Bankart损伤的诊疗进展讲义.ppt

Bankart损伤的诊疗进展 Anatomy Anatomy Anatomy 盂肱韧带的稳定作用与体位有很大关系 Bankart lesion 定义：盂肱关节的前下部结构包括盂肱关节囊的前下部、盂肱下韧带的前束或前下部盂唇自肩盂边缘处撕脱，或伴肩胛盂骨折。 Classification Fibrous Bankart lesion：关节囊破裂，盂肱韧带连同附着的关节盂唇从关节盂上撕脱。肩关节前脱位时最常见的是下盂肱韧带-盂唇复合体损伤，即经典的Bankart损伤，占创伤性肩关节前脱位的85%。 Classification Bony Bankart lesion:下盂肱韧带盂唇复合体损伤同时伴有关节盂前下方的撕脱性骨折。Itoi等认为前下盂唇骨性缺损的宽度盂长度的21%会引起不稳[1]。 [1]Itoi,et al.The effect of a glenoid defect on anterior stability of the shoulder after Bankart repair:a cadaveric study.J Bone Joint Surg AM.2000 Jan;82(1):35-46. Epidemiology 肩关节脱位约占人体脱位的50%，多发生于年轻人，人群发生率约2%，运动员中发生率约7%。 脱位后复发率高，尤其是年轻人，20岁以下患者初次脱位后再脱位的复发率超过90%[2]。 复发性肩关节脱位患者Bankart损伤的发生率为53%-100%[3-6]。 [2]Boyd HB,Hunt HL. Recurrent dislocation of the shoulder,the staple capsulorrhaphy.J Bone Joint Surg(Am),1965,47:1514-1520. [3]Engebretsen L,Craig EvV.Radiologic features of shoulder instability.Clin Orthop Relat Res,1933,(291):29-44. [4]Norlin R.Intaarticular pathology in acute,first-time anterior shoulder dislocation:an arhroseopie study.Arthroscopy,1993,9:546-549. [5]Taylor DC,Arciero RA.Pathologic changes associated with shoulder dislocations:arthroscopic and physical examination fingdings in first-time traumatic anterior dislocations.Am J Sports Med,1997,25:306-311. [6]Hintermann B,Gachter A. Arthroscopic findings after shoulder dislocation.Am J Sports Med,1995,23:545-551. Diagnosis History Physical Examination Imaging Diagnosis Arthroscope Physical Examination Examination Method Significance Shift and load 将肱骨头推入关节盂，向前/后推移 向前/后运动提示该方向不稳定 Sulcus test 坐位，肩部中立位，固定肩胛骨后向下牵拉肘部 肩峰下出现横沟＞2cm提示下方不稳 Anterior apprehension 肩外展90°、肘屈曲90°，随后外旋 恐惧提示向前不稳 Augment test 以上同时向前推肱骨头 进一步引发恐惧或疼痛提示前方不稳 Relocation test 肩外展90°，最大外旋，向后推肱骨头 疼痛或恐惧缓解，或外旋增加提示向前不稳 Anterior apprehension Imaging Diagosis X-ray AP view True AP Scapular Lateral Axillary West Point View Apical-oblique view Stryker notch view X-ray AP view X-ray True AP X-ray Scapular Lateral X-ray X-ray 改良腋位 X-ray X-ray Apical-oblique view X-ray Stryker notch view Imaging Diagnosis CT