肩关节前脱位anteriorshoulder dislocation 知识介绍.pptVIP

Acute anterior dislocation of the shoulder;Anatomy Stability: - ball socket = compression in concavity effect Bone - big head – small cup = unstable Menisci - labium = ↑ depth of cup by 20% Ligaments - glenohumeral capsule Muscles - rotator cuff biceps = holds ball in cup Primary Movers - Deltoid, Pec. major Lat. Dorsy = subluxing forces Dynamic - proprioceptive feedback;Pathophysiology (Lazarus 1996) Chondro-labral defect causes a 65% reduction in stability in the direction of the defect Deficiency of the ant. inf. capsulolabral complex Fracture of ant. lip of glenoid = 15% Detachment of labarum/capsule = 15% Tear of glenohumeral ligaments = 54% Avulsion of subscapularis and ligs of humerus (HAGL) To prevent the persistence of the defect it needs to be repaired Arthroscopically Open ;Acute Injury Something breaks or tears and therefore can be repaired. Repair is better than reconstruct Repair is easier than reconstruct Chronic Instability has additional plastic deformation of the capsule and glenohumeral ligaments therefore needs to be shortened Restoring the normal functional anatomy is impossible;Conservative Treatment Rowe – JBJS, 1957 324 young patient with ant. dislocations 94% had recurrence if 20 years old 62% had recurrence if 30 years old 14% had recurrence if 40 years old Burkhead Rockwood (text book) 40 patients with acute dislocation vigorous rehabilitation Only 16% had good or excellent result (1 in 6) Deny Drew – Injury, November 2002 21% of all patients presenting with shoulder dislocation had previous dislocation in 1 year 43% in patients 15-22 years had re-dislocations;Comparison of Arthroscopic Open Stabilisation Sample Size Follow Up Recurrence ASC Open ASC Open ASC Open Steinbeck 1998 30 32 36 40 17 5 Field 1999 50 50 33 30 8 0 Cole 1999 37 22 52 55 16 9 Hayes etc 1999 44 13 29 29 12 4 Conclusion Ar