肩胛骨骨折的螺旋CT多平面和三维重建诊断

目的 探讨螺旋CT多平面重建（MPR）、表面遮盖显示法（SSD）及最大密度投影法（MIP）在肩胛骨骨折诊断中的价值。方法 回顾性分析40例肩胛骨骨折患者的MPR、SSD及MIP图像；所有病例均用Mareoni Ultra Z型螺旋CT机扫描，并在图像工作站上用MPR、SSD及MIP技术获得多平面和三维图像。结果 MPR、SSD及MIP重建图像清晰显示了40例共45处肩胛骨骨折及7例肩关节脱位；MPR、SSD及MIP能多方位、立体、全面地显示肩胛骨骨折部位和程度。MPR在显示微小骨折方面较好，而MIP、SSD在显示骨折的位置、形态、范围及移位方面较好。结论 MPR、SSD及MIP是诊断肩胛骨骨折的有效方法，对肩胛骨骨折分类、手术入路及内固定器选择等方案的制定有帮助。     

肩胛皮瓣再造阴茎

目的：探索一种新的阴茎再造手术方式。方法：应用肩胛皮瓣游离移植和银丝棒硅胶阴茎假体置入行阴茎再造。结果：自2000年3月起，已在临床应用6例，术后皮瓣全部成活。经随访6－12个月，阴茎形态和功能良好，结论：此手术方法设计合理，术后形态功能良好，供区无明显继发畸形，是一种较好的阴茎再造方法。     

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。     

Familial congenital bilateral agenesis of the acromion: a radiologically illustrated case report

Summary Familial congenital bilateral acromion absence was found in four members of one family. Only one of them presented with gradually increasing pain in his left shoulder, resembling a shoulder impingement syndrome. The other members did not have any symptoms. This is the first report of familial occurrence of this extremely rare congenital anomaly.

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Agénésie familiale bilatérale de l'acromion : une observation illustrée radiologiquement

Résumé L'absence congénitale bilatérale de l'acromion a été observée chez quatre membres d'une même famille. L'un d'eux seulement présentait des douleurs de l'épaule gauche progressivement croissantes ressemblant à un syndrome de blocage de l'épaule. Les autres membres n'avaient aucun symptôme. Il s'agit de la première observation familiale de cette anomalie congénitale extrêmement rare.

     

Effects of movement impairment based treatment in the management of mechanical neck pain

Background

Neck pain is a common musculoskeletal complaint in computer users due to prolonged static or awkward work postures. It has been shown that pathogenesis of neck pain is associated with scapular movement impairment syndromes. However, there is a dearth of literature in treatment based on these syndromes.

双侧扩张肩胛皮瓣在儿童、青少年大面积颌颈部瘢痕修复中的应用：7例报道

目的: 探讨应用双侧扩张肩胛皮瓣游离移植治疗儿童、青少年大面积颌颈部瘢痕的可行性。方法: 回顾2018年8月—2020年12月间,在上海交通大学医学院附属第九人民医院小儿整形病区接受双侧背部扩张皮瓣治疗大面积颌颈部瘢痕的儿童、青少年患者7例。所有患者瘢痕累及范围包括颈部及下颌、前胸部,颈部瘢痕累及颈前区及一侧或双侧颈外侧区,存在不同程度的颈部活动障碍、下颌骨发育不良。手术分为两期,Ⅰ期在双侧背部设计旋肩胛动脉扩张穿支皮瓣并植入扩张器,并行6~14个月的扩张;Ⅱ期行颌颈部瘢痕切除、松解,扩张皮瓣游离移植修复创面,吻合双侧面动、静脉与旋肩胛动脉及伴行静脉,供区创面直接缝合。结果: 7例患者中,出现扩张器植入后切口愈合不良、皮瓣破裂1例,经手术治疗后愈合并完成皮瓣扩张。注水壶堵塞1例,经注水壶外置后完成扩张。皮瓣移植后,1例患者出现皮瓣远端小面积缺血坏死,换药后创面愈合。术后随访6个月~2年,患者颌颈角恢复正常,颈部后伸、前屈、侧曲、旋转明显改善,功能改善满意。2例患者进行皮瓣修薄术及瘢痕条带松解术。结论: 旋肩胛动脉位置恒定,支配的背部皮肤面积大,经扩张后的双侧肩胛皮瓣游离移植可修复儿童、青少年颌颈部大面积瘢痕增生挛缩畸形,供区隐蔽、继发损伤小。     

Scapular dyskinesis type is associated with glenohumeral joint and scapular kinematic alteration during pitching motion in baseball players

IntroductionScapular dyskinesis (SD) is associated with an increased risk of throwing-related shoulder injury onset, resulting in abnormalities in glenohumeral joint (GH) and scapular motions during pitching. The effects of SD on shoulder motion during pitching remain unknown. This study aimed to investigate kinematic alterations in GH and scapular motions during pitching in baseball players with type I SD.MethodsSixty-seven university and independent-league baseball players with and without SD were included. Pitching motion was measured using an optical three-dimensional motion capture system, and a SD test was conducted to evaluate SD. SD was classified into types I–IV. The inter-rater reliability of SD assessment was calculated using kappa coefficients. Three-dimensional GH and scapular kinematics during pitching motion were analyzed.ResultsThe percentage of agreement representing the inter-rater reliability of SD assessment was 77.6% (52/67; kappa coefficient: 0.72). Overall, 24 and 27 participants were categorized into abnormal (type I SD) and normal group (type IV SD), respectively, with normal scapular motion; one individual with type III SD was excluded. The abnormal group exhibited a significantly increased GH external rotation angle (9°) and decreased scapular posterior tilt angle (6°) during the maximum external rotation period compared with the normal group.ConclusionsBaseball players in the abnormal group showed increased GH motion and decreased scapular motion during pitching. The SD test for the evaluation of type I SD can help predict excessive GH external rotation and decreased scapular posterior tilt during pitching.     

The pectoralis minor muscle and shoulder movement-related impairments and pain: Rationale,assessment and management

The adaptive shortening or tightness of the pectoralis minor muscle (PMm) is one of the potential biomechanical mechanisms associated with altered scapular alignment at rest and scapular motion during arm elevation (scapular dyskinesis) in patients with shoulder complaints. This masterclass briefly reviews the role of the PMm in shoulder movement-related impairments and provides a critical overview of the assessment of PMm tightness and the conventional approaches to increase its resting length and extensibility. A rehabilitation approach focused on PMm stretching and simultaneous optimization of the kinematic chain of arm elevation is also discussed, hoping to improve the management of shoulder movement-related impairments and pain.