正常肩关节的影像学表现

广义的肩关节包括盂肱关节（第一肩关节）、肩峰下关节（第二肩关节）、肩胛胸壁间连结、喙锁间连结、肩锁关节及胸锁关节六个部分复合体,前三者是肩关节复合体的主要运动部分,后三者属于微动部分。狭义的肩关节是指盂肱关节,它是由肩盂与肱骨头组成杵臼关节,是人体运动范围最大而又最灵活的关节。盂肱关节的稳定性主要依靠周围软组织结构,包括关节囊、旋袖、肩峰下一三角肌下滑囊;关节囊在下部,它对关节有重要的稳定和压缩作用,保证关节面的紧密相帖及其完整性;     

正常国人活体肩锁关节的运动特点

目的通过3D-激光扫描照相机对肩关节运动进行扫描,了解肩锁关节的运动特点。方法通过在正常活体肩锁关节的锁骨端及肩峰端分别安装一个激光照相扫描仪的探测端子,3D-激光扫描相机扫描肩关节在做前屈、后伸、外展、内收、外旋及内旋等不同位置下两端子的位置,通过计算机计算出两端子在X、Y、Z轴（X轴代表锁骨的长轴,Y轴为冠状面与X轴垂直轴,Z轴为矢状轴）上的旋转情况。结果随着肩关节在前屈、后伸、外展、内收、外旋及内旋等不同位置时运动幅度的增大,肩锁关节的运动大部分逐渐增加,肩锁关节的X轴、Y轴和Z轴的旋转角度的运动范围分别为-2.22°～1.35°、-7.73°～2.35°和-6.67°～4.61°。结论此种方法可较好地测量肩锁关节的运动情况,同时这一技术和结果可被用于进一步研究病理性肩关节运动的改变,为研制符合肩锁关节运动特点的内固定物提供基础的生物力学数据。     

人工肩关节置换术研究进展

人体活动范围最大的肩关节的三维空间功能活动得益于肩关节骨性结构盂肱关节、肩锁关节、胸锁关节、肩胛骨的运动或旋转,以及周围肌肉和韧带组织对功能运动和稳定性的维持.人工肩关节假体的设计比人工髋关节、膝关节假体更复杂,仍不如人工髋关节、膝关节置换术满意.为避免人工肩关节置换术后并发症及改善预后,熟悉肩关节的解剖和力学机制、掌握精确的关节重建技术、合理选择假体尤为重要.该文就肱骨头假体设计的解剖学基础、关节盂假体、半肩置换与全肩置换的选择及影响预后的因素等方面的研究进展作一综述.     

肩锁关节脱位的治疗进展

肩锁关节脱位约占所有肩关节损伤的9%,可引起肩关节疼痛和活动障碍,严重影响患者生活质量和运动能力。近年,随着内固定物及相关生物力学研究的快速发展,肩锁关节脱位的手术治疗正逐步优化改进,手术方式可分为解剖固定和非解剖固定。非解剖固定并发症较多,且需进行再次手术取出内固定物;解剖固定能使肩锁关节更接近原本生物力学状态,术后患者满意度较高。另外,关节镜技术的普及推动了肩锁关节微创治疗。该文就肩锁关节解剖形态、肩锁关节脱位损伤分型及治疗方法等作一综述。     

肩关节前上方稳定结构:喙肩韧带

<正>广义肩关节由肩肱、盂肱、肩锁、胸锁、喙锁和肩胛胸壁间关节6部分构成。如此多的组成关节在运动时相互协调,使肩关节可以完成屈、伸、外展、内收、外旋、内旋、环转等7种动作。作为人体最为灵活,同时也是最不稳定的关节,肩关节不稳的患病率为1.7%,其中前方和前上方不稳总和约为90%[1]。前上方不稳定是由肩袖损伤或缺如及喙肩弓结构破     

肩锁关节脱位的手术治疗进展

肩锁关节损伤是肩部常见损伤,主要包括肩锁关节脱位和锁骨远端骨折,9％ ～ 10％的肩胛带损伤累及肩锁关节.肩锁关节脱位在肩部损伤中发病率较高,约占肩部损伤的12％ [1-2],其治疗方法仍存在争议,以非手术治疗为主.近年来,随着对肩关节损伤机制的研究深入,对于移位较大的肩锁关节损伤患者,大多学者更倾向于手术治疗.本文就目前国内外有关肩锁关节脱位的手术治疗进展作一综述. 一、肩锁关节的解剖特点 肩锁关节是由锁骨远端和肩峰构成的滑膜关节,可活动,中间有关节盘.由关节囊、肩锁韧带、喙锁韧带等维持关节的稳定性.肩锁韧带是限制锁骨和肩峰前、后移位的首要结构,喙锁韧带是限制锁骨垂直移位的重要结构[3].相关研究[4]表明,稳定肩锁关节的主要结构为喙锁韧带.肩锁关节在功能上属微动关节,参与肩关节的联合运动,主要有上下、前后、旋转3种基本运动形式.上肢上举时锁骨会出现40°～50°的旋转,但由于锁骨上旋和肩胛骨下旋同时发生,因此,正常的肩锁关节只有5 °～8°的活动度[5].     

肩关节类风湿性关节炎的外科治疗

肩关节类风湿性关节炎的外科治疗过邦辅肩关节的类风湿性关节炎并不少见。其主要症状为肩关节痛，影响病人活动和睡眠，甚至不能使用腋杖，所以不少病人迫切需求医治。肩关节复合体是上肢活动的中心，包括盂肱关节、肩锁关节和胸锁关节，以及肩峰下滑囊的可平滑活动的组织...     

Endobutton重建喙锁韧带结合肩锁关节韧带修复增强肩锁关节稳定性的研究北大核心CSCD

目的评估Endobutton钢板重建喙锁韧带结合肩锁关节韧带修复能否增强肩锁关节稳定性。方法回顾性比较2016年1月~2019年12月Endobutton重建喙锁韧带结合肩锁关节韧带修复(A组)与单独Endobutton重建喙锁韧带(B组)各19例的临床参数,包括术前和术后1个月、12个月双侧喙锁间距离(X线测量)、Constant-Murley肩关节评分和美国加州大学(UCLA)肩关节评分,术后12个月双侧喙锁间距离的差值。结果38例随访12~18个月,(13.1±1.8)月。2组术后1个月和12个月Constant肩关节评分和UCLA肩关节评分较术前均明显上升,患侧喙锁间距离较术前明显减小,且A组均改善更多(P<0.05)。术后12个月A组患侧喙锁间距离与健侧相比无统计学差异[(4.8±0.1)mm vs.(4.8±0.1)mm,t=-1.837,P=0.083],而B组此距离仍明显大于健侧[(7.2±0.3)mm vs.(4.8±0.1)mm,t=-32.366,P=0.000]。结论Endobutton钢板重建喙锁韧带结合肩锁关节韧带修复比单纯Endobutton重建喙锁韧带更能增加术后肩锁关节的水平及垂直稳定性,减少术后复位丢失,基本恢复肩锁关节的正常位置,更符合肩锁关节的生理状态。     

肩关节上部悬吊复合体韧带损伤的生物力学研究

目的对肩关节上部悬吊复合体韧带损伤进行生物力学分析,为临床诊治此类韧带损伤提供生物力学依据。方法取5个新鲜尸体上肢标本制作肩关节上部悬吊复合体模型,用手术刀依次破坏肩锁韧带、喙锁锥状韧带及斜方韧带,记录并比较标本完整状态下(A组)、单纯肩锁韧带损伤(B组)、肩锁韧带及喙锁锥状韧带损伤(C组),以及肩锁韧带、喙锁锥状韧带、斜方韧带损伤(D组)时中性区及活动范围。结果 4组间在屈伸、旋转、侧屈状态下中性区、活动范围差异均有统计学意义(P0.05),且A组低于B组,B组低于C组,C组低于D组。4组内不同状态下中性区、活动范围差异均有统计学意义(P0.05),且旋转、侧屈状态下大于屈伸状态,侧屈状态下大于旋转状态。结论肩关节上部悬吊复合体韧带损伤需手术治疗,重点在于尽早完成韧带重建并牢固固定,最大限度恢复其正常解剖结构及骨-韧带环的完整性,再联合专业的康复功能训练,早期恢复肩关节稳定性及活动度,进而减少术后并发症的发生。     

肩关节前方不稳定关节镜下治疗进展

肩关节是人体诸多关节中活动度最大的关节,亦是脱位发生率最高的关节之一。肩关节的稳定性主要依靠肩关节周围肌肉、肩盂的外肜、盂唇以及关节囊、盂肱韧带等软组织结构而非骨性结构来维持,如上述软组织结构的完整性遭到破坏,则肱骨头不能在肩关节运动全程中保持于肩盂的中心位置,从而出现肩关节前方不稳定。     

Biomechanics of total shoulder arthroplasty: a preoperative and postoperative analysis

To successfully perform a total shoulder arthroplasty, it is essential to understand the normal anatomy and biomechanics of the shoulder joint. Currently, nonconstrained prostheses offer the most consistent and durable long-term results, allowing for the restoration of normal anatomy and motion close to that of the normal shoulder joint. To determine the effects of the disease process, surgical technique, and postoperative rehabilitation on glenohumeral biomechanics after nonconstrained total shoulder arthroplasty, a prospective clinical trial was undertaken to evaluate preoperative and postoperative shoulder motion clinically and roentgenographically in nine patients with severe arthritis. Preoperatively, the ratio of glenohumeral to scapulothoracic motion was 1:2; for every degree of glenohumeral movement there were two degrees of scapulothoracic motion. This was associated with significant pain and decreased motion in the shoulder and represented the patient's attempt to immobilize the glenohumeral joint for pain relief and maximize shoulder movement with scapulothoracic motion. After total shoulder arthroplasty, significant improvements were observed in pain relief, motion, and function; however, the ratio of glenohumeral to scapulothoracic motion was not significantly different. The abnormal ratio indicates that less motion occurs between the prosthetic components compared with a normal joint, whereas scapulothoracic motion is unchanged. Abnormal shoulder biomechanics seem to be a function of the underlying disease process and were not restored after total shoulder arthroplasty. Despite the successes to date, improvements on the current state of the art are still needed, and will occur with better understanding of the complex biomechanics of the shoulder joint.     

Anatomy, biomechanics, and pathophysiology of instability of the glenohumeral joint

The stability of the shoulder is dependent on both static and dynamic anatomic restraints. In most cases, there must be insufficiency of more than one restraint for the shoulder joint to become instable. Although the role of these restraints is largely known in maintaining shoulder stability, our information on their interactions is insufficient. This article reviews the anatomy and biomechanics of the shoulder and conditions causing instability of the glenohumeral joint.     

The biomechanics of the rotator cuff in health and disease – A narrative review

The rotator cuff has an important role in the stability and function of the glenohumeral joint. It is a complex anatomic structure commonly affected by injury such as tendinopathy and cuff tears. The rotator cuff helps to provide a stabilising effect to the shoulder joint by compressing the humeral head against the glenoid cavity via the concavity compression mechanism. To appreciate the function of the cuff it is imperative to understand the normal biomechanics of the cuff as well as the mechanisms involved in the pathogenesis of cuff disease.The shoulder joint offers a wide range of motion due to the variety of rotational moments the cuff muscles are able to provide. In order for the joint to remain stable, the cuff creates a force couple around the glenohumeral joint with coordinated activation of adjacent muscles, which work together to contain the otherwise intrinsically unstable glenohumeral joint and prevent proximal migration of the humerus. Once this muscular balance is lost, increased translations or subluxation of the humeral head may result, leading to changes in the magnitude and direction of the joint reaction forces at the glenohumeral joint. These mechanical changes may then result in a number of clinical presentations of shoulder dysfunction, disease and pain.This narrative review aims to highlight the importance of functional rotator cuff biomechanics whilst assessing the kinetics and kinematics of the shoulder joint, as well as exploring the various factors involved in cuff disease.     

Biomechanics of posterior shoulder instability-current knowledge and literature review

Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year,even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare,biomechanical knowledge is limited. The purpose of our study was to perform an extensive literature search,including PubMed and Medline,and to give an overview of the current knowledge on the biomechanics of posterior shoulder instability. The Pub Med/Medline databases were utilized,and all articles related to posterior shoulder instability and biomechanics were included to form a comprehensive compilation of current knowledge. A total of 93 articles were deemed relevant according to our inclusion and exclusion criteria. As expected with any newly acknowledged pathology,biomechanical studies on posterior shoulder instability remain limited in the literature. Current biomechanical models are performed in a static manner,which limits their translation for explaining a dynamic pathology. Newer models should incorporate dynamic stabiliza-tion of both the rotator cuff and scapulothoracic joint. There is a current lack of knowledge with regards to the pathomechanism of posterior shoulder instability,with no consensus on appropriate treatment regimens. Further investigation is therefore required at both basic science and clinical levels.     

Shoulder prostheses

The design of shoulder prostheses has been developed through four generations which mirror adaptation to our increasing knowledge of the biomechanics of the shoulder joint. Modern shoulder prostheses are adapted to the size, inclination, posterior offset, and retrotorsion of the shoulder. The main reasons for implantation of a shoulder prosthesis are primary osteoarthritis, posttraumatic and rheumatoid arthritis, avascular necrosis, instability arthritis and cuff defect arthropathy. Typical implants are cup prostheses for surface replacement, anatomical stem prostheses, and reverse prostheses. Total prostheses are functionally better as soon as the arthritis involves the glenoid, whereas hemiprostheses should be preferred as long as the glenoid is intact. The stem is mostly cemented, whereas in younger patients with good bone quality a cementless stem may be used. Cemented glenoids may be considered as standard.     

Schulterendoprothetik

The design of shoulder prostheses has been developed through four generations which mirror adaptation to our increasing knowledge of the biomechanics of the shoulder joint. Modern shoulder prostheses are adapted to the size, inclination, posterior offset, and retrotorsion of the shoulder. The main reasons for implantation of a shoulder prosthesis are primary osteoarthritis, posttraumatic and rheumatoid arthritis, avascular necrosis, instability arthritis and cuff defect arthropathy. Typical implants are cup prostheses for surface replacement, anatomical stem prostheses, and reverse prostheses. Total prostheses are functionally better as soon as the arthritis involves the glenoid, whereas hemiprostheses should be preferred as long as the glenoid is intact. The stem is mostly cemented, whereas in younger patients with good bone quality a cementless stem may be used. Cemented glenoids may be considered as standard.     

Biomechanik der Schulter

The shoulder joint takes a special position among all the other joints of the human body because of its special requirements of stability and mobility. Knowledge of the biomechanics of the shoulder joint forms the basis for the development of modern concepts of reconstructive surgery and arthroplasty. Most of the biomechanical findings are the result of research performed on cadaver shoulders using increasingly sophisticated methods of measurement. These studies elucidate the interaction of the static and dynamic factors which contribute to the delicate balance of the glenohumeral joint. Recently performed research is increasingly being focussed on more detailed analyses of muscle forces and stress distribution in the subchondral bone and periarticular soft tissues. The efficiency of the computer systems now available has enabled the development of complex, virtual shoulder models and three-dimensional finite element analyses. In the future a pure mechanical understanding has to be modified to extend to a concept which includes more data obtained from living subjects, especially with regard to muscle activity under varying loads and neuromuscular feedback systems which currently are difficult to assess.     

Pathologie und Therapie der Rotatorenmanschettenl?sion

The differentiation between traumatic and degenerative rotator cuff lesions is of high importance in everyday clinical practice. Knowledge of the anatomy and biomechanics are essential for the treatment of patients. In the past 15?years, increasing knowledge of the biomechanics of the shoulder joint and surgical treatment options, particularly in arthroscopic reconstructive options, has evolved. Full documentation of primary clinical findings and the close-knit follow-up documentation are of the utmost importance for an expert evaluation. The authors summarize the key aspects of treatment and possible therapeutic options of rotator cuff lesions.     

空心钉固定联合半腱肌肌腱重建喙锁韧带治疗Ⅲ度肩锁关节脱位

目的探讨空心钉固定联合半腱肌肌腱重建喙锁韧带治疗Ⅲ度肩锁关节脱位的疗效。方法对22例Ⅲ度肩锁关节脱位患者行空心钉固定联合半腱肌肌腱重建喙锁韧带治疗。结果患者均获随访,时间10～32个月。肩关节功能恢复良好,局部畸形消失,未见复发。参照Karlsson疗效评定标准:A级18例,B级4例。结论该手术方法设计符合生物力学的要求,方法简单,复位作用良好,是治疗Ⅲ度新鲜肩锁关节脱位有效方法。     

Design und Biomechanik inverser Schulterprothesen

Reverse shoulder arthroplasty has developed from a salvage procedure for a small group of selected patients with pseudoparalysis to a standard procedure for a variety of shoulder diseases associated with rotator cuff insufficiency. By inversing the joint surfaces the humeral head can be stabilized on the glenoid despite an insufficient rotator cuff. A normal shoulder function, however, cannot be expected after such a procedure. Reverse prostheses medialize the centre of rotation and distalize the humerus. This has an influence on the range of motion, the lever arms, the forces and the stability of the reconstructed joints. The currently used prosthesis models differ in many parameters. The following article describes the most important features and biomechanics of reverse prostheses.