肩锁关节运动损伤的机制与转归

<正> 肩锁关节损伤常见于年轻运动员。Hoyt 描述了其损伤机制,认为间接损伤时,损伤力由其作用于上肢的部位通过肱骨而传到肩锁关节,此力通过盂肱关节并集中到肩峰,将肩胛骨推向内上方,而肩锁关节首当其冲,伤力够大时便导致肩锁关节囊被牵拉和撕裂.喙锁韧带因处于松弛状态,极少经这种特殊机制而受损.直接损伤是由跌倒时上臂比较靠近体侧肩部着地所致.损伤力使肩胛骨和锁骨(由喙锁韧带连结)向内下方转动。如此力继续作用,     

脑卒中肩并发症预防与治疗

肩部具有复杂的结构和功能,肩并发症的发生严重阻碍了脑卒中上肢运动功能恢复,甚至使残存功能或已恢复的功能再次丧失[1]。熟悉掌握其解剖和运动生理,能更好的避免因废用或误用而导致的肩并发症。及时、有效地预防和治疗肩并发症,对患者的功能恢复将起到积极的作用。1肩部解剖骨骼组成:肩胛骨、肱骨、锁骨、胸骨、肋骨。关节组成:一般指盂肱关节、肩锁关节、胸锁关节3个关节,但肩胛-肋骨关节(即肩胛胸壁关节)、胸骨-肋骨关节、肋骨-脊柱间关节及肱骨上部关节也在肩部活动中发挥着重要作用。盂肱关节,即狭义的肩关节。1.1解剖特点由肩胛骨的…     

肩腱袖损伤的超声显像应用进展

肩部是由肩胛骨、锁骨、肱骨和被韧带、关节囊以及较多的肌群相互连接构成的上肢关节运动区域。其中肩关节活动幅度最大,但其关节盂较浅,韧带薄弱,关节囊松弛。肩腱袖主要由冈上肌、冈下肌、小圆肌和肩胛下肌组成,上述四肌以完整的扁宽腱膜牢固地附着于肩关节囊的外侧和肱骨外科颈,具有悬吊肱骨,稳定肱骨头与协助三角肌外展肩关节的功能,并构成肩     

肩胛骨骨折的护理与康复训练

肩胛骨位于胸廓后外侧,为三角形肩盂,是组成肩关节的重要组成成份,分别与肱骨头、锁骨外端、胸壁组成肩关节,肩锁关节,肩胸关节等,严重移位可产生明显肩关节功能障碍.     

锁骨钩钢板治疗锁骨远端骨折或肩锁关节脱位——附29例报告

目的：探讨锁骨钩钢板治疗锁骨远端骨折（NeerⅡ型）或肩锁关节脱位（TossyⅢ型）的临床疗效。方法：自2004年6月—2009年6月,应用国产锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位29例。术中复位骨折及肩锁关节,锁骨钩钢板固定后,修复关节囊、肩锁韧带、重叠缝合三角肌及斜方肌,但不进行喙锁韧带修复。术后7 d后进行肩关节功能锻炼。结果：2例术后肩外展疼痛及外展上举受限,取出内固定症状消失,无其它术后并发症。29例随访3～62个月,平均20个月,按Herscovici标准评定术后肩关节功能恢复情况,优良率达100％。结论：锁骨钩钢板在治疗锁骨远端骨折及肩锁关节脱位具有操作简单,固定确切、不损伤关节面、无需修复喙锁韧带、可早期功能锻炼等优点,是一种较理想的治疗方法。     

锁骨钩钢板治疗肩锁关节完全性脱位

肩锁关节完全性脱位是较为严重的肩锁关节损伤,稳定关节的各种韧带均遭到破坏,保守治疗效果差[1],且脱位易复发致肩部明显畸形,肩关节活动疼痛。我院2003年3月~2009年6月采用锁骨钩钢板治疗肩锁关节完全性脱位56例,效果满意,现报告如下。1临床资料1.1一般资料本组56例,男45例,女11例,年龄17~     

正常成人胸锁关节的16层螺旋CT测量研究

目的 探讨16层螺旋CT对正常成人胸锁关节结构的显示与测量价值. 方法 对115例受检者分别进行正常解剖位和双侧上肢上举位胸锁关节CT扫描,对其中符合测量条件的100例扫描所得图像进行薄层重建,并进行三维、二维多平面重组(MPR)处理,测量两侧胸锁关节间距和胸骨关节面角度.采用t检验评价双侧关节的变化,并得出正常参考值范围. 结果 双侧胸锁关节上举位下胸骨关节面冠状位及横轴位关节面角度分别为:冠状位左侧(133.77±6.19)°、右侧(133.58±6.14)°;横轴位左侧(128.48±5.77)°、右侧(128.38±5.99)°.其关节间距分别为:冠状位左侧(7.19±1.23) mm、右侧(7.23±1.24)mm;横轴位左侧(7.44±1.20) mm、右侧(7.43±1.23) mm.双侧胸锁关节解剖位关节间距分别为:冠状位左侧(6.19±1.13) mm、右侧(6.20± 1.13) mm;横轴位左侧(6.83±1.05) mm、右侧(6.83±1.04) mm.比较相同体位下两侧胸锁关节间距及角度正常参考值,两者之间差异无统计学意义(P＞0.05);在不同体位下,两侧胸锁关节间距存在统计学差异(P＜0.01). 结论 16层螺旋CT可重组显示与测量胸锁关节结构,其正常测量值的建立对胸锁关节变异与疾病的诊疗评估有一定的参考作用.     

中国人工肩关节假体的设计与临床应用

肩关节的三维空间功能活动得益于肩关节骨性结构孟肱关节、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.人工肩关节置换目前已广泛应用于临床,针对高龄肱骨近端粉碎性骨折,肱骨头缺血性坏死,肩部恶性肿瘤等疾病取得了较好的疗效.文章将从几个方面介绍在中国人工肩关节置换的进展.     

肩胛骨动力学评估的研究进展

<正>肩关节是日常生活中完成各项运动的重要关节,其具有良好的关节活动。狭义的肩关节包括三个解剖学意义的关节(盂肱关节、肩锁关节、胸锁关节)和两个功能学意义的关节(肩胛胸壁关节和肩肱关节)[1],肩关节依靠其周围肌肉的动力学作用,通过协调上述关节的活动,形成了完美的功能表现。在这其中,绝大多数运动发生在盂肱关节和肩胛胸壁关节[2],可见肩胛骨发挥着重要角色。如肩胛骨动力学发生障碍,将影响肩关节的活动。对于肩胛骨动力学的评估将有     

锁骨钩钢板治疗肩锁关节全脱位及锁骨外侧端骨折

肩锁关节脱位或锁骨外侧端骨折,以往采用克氏针、钢丝、螺钉固定,同时行喙锁韧带修补.但易引起脱位或骨折再移位,或需长时间外固定,发生肩关节僵硬.作者自 2000年 7月以来,采用锁骨钩钢板治疗肩锁关节全脱位及锁骨外侧端骨折 17例,取得满意效果,现报道如下.     

与关节置换相关的国人髋关节结构测量

背景:髋关节置换作为治疗严重髋关节疾病的重要手段已在临床广泛应用,如何更加合理地设计以及置入假体,预防术后并发症的发生,延长假体使用寿命得到越来越多的重视.目的:测量与关节置换相关的陶人髋关节假体相关数据.设计、时间及地点:前瞻性实验,于2008-03/06在青岛大学医学院人体形态学实验中心完成.材料:抽取青岛大学医学院人类学研究室专供科研用的长春、通辽出土的137副完整成人骨盆及股骨,其中男66副,女71副.方法:测量全部标本的髋臼外展角、髋臼前倾角、股骨颈扭转角、股骨颈干角和股骨偏心距5项指标.所得数据输入SPSS11.0软件行统计学分析,并与国内外同类文献资料比较.结果:测耸数据完整,无缺失值.髋臼外展角[男:(42.83±3.75)°,女:(42.07±4.12)°],髋臼前倾角[男:(15.31±6.95)°,女:(14.97±6.44)°],股骨颈扭转角[男:(6.76±9.39)°,女:(7.66±10.30)°]和股骨颈干角[男:(131.81±5.05)°,女:(132.82±5.83)°]的性别差异较小,无显著性意义(P>0.05).男性股骨偏心距大于女性[(44.12±5.14),(41.07±7.25)mm,P<0.05].实验结果与国内文献报道相似,但异于国外数据.结论:髋关节解剖数值的国内地区间差异较小,但与其他国家人种存在差别.适宜的假体设计有助于髋关节置换的开展和减少并发症的风险.     

人工关节置换与关节的运动性损伤

高校体育学院和体育系从事专业运动训练的学生比社会体育和体育教育专业学生的运动性损伤率要高得多。随着比赛对抗程度的明显增强,导致运动性关节损伤有上升趋势。四川省运动训练专业学生运动损伤发病率为75.75%,在运动性损伤中,关节损伤时有发生,严重的关节损伤后可能要通过人工关节置换才可以达到修复。人工关节置换可以基本符合运动损伤后关节功能恢复的生理要求,保持原关节的大部分活动度,恢复后大部分功能良好,而且假体来源不受限,无排斥反应。     

Sacroiliac joint and lumbar zygapophysial joint corticosteroid injections

The sacroiliac joint and the lumbar zygapophysial joints are both known pain generators with demonstrated pain-referral patterns. They are both amenable to image-guided intraarticular injection of corticosteroids, a procedure that is commonly performed for pain. The literature on the efficacy of intraarticular corticosteroid injections for these joints is currently limited. This article covers the diagnostic dilemmas associated with these joints, the utility of anesthetic blocks, and the literature on the efficacy of intraarticular corticosteroid injections.     

Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome

OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections in patients with sacroiliac joint syndrome. DESIGN: A retrospective study design with independent clinical review was utilized. Thirty-one patients were included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered in conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage. RESULTS: Patients' symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up. Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. CONCLUSIONS: These initial findings suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.     

关节置换术后假体周围感染的实验室诊断

关节假体周围感染(PJI)是关节置换术后发生的严重并发症,需尽快明确诊断、积极治疗,以避免产生严重的不良后果。由于实验室传统检查方法敏感性和特异性的限制,PJI的诊断至今仍面临巨大挑战。近年来,一些兼具高敏感性和高特异性的检测方法,包括生物标志物检测和病原学检测方法在PJI诊断方面具有良好的应用前景。文章对关节置换术后PJI早期诊断的研究进展作一综述,以便为临床诊治提供参考。     

颞颌关节重建术治疗颞颌关节真性强直临床观察

目的 探讨颞颌关节重建术的临床疗效。方法用喙突和／或自体肋骨肋软骨游离移植时31例颞颌关节真性蠢直患者进行关节重建术，根据手术前后患者张口度变化、咬合关系、下颌前伸和侧方运动功能的改善，并通过关节开闭口位X射线片采分析关节间隙。综合评价手术治疗效果。结果30例患者术后张口度增大2．0cm以上，咬合关系、下颌前伸及侧方运动功能好，重建的关节具有正常的关节间隙，功能和外形好。结论喙突游离移植、自体肋骨肋软骨游离移植是治疗颞下颌关节真性强直的理想方法。     

Acromioclavicular joint separations

Acromioclavicular (AC) joint separations are common injuries of the shoulder girdle, especially in the young and active population. Typically the mechanism of this injury is a direct force against the lateral aspect of the adducted shoulder, the magnitude of which affects injury severity. While low-grade injuries are frequently managed successfully using non-surgical measures, high-grade injuries frequently warrant surgical intervention to minimize pain and maximize shoulder function. Factors such as duration of injury and activity level should also be taken into account in an effort to individualize each patient’s treatment. A number of surgical techniques have been introduced to manage symptomatic, high-grade injuries. The purpose of this article is to review the important anatomy, biomechanical background, and clinical management of this entity.     

Trapeziometacarpal joint arthritis

Trapeziometacarpal (TM) joint arthritis is a common cause of radial-sided wrist pain that preferentially affects women. It is diagnosed by a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on symptom severity. Nonoperative treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), splinting, and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of disease. This article reviews the literature supporting the various surgical treatment options. Special consideration is given to the comparison of trapeziectomy with and without tendon interposition and ligament reconstruction.     

Temporomandibular joint disease

The best therapy for painful temporomandibular joint problems in most cases appears to be the least. Recommendations are made on the basis of a study of 90 patients.