肩袖损伤2015.pptVIP

Rotator Cuff 肩袖损伤 肱骨头 肩袖 肱骨头 肩袖 关节囊方向看 肱骨头方向看 Rotator Cuff 肩袖损伤 撞击 通常在老年患者 (65++) 勾状的肩峰和肩袖撞击导致疼痛和附加的肩袖撕裂 肩袖损伤 通常地这种情况导致冈上肌损伤,然后是冈下肌 很少情况下会损伤小圆肌 除非在极其严重的情况下,肩胛下肌损伤极其少见,处理也很困难 部分撕裂也非常常见,这种情况 也是治疗的人选 Rotator Cuff 肩袖损伤 四种主要的肩袖撕裂类型： 1）新月形撕裂 2）U形撕裂 3）L形和倒L形撕裂 4）巨大回缩性不可移动性撕裂 Rotator Cuff 肩袖损伤 新月形撕裂 IS—冈下肌 SS—冈上肌 Rotator Cuff 肩袖修补 Rotator Cuff肩袖修复 – 主要考虑因素 主要目标 减少活动疼痛 (SAD) 和恢复运动功能 入路 锚钉放置 过线. 打结 Hawkins-Kennedy test 关于MRI 肩袖解剖 解剖足印（footprint） 关于MRI 正常肩袖的MRI 斜冠状面 正常肩袖的MRI 斜矢状面 正常肩袖的MRI 横断面 损伤肩袖的MRI 魔法角 magic angle phenomenon the fibers are at 55 degrees to the main magnetic field on T1 Erickson SJ, Prost RW, Timins ME. The “magic angle” effect: background physics and clinical relevance. Radiology. 1993;188:23-25. MRI上应得到的信息 1 肩袖走行及连续性 2 高信号 3 脂肪变性 4 肌肉萎缩 5 肌肉回缩 6 三角肌下、肩峰下囊滑液相连 肩袖走行及连续性 脂肪渗透（fatty infiltration） Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999;8:599-605. 肌肉萎缩（muscle atrophy） 1 切线征[1] （tangent sign） 2 肩胛比（scapular ratio）Scapular ratio uses the ratio of the supraspinatus muscle in cross section on the sagittal oblique image compared with the size of the supraspinatus fossa, and in supraspinatus atrophy the ratio is less than 50%[2]. 1 Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol. 1998;33:163-170. 2 Thomazeau H, Rolland Y, Lucas C, et al. Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand. 1996;67:264-268. 肩袖损伤的分类 1 全层撕裂 1）小 ＜1cm 2）中 1-3cm 3）大 3-5cm 4）巨大 ＞5cm DeOrio JK, Co?eld RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joi