盂肱下韧带联合关节囊修复前下方盂唇完全缺失的临床应用

目的探讨关节镜下盂肱下韧带联合关节囊加强固定修复前下方盂唇缺失致复发性肩关节前脱位的方法和疗效。方法回顾性分析沈阳军区总医院骨科2014年6月至2016年10月在关节镜下应用盂肱中下韧带联合关节囊加强固定修复前下方盂唇完全缺失的患者23例,术中采用关节镜下带线锚钉缝合盂肱下韧带及关节囊于盂唇缺失部位。比较术前及术后Rowes评分、ASES评分、UCLA评分。结果术后未出现再脱位、感染等手术相关并发症,23例病例均获随访,随访时间12~42个月,平均(19.6±3.4)个月。患者平均肩关节外旋活动角度丢失(17.3±3.9)°,术后Rowes评分、ASES评分、UCLA评分均显著优于术前。结论关节镜下盂肱下韧带联合关节囊加强固定前下方盂唇缺失部分,可有效恢复肩关节前方稳定性,是治疗因前下方盂唇完全缺失引起慢性复发性肩关节前脱位的较好方法。     

改良弹性固定Latarjet术治疗伴明显关节盂骨缺损复发性肩关节前脱位的短期随访

背景：关节镜辅助下Latarjet术虽然是治疗伴有明显关节盂骨缺损所致前向不稳定的“金标准”,但存在较高的肩关节退变进展等并发症,采用关节镜下改良弹性固定Latarjet术近年来的临床效果较好,但多为个案报道,有必要深入评估改良弹性固定Latarjet术治疗伴盂骨缺损的复发性肩关节前脱位的疗效。目的：观察关节镜下改良弹性固定Latarjet术治疗伴盂骨缺损的复发性肩关节前脱位的早期疗效。方法：选择遵义医科大学附属医院2017年1月至2019年10月收治的伴明显关节盂骨缺损的复发性肩关节前脱位患者42例,均采用关节镜下改良弹性固定Latarjet术治疗。比较术前、术后目测类比评分、美国加州大学肩关节系统评分、美国肩肘外科协会评分、Rowe评分及Walch-Duplay评分,术后复查肩关节CT+三维重建及肩关节平片,评估骨块位置、肩盂缺损纠正程度、肩关节退变情况以及转位喙突愈合吸收等。结果与结论：(1)42例患者手术过程顺利,术后无神经、血管损伤等严重并发症,所有患者均接受随访,随访时间20-34个月;(2)患者术后10 d目测类比评分及末次随访美国加州大学肩关节系统评分、美国肩肘外科协会...     

关节镜下双排锚钉治疗肩关节前侧盂缘骨折的临床疗效观察

目的观察关节镜下双排锚钉修复肩关节前侧盂缘骨折的中长期临床疗效。方法自2011年5月至2014年2月,观察我院收治的19例肩关节盂前侧骨折患者,年龄在21~52岁,平均年龄34.9岁。所有患者采用双排锚钉缝合技术对移位的关节盂骨折进行复位,固定,采用视觉模拟评分法(Visual Analogue Scale,VAS)评分、Constant肩关节评分,ROWE肩关节功能评分,记录关节肩关节活动度,对比术前、术后随访数据评估其临床效果。结果平均随访时间为3.5年。VAS评分从术前7.3±1.4下降到1.4±0.7,明显缓解(t=6.332,<0.01),Constant评分由术前42.1±4.9,到术后89.8±5.4,有明显改善(t=5.827,P<0.01);ROWE评分由术前66.1±11.6,改善为91.7±3.6(t=8.305,P<0.01);关节活动度均有改善。结论关节镜下采用双排锚钉治疗关节盂前侧骨折,损伤小,解剖复位,固定牢靠,中长期效果满意。     

肩关节复发性前脱位的手术治疗

目的：探讨肩关节复发性前脱位手术治疗的术式选择的适应征及不同手术方法的临床疗效,以及术后康复治疗的方法.方法：对19例肩关节复发性脱位行手术治疗获得1a以上的术后随访的患者进行回顾总结,15例患者肩关节囊松弛、关节囊无严重破损者行Putti-Platt手术,4例患者肩关节囊前壁严重破损呈碎布条状,无法进行肩关节囊前壁修复和紧缩手术者行Bristow手术,关节功能按优、良、中、差进行评分.结果：本组19例患者术后1年肩关节功能优6例,良11例,中2例.结论：Putti-Platt术式能有效地增强肩关节前方的稳定性,适用于肩关节囊松弛、关节囊无严重破损患者,对于关节囊严重损伤无法进行肩关节囊前壁修复和紧缩的病例可采用操作较为复杂的Bristow手术.术后规范的固定和系统康复训练是保证手术疗效的重要环节.     

关节镜手术治疗合并Bankart损伤的初次肩关节脱位

目的探讨应用关节镜手术方法治疗初次肩关节脱位的临床疗效。方法回顾性分析2014年6月至2016年10月收治的35例初次肩关节脱位并行肩关节镜手术治疗患者的临床资料,所有患者均合并Bankart损伤,术中应用缝合锚钉修复撕裂的关节盂唇,术后早期随访并进行肩关节功能评分。结果 35例患者均术后随访1~6个月,平均3个月,术后随访肩关节稳定性及功能性情况,未再发生脱位。肩关节美国肩肘协会评分系统(ASES)和Rowe评分术后优于术前,差异有统计学意义(P0.05)。结论关节镜手术治疗合并Bankart损伤的初次肩关节脱位术中创伤小、术后肩关节功能恢复快,是肩关节初次脱位较好的治疗方式。     

关节镜下Fastin带线锚钉修复外侧半月板前角损伤

背景：Fastin锚钉已被广泛用于肩袖损伤、韧带损伤等治疗,但用于半月板修复方面国内报道较少。 目的：探讨关节镜下应用带线锚钉治疗外侧半月板前角损伤的方法和临床疗效。 方法：回顾性分析经MRI诊断并经关节镜下确诊外侧半月板前角损伤适合行缝合修复的22例患者的临床资料,所有患者行关节镜下带线锚钉固定缝合,通过症状、体征、Lysholm及国际膝关节评分委员会评分对其临床效果进行评价。 结果与结论：患者均获得随访,时间7-28个月(平均19.3个月),无严重并发症发生,Lysholm评分和国际膝关节评分委员会评分分别由治疗前的(45.20±7.47)分和(41.55±8.91)分升高到治疗后的(90.60±5.46)分和(91.85±1.09)分(P < 0.05),说明关节镜下应用带线锚钉治疗半月板前角损伤能够达到良好的临床效果。     

关节置换与关节镜下修复肩关节复发性前脱位伴重度骨缺损:3年随访对比

背景:随着外科技术、重建材料技术的发展,关节置换在肩关节脱位中也得到了广泛应用,特别是各种定制型或装配型假体使得置换适应证明显提高。目的:观察与随访关节镜与关节置换治疗肩关节复发性前脱位伴重度骨缺损的远期疗效。方法:纳入肩关节复发性前脱位伴重度骨缺损患者144例,根据随机抽签分为治疗组与对照组,每组72例。对照组行关节镜下内固定治疗,治疗组行关节置换治疗。通过电话调查与复诊完成3年随访,记录患者Neer肩关节功能评分、肩关节活动度及并发症发生情况。结果与结论:随访3年,治疗组的肩关节功能优良率90%明显高于对照组81%(P0.05)。两组3年随访时的前屈上举幅度都明显提高,而体侧外旋幅度明显降低,组内对比差异有显著性意义(P0.05);同时3年随访时治疗组的前屈上举与体侧外旋幅度与对照组相比差异有显著性意义(P0.05)。治疗组随访期间的切口感染、肩关节脱位、固定物松动等并发症发生率明显低于对照组(P0.05)。提示相对于关节镜下内固定治疗,关节置换修复肩关节复发性前脱位伴重度骨缺损在随访远期可明显改善肩关节功能及肩关节活动度,并发症少,从而有效重建肩关节。     

关节镜手术与保守治疗青年人群初次肩关节前脱位的临床疗效

目的 比较关节镜手术与保守方法治疗青年人群初次肩关节前脱位的临床疗效。方法 回顾性分析2010年1月~2013年7月我院64例诊断为急性初次肩关节前肩脱位的患者资料。其中32例患者行关节镜修复术为关节镜手术组,32例患者行保守治疗为保守治疗组,随访5年。比较两组WOSI指数评分,肩膀、手和手臂的残疾评分。结果 保守治疗组23例患者在5~18个月后发生再次脱位;关节镜手术组仅有2例患者在术后1年出现再次脱位。随访18个月后,关节镜手术组患者WOSI评分、DASH评分均高于保守治疗组,差异有统计学意义（P＜0.05）;末次随访显示,两组患者（包括复发性脱位进行关节镜稳定术患者）WOSI评分、DASH评分比较,差异无统计学意义（P＞0.05）。结论 关节镜手术治疗青年人群初次肩关节前脱位的复发率较低,患者肩关节稳定性较好,肩膀及手功能恢复较好。     

关节镜下膝内侧支持带紧缩外侧支持带松解治疗髌骨脱位

目的 　探讨关节镜下膝内侧支持带紧缩外侧支持带松解术在治疗髌骨脱位中的临床疗效。 方法 自2009 年3 月～2011年7月收治25 例25膝髌骨脱位,术前未接受过外科手术治疗。术中关节镜监视下松解外侧支持带并紧缩缝合内侧支持带。术后行正规康复训练。随访18～24个月,了解膝关节脱位复发情况及患膝功能恢复情况。 结果　术后无髌骨脱位复发,手术前后Lysholm 膝关节功能综合评分分别为（59.00±13.37）分和 （92.14±5.15）分（P＜0.05）;手术后影像测量对比髌骨适合角从术前（21.10±5.61）°纠正到（-1.70±7.41）°(P＜0.05);外侧髌股角从术前（-1.3±1.6）°纠正到（6.1±1.4）°(P＜0.05）,上述3项指标手术前后比较,均有统计学差异。 结论　关节镜辅助下膝内侧支持带紧缩配合外侧支持带松解术治疗髌骨脱位,手术创伤小,疗效满意。     

肩关节前下盂唇损伤非牵引下关节镜修复术的临床分析

目的探讨非牵引技术在肩关节前下盂唇损伤肩关节镜修复术中的应用效果。方法回顾性分析2009年1月至2015年1月我科收治的182例肩关节前下盂唇损伤患者的临床资料,年龄18~39岁,平均(26.5±9.3)岁;病程1~10年,平均(3.2±2.6)年;复发脱位6~62次,平均(24.2±17.3)次。在非牵引技术下进行了侧卧位肩关节镜下非骨性修复术,术后采用Rowes评分、UCLA评分系统进行疗效评价。结果 182例获6~18个月随访,平均(12.5±6.7)个月。12例术后外旋活动受限20°,无法参加对抗性训练,余170例能够参加对抗性训练。全部患者平均肩关节外旋活动角度丢失(10.5±4.1)°。术后UCLA评分(89±3.5)分较术前(25±6.2)分明显提高,差异具有统计学意义(P0.05);术后Rowes评分(28.7±2.2)分较术前(7.3±1.6)分明显提高,差异具有统计学意义(P0.05)。结论非牵引技术在训练伤致肩关节前下盂唇损伤肩关节镜修复术中的应用疗效满意,术中因无巨大的外力牵引从而保护了臂丛神经、血管等组织,有利于患者快速康复,值得在基层医院推广应用。     

Reflex connections from forearm and hand afferents to shoulder girdle muscles in humans

Using surface electromyographic recordings from the trapezius and serratus anterior muscles and percutaneous electrical stimulation of the median, ulnar and radial nerves, the reflex connections from forearm and hand afferents to these shoulder girdle muscles have been investigated in normal human subjects. Stimulation of the median, ulnar and radial nerves at the shoulder, elbow and wrist evoked late, excitatory reflexes in the upper and lower parts of trapezius and in serratus anterior. These reflexes are not evoked by stimulation of cutaneous afferents alone, since there was no response to stimulation of the distal cutaneous branches of these three nerves. Measurements of the conduction velocity of afferents of the median, ulnar and radial nerve evoking these reflexes gave a mean conduction velocity of approximately 50 m/s. The lowest stimulus intensities at which these reflexes could be evoked were found to be 0.3 times motor threshold (MT). By taking into account the reflex latency, the length of the conduction path and that the reflex was mediated by low threshold, fast conducting afferents, it is proposed that group I muscle afferents from the forearm or hand evoke a supraspinal reflex to trapezius and serratus anterior. It appears that the functional significance of these reflexes is to aid in the stability of the shoulder girdle. Electronic Publication     

Assessment of anterior shoulder instability by CT arthrography

Computed tomography (CT) immediately after double-contrast shoulder arthrography was taken in twenty-two young male patients with anterior shoulder instability including recurrent dislocation and subluxation. This recently developed technique called CT arthrography can provide significant information about patients with glenohumeral instability which is difficult to obtain by conventional arthrography. Information about glenoid labrum pathology is useful for proper management of the shoulder with instability. Lesions identified in this study include anterior labral defects (attenuation, tear, displacement), anterior capsular distension and/or detachment, Hill-Sachs lesion, anterior glenoid rim compression fracture, and fracture of scapula. This article describes the method used in CT arthrography of the glenohumeral joint, reviews the normal cross-sectional anatomy, and emphasizes the importance of the application of CT arthrography in the shoulder disorder with instability. CT arthrography of the glenohumeral joint is easy to perform, is accurate, and has lower radiation dose than arthrotomography.     

Scapular muscle activation and co-activation following a fatigue task

Scapular muscles precisely move the scapulothoracic articulation and if fatigued may contribute to pathology. Fatigue of serratus anterior may be a mechanism for shoulder pathology by altering scapula motions and requiring compensation by other shoulder muscles. A total of 28 asymptomatic subjects performed a task to fatigue the serratus anterior, while muscle activity was recorded from three muscles. Mean normalized activation levels and activation ratios were examined before and after the fatigue task during arm elevation and lowering. All muscles demonstrated meaningful declines in the median frequency of the electromyographic signal during the task. Following the task, only the upper trapezius had higher mean activation levels (mean difference 10.79% MVIC), while the serratus anterior/lower trapezius activation ratio was altered (mean difference −0.3). Higher mean upper trapezius activation may be compensatory for fatigue of other shoulder muscles and may reflect fiber type or central control mechanisms. Serratus anterior eccentric endurance training may be beneficial for the prevention of shoulder pathology.     

Changes in multi-segmented body movements and EMG activity while standing on firm and foam support surfaces

Postural control ensures stability during both static posture and locomotion by initiating corrective adjustments in body movement. This is particularly important when the conditions of the support surface change. We investigated the effects of standing on a compliant foam surface using 12 normal subjects (mean age 26 years) in terms of: linear movements at the head, shoulder, hip and knee; EMG activity of the tibialis anterior and gastrocnemius muscles and torques towards the support surface. As subjects repeated the trials with eyes open or closed, we were also able to determine the effects of vision on multi-segmented body movements during standing upon different support surface conditions. As expected, EMG activity, torque variance values and body movements at all measured positions increased significantly when standing on foam compared with the firm surface. Linear knee and hip movements increased more, relative to shoulder and head movements while standing on foam. Vision stabilized the head and shoulder movements more than hip and knee movements while standing on foam support surface. Moreover, vision significantly reduced the tibialis anterior EMG activity and torque variance during the trials involving foam. In conclusion, the foam support surface increased corrective muscle and torque activity, and changed the firm-surface multi-segmented body movement pattern. Vision improved the ability of postural control to handle compliant surface conditions. Several essential features of postural control have been found from recording movements from multiple points on the body, synchronized with recording torque and EMG.     

经皮导入内固定治疗肱骨近端骨折合并肩关节前脱位的力学分析

目的　通过力学分析研究经皮导入内固定方法治疗肱骨近端骨折合并肩关节前脱位的可行性。方法　实验分二部分进行：一是用尾部加压调角空心螺纹钉按手术操作进行拉脱试验，测定将螺纹钉从肱骨头内拉出所需最小力(P(下标 min))；二是利用生物力学测试机测定志愿者单纯肩关节前脱位麻醉下牵引复位所需的最大力(P(下标 max))。实验按年龄分为A、B两组，A组25~45岁，B组＞45岁。对两组测试数据进行数据分析。结果　当尾部加压调角空心螺纹钉拧入肱骨头20 mm时，螺钉自肱骨头内拉出所需最小拉力P(下标 minA)=284N，P(下标 minB)=198N，牵引复位单纯肩关节前脱位所需最大拉力P(下标 maxA)=206N，P(下标 maxB)=195N，通过比较极值，得出P(下标 min)>P(下标 max)，即牵引复位单纯肩关节前脱位所需最大拉力小于螺钉自肱骨头内拉出的最小拉力。结论　尾部加压调角空心螺纹钉对肱骨头的固定作用可满足经皮导入内固定治疗肱骨近端骨折合并肩关节前脱位过程中的要求。     

Rotator cuff muscles perform different functional roles during shoulder external rotation exercises

The aim of this study was to compare activity in shoulder muscles during an external rotation task under conditions of increasing arm support to investigate whether changing support requirements would influence muscle recruitment levels, particularly in the rotator cuff (RC) muscles. Electromyographic recordings were collected from seven shoulder muscles using surface and indwelling electrodes. The dominant shoulder of 14 healthy participants were examined during dynamic shoulder external rotation performed at 90° abduction with the arm fully supported, partially supported, and unsupported. Linear regressions between arm support load and the averaged muscle activity across participants for each muscle showed infraspinatus predominantly contributing to rotating the shoulder whilst supraspinatus, deltoid, upper trapezius, and serratus anterior were predominantly functioning in support/stabilization roles. During dynamic shoulder external rotation in mid‐range abduction, the RC muscles perform different functional roles. Infraspinatus is responsible for producing external rotation torque, supraspinatus is playing a larger joint stabilizer role, and subscapularis is contributing minimally to joint stability. The results also indicate that increasing support load requirements during an external rotation task may be a functionally specific way to retrain the stabilization function of axioscapular muscles. Manipulating joint stabilization requirements while maintaining constant rotational load is a novel method of investigating the differential contribution of muscles to joint movement and stabilization during a given task. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

肩胛骨前后联合入路治疗陈旧性浮肩损伤（附6例报告）

目的：探讨肩胛骨前后联合入路治疗陈旧性浮肩损伤的临床疗效。方法：采用肩胛骨前后联合入路对6例陈旧性浮肩损伤进行手术治疗。结果：根据Herscovici功能评估标准，其中优1例，良2例，可3例，无血管神经副损伤。结论：采用肩胛骨前后联合入路处理陈旧性浮肩损伤，术野显露清楚，易于操作与复位固定，可以有效地避开血管神经，安全可靠。     

联合肌腱转位手术对肩关节稳定作用的生物力学研究

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