课件：肩关节疾病的诊断王少山.ppt

问题 ？ 谢谢！ THANK YOU SUCCESS * * 可编辑 盂肱关节骨性关节炎 发病率 白种人较高 黄种人低 主要特征 年龄 发病缓慢 疼痛逐渐明显 肩关节功能逐渐丧失 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 Stages of subacromial impingement: Neer’s classification Historical interest,