肩关节前脱位anteriorshoulderdislocation文件材料.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;Non operative treatment of shoulder dislocation in young athletes Arciera – J Arthroscopy, 1995 De Beardino – J South Orthopaedic Ass, 1996 Haelen – J Arch Orthopaedic Trauma Surgery, 1990 Hovelius – J Orthopaedic Science, 1999 Wheeler – J Arthroscopy, 1998 Kirkby – J Arthroscopy, 1999 all over 80% recurrence rate Non operative treatment is unacceptable;Prospective Randomised Study Bottani etc.–Military Personnel Medicine Vol 30 No 4 2000 First Time Acute Traumatic Shoulder Dislocation Stabilisation V’s Non Operative: Follow up in 36 months 24 patients aged 18-26y. 14 Non Operative – rehab immobilised 4 weeks 9 of 12 non operative had instability (75%) (6 open Bankart repair) 10 ASC Bankart repair with bioabsorbable tack 10 days 1 of 9 operated patients had instability (11%) ;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 Arthroscopic repair for chronic instability is inferior to open repair ? Due to plastic deformation;Arthroscopic Techniques for Primary Dislocations 1982 Johusa – with staples 1987 Morgen Badenstab – transglenoid sutures 1991 Caspari -Cannulated bio-absorbable tacks 1993 Wolf Snyder – suture anchors = difficult 1989 Wheller - ASC staple 1993 Gohlke - Suture anchors 1994 Arciera - ASC transglenoid 1996 Speer - Bio-absorbable tack 1999 Wintzell - ASC lavage