分法对两组各治疗12天后的疗效进行评定。结果：观察组治愈40例（80．0％），显效8例（16．0％），好转2例（4．0％）；对照组治愈10例（43．5％），显效11例（47．8％），好转2例（8．7％）；两组比较，差异显著（P〈0．05）。结论：静脉推注神经妥乐平联合常规治疗神经根型颈椎病疗效满意。     

罗哌卡因和利多卡因臂丛神经阻滞麻醉效果观察

目的：观察0．3％罗哌卡因和1％利多卡因腋路和肌间沟两点臂丛神经阻滞的临床效果,为上肢手术提供更安全、有效、平稳的麻醉方法。方法：上肢手术80例,ASA工或Ⅱ级,随机分为两点法组和一点法组各40例。两点法组行腋路和肌间沟两点法臂丛神经阻滞,一点法组用1％利多卡因和0．25％布比卡因混合液在腋路或肌间沟一点法阻滞麻醉。观察两组感觉和运动阻滞起效及维持时间,评价麻醉效果和术者满意程度,并监测心率(HR)、血压(BP)、脉搏血氧饱和度(SPO2)。结果：两组感觉和运动阻滞起效及维持时间均无显著性差异(P＞0．05),而两点法组麻醉效果确切,无不良反应,术者及病人满意程度高,麻醉优良率95％,与一点法组72．5％比较有显著性差异(P＜0．05)。结论：两点法臂丛神经阻滞麻醉效果确切,血流动力学平稳,能满足上肢手术的需要,术者和病人满意程度高。     

Swimmer's shoulder

The shoulder is the joint most subjected to repetitive microtrauma in swimming. This results in clinical manifestations of subacromial encroachment. The anatomy, radiographic changes, clinical findings, and histopathology of this disease process are discussed. The role of conservative exercises used in prevention as well as the role of surgical decompression of the subacromial space is explained.     

Role of shoulder ultrasonography in the evaluation of the painful shoulder

The purpose of this study was to determine the accuracy of ultrasonography in the detection of rotator cuff tears. In a prospective study of 41 patients, the ultrasound results could be compared with the combined results of (CT) arthrography, arthroscopy and operation. The sensitivity of sonography in detecting partial and total rotator cuff tears was 86%, the specificity 91%, the positive predictive value 96% and the negative predictive value 73%. In spite of the relatively small size of this series, our results are comparable with those of most other studies. Based on these results, sonography can provide a non-invasive, rapid and inexpensive diagnostic method for screening patients with shoulder complaints. A disadvantage of the method is its long learning curve.     

MRI of shoulder trauma

Magnetic resonance imaging (MRI) is an invaluable tool for evaluating traumatic injuries of the shoulder. This article discusses MRI of shoulder trauma based on mechanism of injury. Acute direct traumatic injuries, acute indirect traumatic injuries, and repetitive microtraumatic injuries (impingement/traction) are discussed. Finally, common pitfalls in shoulder imaging are addressed.     

MRI of the shoulder

Magnetic resonance imaging of the shoulder is routinely used, especially in the evaluation of rotator cuff disease and glenohumeral instability. More recent studies have provided a more sophisticated understanding of what represents a pathologic rotator cuff. Similarly, there has been an increased focus on the role of the glenohumeral ligaments and their labral attachment sites in maintaining glenohumeral stability. There have been technical advances as well, including the increased use of magnetic resonance arthrography. In addition, newer studies have shed light on the pathophysiology of the long bicipital tendon and compression neuropathies involving the suprascapular and axillary nerves.     

Radiology of shoulder prostheses

This article is chiefly limited to the routine radiographic evaluation of shoulder arthroplasties and guidelines to their interpretation. Other imaging modalities for the evaluation of joint replacements are discussed elsewhere in this issue. The basic types of shoulder reconstructions and some of the shoulder replacement designs in previous and current use at The New York Orthopedic Hospital at Columbia Presbyterian Medical Center are illustrated, along with the indications and contraindications of the various types of reconstructions. Their complications and pertinent anatomy are included.     

MRI of the shoulder

Shoulder imaging is one of the major applications in musculoskeletal MRI. In order to analyze the images it is important to keep informed about anatomical and pathological findings and publications. In this article MRI technique, anatomy and pathology is reviewed. Technical considerations about MR sequences and examination strategy are only shortly discussed with emphasis on turbo spin echo and short T1 inversion recovery imaging. Basic anatomy as well as recent findings, including macroscopic aspects of the supraspinatus fat pad, composition of the supraspinatus muscle belly, and variability of the glenohumeral ligaments or coracoid ligament, are presented. Basic pathological conditions are described in detail, e. g. instability particularly problems in differentiating the various subtypes of labral pathology. Rotator cuff diseases are elucidated with emphasis on some rarer entities such as subscapularis calcifying tendinitis, coracoid impingement, chronic bursitis producing the double-line sign, prominent coraco-acromial ligament and the impingement due to an inflamed os acromiale.     

MRI of shoulder instability

The most unstable joint in the body, the glenohumeral joint is subject to many insults including microinstability, subluxation and dislocation. During the last two decades, MRI has allowed for direct visualization of many of the lesions related to instability, aiding in diagnosis as well as therapeutic planning and follow-up. This article reviews the use of MRI for shoulder instability and describes the different types of lesions associated with this disorder. Topics include technical considerations, the use of MR arthrography, normal anatomy and variants, labral and glenohumeral ligament pathology, and osseous lesions related to instability.