投掷肩保守治疗 ppt课件.ppt

文档介绍：投掷运动员SLAP损伤保守VS手术
SLAP
Andrews et
1990年Snyder首次提出了SLAP概念并分类
Andrews JR, Carson WG Jr, McLeod WD: Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 13: 337–341, 1985 2)Snyder SJ, Karzel RP, Del Pizzo W, et al: SLAP lesions of the shoulder. Arthroscopy 6: 274–279, 1990
论据一:血运差
肩胛上动脉,旋肱后动脉和旋肩胛动脉
主要来自于关节囊和骨膜的血管,并非来自于盂唇下方骨质,血运来源类似于半月板,不利于术后愈合。
Cooper DE, Arnoczky SP, O’Brien SJ, et al: Anatomy, histology, and vascularity of the glenoid labrum: An anatomical study. J Bone Joint Surg 74A: 46–52, 1992
印度墨汁染色显示前上血运差
论据二:组织学
纤维软骨:损伤后恢复慢,受伤机制存在,易再撕裂。
, Ferry JA, Schiller AL, et al: Histological studies of the glenoid labrum from fetal life to old age. J Bone Joint Surg 72A: 1344–1348, 1990
论据三:正常变异(691例患者)
观点:正常可以有缺损和空隙,SLAP后的不稳一定程度上可以接受
论据四:受伤机制
机制一: Andrews提出投掷减速阶段二头肌腱对盂唇的牵拉伤。Andrews JR, Carson WG, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337-341.
机制二: Burkhart等提出投掷运动员会出现适应性的后下关节囊、盂肱下韧带后下部分挛缩增厚,使头向后上移动,形成内撞击,伴轻微前方不稳,引起SLAP。
机制三: PEEL-BACK(剥离机制)
机制四
Weed-puller(除草机制):
减速阶段二头肌向下扭压SLAP到头上,
盂唇被肱骨头损伤。
Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. ics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233-239.
机制五
scapulothoracic dyskinesis:肩胛胸壁动力障碍。
‘‘SICK’’(scapular malposition, inferior medial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement)
众多受伤机制不是手术能够解决的。
Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part III: the SICK scapula, scapular dyskinesis, the ic chain, and rehabilitation. Arthroscopy. 2003; 19(6):641-661.