Dislocation ISAKOS肩关节脱位 课件.ppt

Conservative Treatment Rowe – JBJS, 1957 324 young patient with ant. dislocations 94% had recurrence if 20 years old 62% had recurrence if 30 years old 14% had recurrence if 40 years old Burkhead Rockwood (text book) 40 patients with acute dislocation vigorous rehabilitation Only 16% had good or excellent result (1 in 6) Deny Drew – Injury, November 2002 21% of all patients presenting with shoulder dislocation had previous dislocation in 1 year 43% in patients 15-22 years had re-dislocations Arthroscopic Repairs Einoder, 1984 Knee Club Described Arthroscopic transglenoid sutures using: K wire with eye (ACL) introduced via anterior portal Sucking tube Sutures tied over infraspinatus fascia or spine of scapula Results 4 out 5 patients returned to the same level of sport with no re-dislocations Randomised Studies Asc. Stabilisation V’s Non Operative Arciera et. al. – A.J. Sports Med., 1994 32 military men with acute 1st up dislocation, Average of 32 months follow up 15 patients – non operative – 80% redislocated 21 patients – transglenoid suture – 14% redislocated Bottony Wilkings etc. A.J. Sports Medicine 2000 Patients with acute traumatic first time shoulder dislocation 14 young patients – non op, 75% redislocation 10 young patients – Asc. Bankart repair, 10% redislocation Bozzotta Helpastorger (Austria) – J. Arthroscopy, 2000 Arthroscopic Transglenoid Suture Repair for Initial Ant. Shoulder Dislocation 72 Patients 61♂ 11♀ - Sporting ambitious patients 25 Patients Bankart lesion (6 with bone) 43 Patients Capsulolabral avulsion Results 5 patients Re dislocated 2 had significant trauma 3 had insignificant trauma = 4% Therefore results of primary repair are better than surgery for recurrent dislocation But transgleniod repairs are obsolete Investigations Plain x-rays CT scans if complicated associated feature MRI rarely – get more information from Asc. Examination Under GA Supine load shift test with arm at 80° abducted co