肩袖损伤讲解讲义.ppt

肩袖损伤讲解;概念和功能;4;4;肩袖解剖;肩袖解剖;组成和功能;病因;分类;分类;;临床表现; 当我们在临床上遇到疑似病人，只有X片而无MRI检查时， 1 我们能从X片中得到什么信息？ 2 我们印象中的可疑诊断有哪些？ 3 针对性的体查有哪些？; ;Gazzola S, Bleakney RR.Current imaging of the rotator cuff[J].Sports Med Arthrosc, 2011,19(3):300-9. ;Type I calci?cation with a ?uffy, ?eecy appearance with poorly de?ned borders, with acute symptoms and termed the resorptive phase. Type II calci?cation, more discreet and of homogenous density, with well-circumscribed borders, and in the formative phase.;2 可疑诊断; 针对肩袖损伤的体查;2 full can test 1) 90 degrees in the horizontal plane 2) rotated 45degrees externally 3) with the thumb pointing upward;painful arc test 60°-120° 1) shoulder in external rotation 2) palm facing up ;4 resisted isometric abduction 1) the arm in neutral rotation 2) abducts the arm to 90 degrees ;1 external rotation strength test=Patte’s test 1) the patient’s elbow in 90 degrees 2) in the plane of the scapula ;2 external rotation lag sign 1) elbow passively flexed to 90 degrees 2) maximal external rotation ;3 drop sign 1) almost full external rotation 2) elbow flexed at 90 degrees;4 weakness with external rotation 1) elbows flexed to 90 degrees 2) the thumbs up 3) shoulders rotated internally 20 degrees;3 肩胛下肌 肩内旋、后伸功能;2 internal rotation lag sign ;3 belly press ;4 bear hug test ;4 针对肩峰下撞击综合症的体查;Hawkins-Kennedy test;关于MRI;解剖足印（footprint）;关于MRI;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; 肩袖走行及连续性;脂肪渗透（fatty infiltration）;肌肉萎缩（muscle atrophy）;;肩袖损伤的分类;肩袖损伤的分类;肩袖损伤的治疗;肩袖损伤的治疗;开放手术骨质端的固定;肩袖损伤的治疗;不可修复肩袖损伤的判定;and 2) fatty in?ltration of the rotator cuff muscles at stage three or greater. ;不可修复肩袖损伤的治疗; latissimus dorsi transfers 一篇关于背阔肌修复巨大撕裂肩袖损伤的系统评价结果显示：在45.5个月的随访期内，Constant score, active forward elevation和ac