系统康复治疗对年轻肩关节脱位患者肩关节稳定性的作用

目的 对年轻患者肩关节脱位进行系统的康复治疗，以检验系统康复疗法疗效优于单纯固定的假设。方法 根据所采用的治疗方法，将43例40岁以下的急性肩关节脱位患者分成实验组23例，对照组20例。实验组患者进行包括关节活动范围锻炼、发展肩胛骨周围肌的肌力训练、发展肩袖肌的肌力、适度的外展、外旋锻炼及耐力训练在内的系统康复治疗。对照组只进行单纯固定后未经系统康复治疗。对两组患者的临床效果进行比较。结果 实验组复发率为17%（4/23），对照组复发率为45%（9/20），两组复发率比较差异有显著性意义（x^2=3.866,P&;lt;0.05）；随访结果显示肩关节ASES评分实验组为90.9&;#177;4.87，对照组为75.4&;#177;4.94，两组差异有非常显著性意义（t=9.94,P=2.99&;#215;10^-12&;lt;0.01）。结论 肩关节脱位年轻患者进行系统的康复锻炼，可以提高患肩的稳定性。     

滑轮吊环训练对重度肩锁关节脱位锁骨钢板固定术后患者的防粘连作用

肩锁关节脱位的手术方法较多,有肩锁韧带关节囊缝合术,肩锁关节克氏针固定术,近年来又多采用克氏针张力带固定。但多数方法不十分理想,一方面因固定欠牢固,均需在术后一段时间内限制活动,早期不能进行康复练习,而出现肩关节的功能障碍;另一方面肩关节活动锻炼时,在局部产生的剪切力容易导致克氏针、张力带钢丝移位,甚至疲劳断裂,使复位失败。Ⅲ度肩锁关节脱位应用Wolter-锁骨钢板(以下简称W-钢板)固定效果可靠,为患者能早期进行肩关节功能康复锻炼提供了保证,肩关节康复手段的早期介入又是该手术成功的关键。     

脑卒中患者肩关节半脱位的康复护理

目的探讨康复护理对脑卒中患者肩关节半脱位的影响.方法47例脑卒中合并肩关节半脱位患者,通过正确肢体摆放、纠正肩胛骨位置、促进肩关节周围稳定肌的恢复和维持肩关节活动等措施进行康复护理.在治疗前后进行肩关节半脱位的测量和ADL评定.结果47例患者治疗前后肩关节半脱位和能力明显改善.结论康复护理有效预防和治疗肩关节半脱位.     

肩锁钩钢板治疗肩锁关节脱位

目的：探讨治疗肩锁关节脱位的方法.方法：采用肩锁钩钢板治疗新鲜完全的肩锁关节脱位30例,并随访6～18个月,平均8个月. 结果：按照Lazzcano标准判定本组疗效优28例,良2例.结论：利用肩锁钩钢板治疗肩锁关节脱位固定牢靠,并发症少,肩关节功能恢复良好,值得推广应用.     

全关节镜下双纽扣钢板固定技术治疗急性肩锁关节脱位的康复护理

目的探讨应用全关节镜下双纽扣钢板固定技术治疗急性肩锁关节脱位的康复护理。方法2007年8月至2009年3月,对8例肩锁关节脱位的患者进行肩关节镜下双纽扣钢板固定技术行喙锁韧带重建,术后制定系统的康复护理计划、分阶段进行肢体功能康复锻炼,在确保安全的前提下督促患者尽早进行主动和被动功能锻炼,定期随访。术后3个月、6个月和1年分别进行随访,用Constant评分和疼痛视觉模拟评分（VAS评分）进行疗效评价,并拍摄X线片确定有无再发脱位及半脱位。结果8例患者均获得3个月以上随访,平均7．2个月。术后3个月Constant评分平均为93．9分,VAS评分平均为1．75分,其中1例仍有肩锁关节疼痛,肩关节活动范围轻度受限;术后6个月时所有患者均无明显疼痛,对肩关节功能均满意,X线片显示无再发脱位。结论肩关节镜下应用双纽扣钢板固定技术行喙锁韧带重建术是治疗肩锁关节脱位的一种有效方法,术后的康复治疗与手术同等重要,完善的术后康复计划是肩关节达到良好功能恢复的必备条件,也是提高患者满意度的重要措施。     

充气式肩吊带对偏瘫后肩关节半脱位的疗效

目的观察充气式肩吊带对偏瘫后肩关节半脱位的治疗作用。方法将68例脑卒中偏瘫伴肩关节半脱位的患者分为治疗组和对照组各34例。两组患者均接受常规康复技术治疗肩关节半脱位,治疗组患者在此基础上佩戴充气式肩吊带。治疗前后根据X线片测量双侧肩峰与肱骨头间距(AHI),进行Fugl-Meyer运动功能评定,视觉模拟评分(VAS)评定肩痛。结果治疗8周后,与对照组相比,治疗组的复位率及总有效率无显著性差异(P>0.05);治疗组肩痛发生率、VAS评分、患侧上肢Fugl-Meyer运动功能评分优于对照组(P<0.05)。结论在常规康复治疗的基础上,加用充气式肩吊带治疗偏瘫后肩关节半脱位,可减少肩痛的发生,减轻肩痛程度,有利于提高偏瘫上肢运动功能。     

肩锁关节钢板治疗肩锁关节脱位疗效分析

目的:研究肩锁关节钢板内固定在TossyⅡ、Ⅲ型肩锁关节脱位患者中的治疗效果。方法:应用肩锁关节钢板内固定手术治疗TossyⅡ、Ⅲ型肩锁关节脱位患者87例,观察患者的疗效、软组织修复及术后反应。结果:肩锁关节钢板能够牢靠固定错位的肩锁关节,使脱位关节保持复位状态,同时促进损伤结构的重建及患者运动功能恢复。结论:肩锁关节钢板内固定术的疗效显著,易于操作,能够最大限度地保留正常结构的生理功能,适宜于治疗中重度肩锁关节脱位患者,值得临床推广应用。     

可吸收螺钉治疗肩锁关节脱位

目的分析观察可吸收螺钉治疗Ⅲ度肩锁关节脱位的治疗效果。方法对Ⅲ度肩锁关节损伤用1枚可吸收螺钉固定锁骨、喙突,同时用可吸收线修复喙锁、肩锁韧带。结果本组15例,术后平均随访12·5月,根据Herscovci标准评定,优9例,良6例。结论可吸收螺钉早期为韧带修复提供足够时间的稳定环境,随着螺钉强度的逐渐丢失,韧带承载不断增加的生理应力,直至完全恢复正常强度。该手术方法简单,创伤小,可免除二次手术,优良率高,是一种可行的符合肩部解剖生理状态的手术方法。     

对肩关节周围炎患者实施中医康复治疗的方法

目的：通过分析中医药防治肩关节周围炎（简称肩周炎）的方法，指导肩周炎患者的康复治疗。方法：归纳总结中医对肩周炎的辨证施治，以及饮食调养、药膳、中成药、验方、外治法、功能锻炼、日常保健等防治措施。结果：①按中医肩周炎可分为风寒湿型，治疗原则为祛风散寒，通络止痛；瘀滞型，治疗原则为活血化瘀，通络止痛；气血虚型，治疗原则为益气养血，祛风通络。②饮食调养包括葛根、鳝鱼、海马、甲鱼。③药膳有当归煮蛋、桑枝炖鸡、芪归炖鸡、归参羊肉汤、桂枝苡仁粥、仙茅五加粥、海马山甲酒、葛根黑豆酒、黄芪当归酒。④中成药有伸筋丹、风湿寒痛片、痹苦乃停片、痹隆清安片、昆明山海棠片、风痛安胶囊、祛风止痛胶囊。⑧验方包括玉竹汤、羌活汤、桂枝四物汤、黄芪桂枝汤、祛风宣痹汤、桑枝羌活饮、祛痰通痹饮。⑥外治法包括热熨法、外敷法、淋洗法、膏药法。⑦根据自身的情况可进行屈肘甩手、手指爬墙、体后拉手、展翅。后伸摸棘、梳头等交替功能锻炼。结论：中医药防治肩周炎有规范的诊断标准和防治措施，在肩周炎的治疗康复中发挥着重要的作用．     

陈旧性肩锁关节脱位20例手术治疗分析

目的：探讨Dewar手术合并锁骨钩钢板治疗完全性陈旧性肩锁关节脱位的治疗疗效。方法：对20例完全性陈旧性肩锁关节脱位在Dewar手术原有基础上附加锁骨钩钢板固定肩锁关节。结果：随访肩关节功能1-4 a（平均1.8a）,优良18例,满意2例,肩锁关节外形正常。结论：Dewar手术合并锁骨钩钢板治疗完全性陈旧性肩锁关节脱位是一种简单,有效切实可行的治疗方案。     

肩关节镜手术治疗青年初次肩关节前脱位的临床疗效分析

目的 探讨肩关节镜手术与传统保守方法治疗青年患者初次肩关节前脱位的临床疗效.方法 前瞻性纳入2012年-2016年在该院就诊的青年肩关节前脱位患者,共80例.其中,男49例,女31例,年龄18～40岁,平均(28.61±9.62)岁,所有患者入组前签署知情同意书,将患者随机分为A、B两组,每组各40例,A组采用肩关节镜...     

脑卒中偏瘫所致肩关节不全脱位的早期康复

Uncomplete dislocation of shoulder after stroke was also known as glenohumeral semiluxation,an important complication of paralysis.The incidence of retarded paralysis of upper went up to 60％～ 73％ [1].In the current study,early anti－ spasticity,sling and protecting techniques were used for paralytic patients. 1 Subject and Method 1.1 Subject Outpatients and inpatients with glenohumeral semiluxation from 1995～ 2000 were included(n=420) in the current study,120 patients with uncomplete disl…     

关节镜下缝线桥技术治疗老年创伤性肩关节脱位合并肩袖损伤的疗效评价

目的比较关节镜下缝线桥技术肩袖修补与保守方法治疗老年创伤性肩关节脱位合并肩袖损伤的疗效。方法前瞻性研究2010年8月-2013年8月采用关节镜下缝线桥技术肩袖修补或保守方法治疗老年创伤性肩关节脱位合并肩袖损伤患者共63例,根据患者治疗方法将其分为关节镜下缝线桥技术肩袖修补治疗组(手术组)和保守方法治疗组(对照组)。手术组完整随访30例,男16例,女14例;年龄66~83岁,平均74.5岁;参照DEORIO和COFIELD的分级标准,中撕裂27例,大撕裂3例。对照组完整随访30例,男17例,女13例;年龄65~82岁,平均74.2岁;参照DEORIO和COFIELD的分级标准,中撕裂27例,大撕裂3例。比较两组患者分组时、治疗1年后视觉模拟评分(VAS)、关节活动范围、简明肩关节功能测试(SST)评分、欧洲肩关节协会的Constant肩关节评分,并记录随访期间肩关节脱位复发例数。结果 60例患者获得至少1年的完整随访,手术组30例,对照组30例。分组时两组患者VAS评分、肩关节活动范围、SST评分、Constant评分组间差异无统计学意义(P0.05);随访1年时手术组患者的VAS评分、肩关节活动范围、SST评分和Constant评分均明显优于对照组,差异有统计学意义(P0.05)。随访期间手术组无肩关节脱位复发,对照组5例发生肩关节脱位复发,差异有统计学意义(P0.05)。结论采用关节镜下缝线桥技术肩袖修补治疗合并肩袖中、大型撕裂的老年创伤性肩关节脱位患者,可以明显改善患者肩关节功能,降低肩关节脱位复发率,长期随访结果有待进一步研究。     

Prereduction radiographs in clinically evident anterior shoulder dislocation

The main study objective was to determine if experienced emergency physicians can accurately identify a subgroup of patients with anterior shoulder dislocation for whom prereduction radiographs do not alter patient management. Our prospective study evaluated 97 patients who presented to 2 ski-hill clinics and to our rural emergency department with possible shoulder dislocation between November 1996 and May 1997. Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67.8%) of possible dislocation. All 40 cases were found to have a dislocation (100%; 95% Cl, 91.19% to 100%), and the prereduction radiograph did not affect management of the injury. Prereduction radiographs added 29.6 +/- 12.68 minutes to treatment. We conclude that shoulder dislocation is often readily apparent from history and physical examination. When the experienced emergency physician is certain of the diagnosis of anterior shoulder dislocation, prereduction radiography delays treatment and does not alter management.     

护肩带用于预防脑卒中患者肩关节脱位的临床观察

目的 探讨护肩带对脑卒中患者肩关节脱位的预防作用.方法 选择脑卒中偏瘫患者60例,分成观察组与对照组各30例,观察组在常规治疗及康复训练的基础上采用护肩带对患侧肩关节保护;对照组在常规治疗及康复训练基础上用三角巾及吊带托起患侧上肢.两组治疗前及治疗4周后,进行肩关节脱位测量及上肢运动功能评价比较.结果 治疗4周后, 两组肩关节脱位发生率分别为观察组13.3%、对照组30.0%,x2=4.32,P＜0.05;两组上肢功能评定得分和Barthel指数记分评定比较有统计学意义.结论 护肩带对脑卒中患者肩关节脱位有预防作用.     

The role of post-reduction radiographs after shoulder dislocation

We sought to determine whether post-reduction radiographs add clinically important information to what is seen on pre-reduction X-rays in Emergency Department (ED) patients with anterior shoulder dislocations. In this prospective, observational study, clinicians recorded preliminary pre-reduction and post-reduction X-ray readings on patients with shoulder dislocations. The films were subsequently reviewed by a blinded attending radiologist. Seventy-three patients presented to the ED with shoulder dislocations over an 18-month period; 55 of these patients had pre- and post-reduction X-rays and were included in the study. Eight of these patients had fractures seen on preliminary reading of post-reduction X-rays; one (1.8%, 95% confidence interval [CI] 0-9.7%) of these fractures was not seen on preliminary reading of pre-reduction films. On preliminary reading, all patients' shoulders were relocated on post-reduction X-rays (100%; 95% CI 93.5-100%). Forty of these patients had their X-rays read by a blinded attending radiologist. Sixteen fractures were seen on post-reduction X-rays, of which 6 (15.0%; 95% CI 5.7-29.8%) were not seen on pre-reduction X-rays. All patients (100%; 95% CI 91.2-100%) whose post-reduction films were read by blinded attending radiologists had shoulder relocation confirmed. In conclusion, although the majority (62.5%) of fractures associated with shoulder dislocations are seen on pre-reduction radiographs, more than one-third (37.5%) of fractures may be visible only on post-reduction X-rays. None of the fractures missed on pre-reduction X-rays changed patient management in the ED. There were no persistent shoulder dislocations found on post-reduction films.     

中青年急性非结石性胆囊炎48例保守治疗效果分析

目的探讨中青年急性非结石性胆囊炎保守治疗方法及效果。方法回顾性分析48例非结石性胆囊炎中青年患者的临床资料。结果经保守治疗治愈32例,有效15例,死亡1例,治疗有效率为97．9％。结论中青年急性非结石性胆囊炎保守治疗效果确切。     

Endovascular management of an axillary arterial injury post shoulder dislocation

Axillary arterial injury is a rare complication of non‐recurrent glenohumeral joint dislocation. Previously this type of injury would have required open exploration of the axillary artery with associated risk of iatrogenic injury to the axillary vein or brachial plexus. We present the case of a 75‐year‐old lady, who following a fall in her own home, sustained a dislocation of her right shoulder joint complicated by avulsion of a branch of her axillary artery. We describe the successful endovascular management of the injury using a self‐expanding stent and propose this as the preferred surgical option where the artery is not completely transected.     

Clinical outcomes of rehabilitation for patients following lateral patellar dislocation: a systematic review

ObjectivesLittle has been published about which physiotherapy interventions are used to treat patients with instability of the patella. The purpose of this study was to review the literature systematically to determine the clinical outcomes of rehabilitation for patients following a lateral patellar dislocation.Data sourcesAMED, CINHAL, Cochrane Library, EMBASE, MEDLINE, PEDro and Scopus database searches were performed from their inception to August 2009. A search of unpublished and grey literature databases was undertaken, in addition to contacting all authors of included publications.Review methodsAll publications presenting the outcomes of patients following a conservatively managed lateral patellar dislocation were included. All eligible articles were appraised critically using the Critical Appraisal Skills Programme appraisal tool. Data on interventions, cohort characteristics, outcome measures and results were extracted. A narrative research synthesis method approach was adopted.ResultsIn total, 29 publications were eligible for inclusion in this review. Although a proportion of patients experienced recurrent instability and dislocation episodes after rehabilitation, a large proportion of patients reported acceptable outcomes following physiotherapy. No randomised controlled clinical trials were identified assessing different physiotherapy interventions. The evidence base included a number of under-powered studies which poorly described the specific physiotherapy interventions prescribed.ConclusionsFurther, well-designed randomised controlled trials assessing different conservative management strategies with specific patient groups, to provide pre-intervention as well as follow-up data, are required to determine the optimal clinical outcomes of physiotherapy for patients following a lateral patellar dislocation.     

A neglected posterior fracture dislocation of the shoulder with ipsilateral distal humeral shaft fracture

Background: Cases of posterior dislocation or fracture-dislocation of the shoulder are rare. A combination of posterior dislocation and ipsilateral humeral shaft fracture, especially a distal third one, is even rarer. In such injuries, the diagnosis of shoulder dislocation may be missed because great attention is usually given to the fractured humerus. Objectives: We present this case report to raise awareness among emergency physicians of this manner of injury. Case report: We present a case report of a 30-year-old woman who had posterior fracture dislocation of the right shoulder with ipsilateral distal humeral shaft fracture. The shaft fracture was initially evaluated, internally reduced, and fixed, whereas the posterior fracture-dislocation of the shoulder was not recognized. A belated diagnosis was established 1 month after the operation, when a computed tomography scan was performed because the patient reported continuous pain and limited range of motion of the shoulder. A second reduction was performed to reduce the dislocation. The patient had partial functional recovery 1 year later. Conclusions: Consideration of this condition, coupled with thorough and appropriate physical and radiological examinations, could lead to improved recognition of such cases.