最新精编医学专题—肩袖损伤.ppt

肩袖损伤(sǔnshāng)肩袖损伤(sǔnshāng)的流行病学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(dédào)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？GazzolaSBleakneyRR.Currentimagingoftherotatorcuff[J].SportsMedArthrosc201119(3):300-9.TypeIcalcificationwithafluffyfleecyappearancewithpoorlydefinedborderswithacutesymptomsandtermedtheresorptivephase.TypeIIcalcificationmorediscreetandofhomogenousdensitywithwell-circumscribedbordersandintheformativephase.2可疑(kěyí)诊断3针对肩袖损伤(sǔnshāng)的体查2fullcantest1)90degreesinthehorizontalplane2)rotated45degreesexternally3)withthethumbpointingupwardpainfularctest60°-120°1)shoulderinexternalrotation2)palmfacingup4resistedisometricabduction1)thearminneutralrotation2)abductsthearmto90degrees1externalrotationstrengthtest=Patte’stest1)thepatient’selbowin90degrees2)intheplaneofthescapula2externalrotationlagsign1)elbowpassivelyflexedto90degrees2)maximalexternalrotation3dropsign1)almostfullexternalrotation2)elbowflexedat90degrees4weaknesswithexternalrotation1)elbowsflexedto90degrees2)thethumbsup3)shouldersrotatedinternally20degrees3肩胛(jiānjiǎ)下肌肩内旋、后伸功能2internalrotationlagsign3bellypress4bearhugtest4针对(zhēnduì)肩峰下撞击综合症的体查Hawkins-Kennedytest关于(guānyú)MRI解剖(jiěpōu)足印（footprint）关于(guānyú)MRI正常(zhèngcháng)肩袖的MRI斜矢状面正常(zhèngcháng)肩袖的MRI横断面损伤(sǔnshāng)肩袖的MRI魔法(mófǎ)角magicanglephenomenonthefibersareat55degreestothemainmagneticfieldonT1EricksonSJProstRWTiminsME.The“magicangle”effect:backgroundphysicsandclinicalrelevance.Radiology.1993;188:23-25.我们(wǒmen)在MRI上应得到的信息肩袖走行及连续性脂肪(zhīfáng)渗透（fattyinfiltration）肌肉(jīròu)萎缩（muscleatrophy）肩袖损伤(sǔnshāng)的分类肩袖损伤(sǔnshāng)的分类肩袖损伤(sǔnshāng)的治疗肩袖损伤(sǔnshāng)的治疗开放手术(shǒushù)骨质端的固定肩袖损伤(sǔnshāng)的治疗不可修复肩袖损伤(sǔnshāng)的判定and2)fattyinfiltrationoftherotatorcuffmusclesatstagethreeorgreater.不可修复肩袖损伤(sǔnshāng