肩关节前脱位Anterior-Shoulder-Dislocation.ppt

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1、AcuteanteriordislocationoftheshoulderAnatomyStability:-ball&socket=compressioninconcavityeffectBone-bighead–smallcup=unstableMenisci-labium=↑depthofcupby20%Ligaments-glenohumeral&capsuleMuscles-rotatorcuff&biceps=holdsballincupPrimaryMovers-Deltoid,Pec.major&Lat.Dorsy=sublux

2、ingforcesDynamic-proprioceptivefeedbackPathophysiology(Lazarus1996)Chondro-labraldefectcausesa65%reductioninstabilityinthedirectionofthedefectDeficiencyoftheant.inf.capsulolabralcomplexFractureofant.lipofglenoid=15%Detachmentoflabarum/capsule=15%Tearofglenohumeralligaments=5

3、4%Avulsionofsubscapularisandligsofhumerus(HAGL)TopreventthepersistenceofthedefectitneedstoberepairedArthroscopicallyOpenAcuteInjurySomethingbreaksortearsandthereforecanberepaired.RepairisbetterthanreconstructRepairiseasierthanreconstructChronicInstabilityhasadditionalplasti

4、cdeformationofthecapsuleandglenohumeralligamentsthereforeneedstobeshortenedRestoringthenormalfunctionalanatomyisimpossibleConservativeTreatmentRowe–JBJS,1957324youngpatientwithant.dislocations94%hadrecurrenceif<20yearsold62%hadrecurrenceif<30yearsold14%hadrecurrenceif>40year

5、soldBurkhead&Rockwood(textbook)40patientswithacutedislocation&vigorousrehabilitationOnly16%hadgoodorexcellentresult(1in6)Deny&Drew–Injury,November200221%ofallpatientspresentingwithshoulderdislocationhadpreviousdislocationin1year43%inpatients15-22yearshadre-dislocationsNonope

6、rativetreatmentofshoulderdislocationinyoungathletesArciera–JArthroscopy,1995DeBeardino–JSouthOrthopaedicAss,1996Haelen–JArchOrthopaedicTraumaSurgery,1990Hovelius–JOrthopaedicScience,1999Wheeler–JArthroscopy,1998Kirkby–JArthroscopy,1999allover80%recurrencerateNonoperativetrea

7、tmentisunacceptableProspectiveRandomisedStudyBottanietc.–MilitaryPersonnelMedicineVol30No42000FirstTimeAcuteTraumaticShoulderDislocationStabilisationV’sNonOperative:Followupin36months24patientsaged18-26y.14NonOperative–rehabimmobilised4weeks9of12nonoperativehadinstability(75

8、%)(6openBankartrepair)10ASCBankartrepairwithbioabsorbabletack<10days1of9ope