肩关节疾病的诊断pptppt课件.ppt

临床表现 疼痛 肩无力 肩关节障碍 对治疗不敏感 肩僵硬 关节积液 临床评估 有固定的疼痛点 有固定的压痛点 研磨音 影像学评估 普通X线片 CT扫描 磁共振 盂唇损伤 盂唇的解剖 与二头肌长头的关系 盂唇的作用 二头肌在盂唇损伤的病理作用 盂唇损伤的分型 肱二头肌腱有关的盂唇损伤 原发性肌腱病-结节间沟内的肌腱炎症 肱二头肌腱继发性腱病— 肱骨头与喙肩弓持续撞击 过顶运动投掷后的减速期 临床评估检查 Obrien Clunk Compression 钙化性肌腱炎 主要是累计岗上肌、岗下肌、肩胛下肌 病因 体内钙的代谢紊乱 机制 大量钙质沉积在肌腱内 疼痛原因 突然肌腱内的沉积钙大量释放 Calcific Tendonitis Classifications Stages of Calcifying Tendinitis:Uthoff’s Classification ? Radiological classification of Calcifying Tendinitis : Bosworth Radiological morphology of Calcifying Tendinitis : Molé Classification Radiological staging of Calcifying Tendinitis : Gartner and Heyer Classification Stages of Calcifying Tendinitis: Uhthoff’s? Classification ? 1 - Pre-calcific stage - Metaplasia of tenocytes into chondrocytes2 - Calcific stage???????? Formative phase???????? Resting phase???????? Resorptive stage3 - Post-calcific phase Radiological classification of Calcifying Tendinitis : Bosworth Tiny????????? Barely visible on fluoroscopy Medium??? ? 1.5cm;  Large??????? 1.5cm Radiological morphology of Calcifying Tendinitis : Molé Classification (1993) A? calcification dense homogenous with clear contours B? calcification dense split/separated with clear contours C? calcification non-homogenous serrated contours D? calcification dystrophic calcification of the insertion in continuity with the tuberosity Radiological classification of Calcifying Tendinitis: Gartner and Heyer Type 1: clearly circumscribed and dense, formative Type 2: clearly circumscribed, translucent, cloudy and dense Type 3: Cloudy and translucent, resorptive  临床评估 突然的肩部剧烈疼痛 肩的功能基本不受影响 一周内可缓解 普通片可明确诊断 问题 ？ 谢谢！ 撞击症的症状 疼 痛 发病 疼痛成隐匿性进展 部位 肩前外侧有时放射至肘 方式 肩关节运动到某一部位 夜间疼痛 只在患侧卧位时疼 特殊检查 Neer Hawkins 影像学检查 撞击综合症－治疗 保守治疗 休息 避免做可能使肩关节疼痛的动作 前后部肩袖肌力练习 撞击综合症－治疗 保守治疗 肩峰下注射 玻璃酸钠（施沛特）2支 得保松＋布比卡因 肩