喙突移位术治疗肩关节前脱位的生物力学研究进展

目的 对喙突移位术治疗肩关节前脱位的生物力学研究进展进行综述。方法 查阅国内外有关喙突移位术治疗肩关节前脱位的生物力学研究文献,总结研究进展。结果 当前研究结果表明,当进行喙突移位术时,应注意将骨块边缘与关节盂平齐,将其在矢状面上固定于关节囊发生破损的方向。若采用传统螺钉固定方式,则应采用双皮质螺钉固定,而螺钉材料等细节对生物力学特征影响较小。皮质纽扣固定作为一种新型固定方式,从单纯生物力学表现上略差于螺钉。术后喙突骨块最常发生骨吸收的部位为骨块近端内侧,分析可能与固定物导致的应力遮蔽有关。结论 目前对于喙突移位术骨块固定方式及固定物选择尚无详细的指导规范,临床上针对不同损伤程度下的最优治疗方案、术后骨愈合及骨重塑的影响因素、术后骨关节面压力等问题,仍需通过高质量生物力学研究进一步明确。     

前后对抗牵引法治疗肩关节前脱位

我院于1987年9月-2002年9月采用前后对抗牵引法，治疗肩关节前脱位，疗效满意，现介绍如下。     

牵引划弧法整复肩关节前脱位

自1996年以来,我们应用牵引划弧法整复肩关节前脱位32例,疗效满意.现总结报告如下.     

介绍肩关节前脱位的简易复位法

目的 为临床提供4种肩关节脱位手法整复的简便方法；为手术单人操作的顺利完成提供可靠保障，减少患者痛苦。方法 其要点是让患者侧坐在椅子上．患肩以“骑跨式”放在椅背之顶端，让椅背顶端将腋下顶起，使肱骨上端自然得到一种向外推挤的力量。结果 59例患者，酌情选用4种方法之一，均由一名术者单人操作完成．省时、省力、无并发症．患者易接受。结论 这四种肩关节复位法简便易行、效果可靠，患者痛苦少，术者容易理解和掌握。     

FARES法治疗肩关节前下脱位合并肱骨大结节骨折

[目的]评价Fares法与Hippocrates法治疗肩关节前脱位合并肱骨大结节骨折的疗效。[方法]采用回顾性研究方法,选取2007年3月~2015年12月因肩关节前脱位合并肱骨大结节撕脱骨折患者60例,其中男36例,女24例,手法复位分为FARES法治疗组与传统Hippocrates法治疗组,其中Fares法治疗组32例,传统Hippocrates组28例。对比分析两组患者复位时主观疼痛感觉、复位成功率、平均复位操作时间、复位后并发症等,并基于CT扫描评估肱骨大结节骨折块的位置。[结果]FARES复位法可更有效放松患者紧张肌群,减轻复位时痛苦,VAS评分明显低于Hippocrates组(P0.05);Fares法复位成功率93.75%(30/32)显著高于Hippocrates法的75%(21/28)(P0.05);FARES法复位平均操作时间3.07 min明显短于Hippocrates法的5.45 min(P0.05);并且复位术后并发症发生概率亦明显低于Hippocrates组(P0.01);两种方法复位后其肱骨大结节骨折块移位距离差异无统计学意义(P0.05),两者复位效果相当。[结论]FARES复位法可有效降低肩关节脱位合并肱骨大结节骨折复位时主观疼痛感,复位操作时间短、成功率高,复位后并发症发生率低;且复位后肱骨大结节骨折块位置与Hippocrates法相当。     

肩关节零度位法复位肩关节前脱位26例分析

肩关节前脱位临床常见,约占肩关节脱位的95%,不合适的复位方法会导致复位困难和产生各种并发症。2002年5月～2010年10月,我们采用肩关节零度位法(A组)复位肩关节前脱位26例,取得满意效果,并对照采用传统足蹬法(B组)复位肩关节前脱位22例,报告如下。     

悬吊牵引复位法治疗首次肩关节前脱位

2014 年6 月～2018 年12 月,我科采用悬吊牵引复位法治疗60 例首次肩关节前脱位患者,疗效满意,报道如下. 1 材料与方法 1. 1 病例资料 本组60 例,男24 例,女36例,年龄54 ～88 岁.均确诊为首次肩关节前脱位.     

复发性肩关节前脱位的关节镜下治疗

目的评价肩关节镜下治疗复发性肩关节前脱位的疗效。方法对25例肩关节单方向不稳定致复发性肩关节前脱位的临床资料进行分析,所有患者均采用锚钉进行肩关节镜下手术。结果本组获平均14个月的随访。肩关节功能术前和术后依据Neer评分系统分别为（76．2±3．6）、（90．0±2．8）分,差异有统计学意义（P〈0．01）。结论肩关节镜手术能有效治疗单方向不稳致复发性肩关节前脱位。     

难复位性肩关节脱位的手法治疗

我科自2001—2004年对7例难复性肩关节脱位采用改良足蹬法复位，取得满意效果，介绍如下：     

改进肩胛操作法治疗肩关节前脱位的临床体会

肩关节脱位在骨科门诊较常见，分前脱位和后脱位两种，其中以前脱位较多。为了纠正此种脱位，现在普遍使用的方法有Kocher手法和Hippocrates手法，还有悬垂牵引法(Stimson法)。以前两种手法常用，这两种手法都是向下牵引上臂，同时使上臂外旋及内收，使脱出的肱骨头引向关节盂而复位。这些手法操作比较复杂，病人痛苦，有时需要麻醉，并有发生骨折的可能。     

Painless reduction of anterior shoulder dislocation by Kocher's method

Kocher described his method of reduction of anterior shoulder dislocation in German, which was misinterpreted. A new element of traction was added which causes considerable pain. We present our experience with the original method in reducing 12 anterior shoulder dislocations without using sedation or anaesthesia. The original method is gentle, painless and requires neither sedation nor anaesthesia. Patient reassurance and confidence is essential. The patient initiates the movements, the surgeon just guiding him through the manoeuvre. It was successful in 10 dislocations. In two dislocations, the humeral head had to be gently guided laterally and superiorly into the glenoid using an index finger in the axilla. The method is easily reproducible after a demonstration. Patients can go home within a few minutes of the procedure.     

闭合复位治疗肩关节前脱位合并肱骨颈骨折

闭合复位治疗肩关节前脱位合并肱骨颈骨折广州市中医医院（５１０１３０）钟正仁作者自１９７９年至今治疗１０例肩关节前脱位合并肱骨颈骨折，８例闭合复位获得成功。现报告如下。临床资料１０例中男４例，女６例；年龄１３～６４岁；喙突下脱位３例，盂下脱位５例，锁骨...     

Posterior luxation of the shoulder joint and contralateral shoulder joint fracture dislocation: a rare combination

Summary The posterior luxation of the shoulder joint is a rarely reported and often not recognized lesion in the clinical workday. The authors present the first case of a posterior luxation of the shoulder joint in combination with an contralateral anterior shoulder joint fracture dislocation. In that case the authors stress the importance of an exact clinical and radiology diagnostic and the right way to reduce a posterior luxation of the shoulder joint. Finally they draw the readers attention to operative steps to prevent a reluxation of the shoulder joint.      

肩关节前脱位复位

2006年1月～2007年6月,笔者采用蹬肩外展牵引复位方法治疗新鲜肩关节前脱位25例,与牵引推拿法、Hippocrateri法等比较,优点明显。     

二人牵拉复位法治疗肩关节前脱位

自2003年8月-2005年9月，运用二人牵拉复位法、外敷内服药物等综合疗法治疗肩关节前脱位50例，疗效满意。     

先天性肩关节脱位并眩骨头发育不良1例

1病例资料 患儿，男，21d。出生后发现左侧上肢不活动，余肢体活动灵活，未引起患儿家长重视，但随时间增长，左上肢仍不能活动，来院就诊。查体，发育正常，营养良好，头颅及五官无畸形，颈部及甲状腺正常。     

Innovative use of computer-assisted tomography in the management of an irreducible anterior shoulder dislocation

Anterior dislocation of the shoulder is a common injury which is often reduced in the emergency department, without specialist orthopedic input. We report a case of an irreducible locked anterior glenohumeral dislocation with impaction of the humeral head onto the antero-inferior glenoid rim and subsequent generation of a Hill-Sachs lesion. To our knowledge, we describe the first reported case of using computer-assisted tomography to generate a sequence of movements to safely disimpact the locked dislocation without causing further iatrogenic injury or a fracture through the humeral articular surface. This novel image-assisted closed reduction technique spared the patient from the morbidity associated with performing open reduction surgery. At 6-month follow-up, the patient reported no re-dislocations, returned to work and had excellent range of motion.     

Bilateral irreducible inferior shoulder dislocation: A case report

IntroductionBilateral inferior shoulder dislocation is rare; but the dislocation is almost always reducible by closed means. We present a unique case of irreducible bilateral inferior shoulder dislocation.Presentation of caseA 35-year old male fell down from height. Direct axial loading while both shoulders were fully abducted resulted in bilateral inferior shoulder dislocation. All attempts of closed reduction failed. Open reduction revealed that the cause of irreducibility was the entrapment of the humeral head in a button-hole through the inferior joint capsule and the surrounding soft tissue envelope. At 6 months, there was almost full range of motion and no pain.DiscussionThe direct axial loading resulted in a narrow defect in the inferior joint capsule/soft tissue envelope; and this may have led to button-hole entrapment of the dislocated humeral head and irreducibility. Open reduction required widening of the button-hole while protecting the axillary neurovascular bundle.ConclusionWe present a rare case of bilateral irreducible inferior shoulder dislocation. We highlight the pathomechanics of irreducibility: button-hole entrapment of the humeral head. We emphasize technical tips during open reduction such as widening of the button-hole and protection of the axillary neurovascular bundle. The outcome is good although some limitation of shoulder abduction is to be expected.