朋友们大家好！今天是2020年1月20日周一。祝您新的一年身体健康、万事如意！开卷有益！欢迎您来到《听高绪仁讲肩关节那些事儿》第257期！知之者不如好之者，好之者不如乐之者。简单的事情重复做，重复的事情坚持做，坚持的事情开心做！骐骥一跃，不能十步；驽马十驾，功在不舍。锲而舍之，朽木不折；锲而不舍，金石可镂。没有天生的专家，为了我们的患者，唯有每天坚韧不拔、坚持不懈地努力学习、实践和提升。相信持续的力量，将每天的平凡逐渐变成不平凡，只争朝夕、不负韶华！ 上图：2020年1月20日周一，膝肩髋关节关节镜与人工关节置换手术及康复专家高绪仁在徐州医科大学附属医院（徐医附院）暨徐州二院骨科关节外科手术室为患者进行肩关节镜微创手术治疗肩袖损伤。 上图：2020年1月20日周一，膝肩髋关节关节镜与人工关节置换手术及康复专家高绪仁在徐州医科大学附属医院（徐医附院）暨徐州二院骨科关节外科手术室为患者进行人工关节置换手术。 今天有人问我一个问题：“高主任您好！2020年1月份的美国肩肘外科杂志主要有哪几篇文章呀？” 这是一个很好的问题。 美国肩肘外科杂志是世界上肩肘外科专家都爱看的一本杂志。每月一期，每期都值得我们仔细研读。 Editorial JSES family of journals William J. Mallon, Pierre Mansat p1 Published in issue: January 2020 Full-Text HTML PDF Shoulder肩关节部分 Autologous chondrocyte implantation for treatment of focal articular cartilage defects of the humeral head 《自体软骨细胞移植治疗肱骨头局灶性软骨缺损》 Elisabeth Boehm, Marvin Minkus, Markus Scheibel p2–11 Published online: September 20, 2019 Full-Text HTML PDF Factors associated with choice for surgery in newly symptomatic degenerative rotator cuff tears: a prospective cohort evaluation 《对新出现的有症状的退变性肩袖撕裂影响手术策略选择的因素：一个前瞻性群组评价》 Jay D. Keener, Alexander W. Aleem, Aaron M. Chamberlain, Julianne Sefko, Karen Steger-May p12–19 Published online: October 15, 2019 Full-Text HTML PDF Next-generation sequencing for diagnosis of infection: is more sensitive really better? 《用于感染诊断的新一代测序技术：更加敏感真的更好么？ Allison J. Rao, Ian S. MacLean, Amanda J. Naylor, Grant E. Garrigues, Nikhil N. Verma, Gregory P. Nicholson p20–26 Published online: October 13, 2019 Full-Text HTML PDF Operative treatment of displaced midshaft clavicular fractures is not cost-effective 《手术治疗移位的锁骨中断骨折性价比不高》 Anne-Kathrine R. Sørensen, Lianna H. Hammeken, Andreas H. Qvist, Steen L. Jensen, Lars H. Ehlers p27–35 Published online: September 25, 2019 Full-Text HTML PDF Supplemental Materials Effects of self-stretching with mobilization on shoulder range of motion in individuals with glenohumeral internal rotation deficits: arandomized controlled trial 《对于盂肱关节内旋缺失的患者活动肩关节时自我牵伸的效果：一个随机对照研究》 Min-Hyeok Kang, Jae-Seop Oh p36–43 Published online: October 15, 2019 Full-Text HTML PDF Shoulder arthroplasty in patients with immunosuppression following solid organ transplantation 《固体器官移植后免疫抑制的患者的人工肩关节置换手术》 Taku Hatta, Joseph M. Statz, Eiji Itoi, Robert H. Cofield, John W. Sperling, Mark E. Morrey p44–49 Published online: August 7, 2019 Full-Text HTML PDF Return to play and performance after shoulder instability in National Basketball Association athletes 《美国职业篮球联赛NBA运动员肩关节不稳后重返运动及表现》 Yining Lu, Kelechi R. Okoroha, Bhavik H. Patel, Benedict U. Nwachukwu, James D. Baker, Alexander J. Idarraga, Brian Forsythe p50–57 Published online: August 19, 2019 Full-Text HTML PDF Clinical results of bony increased-offset reverse shoulder arthroplasty (BIO-RSA) associated with an onlay 145° curved stem in patients with cuff tear arthropathy: a comparative study 《骨性增加偏心距反式肩关节置换（BIO-RSA）合并145度弧形嵌体肱骨柄治疗肩袖撕裂关节病的临床效果：一个比较性研究》 Edoardo Franceschetti, Riccardo Ranieri, Edoardo Giovanetti de Sanctis, Alessio Palumbo, Francesco Franceschi p58–67 Published online: August 7, 2019 Full-Text HTML PDF Characteristics of functional shoulder instability 《功能性肩关节不稳的特点》 Philipp Moroder, Victor Danzinger, Nina Maziak, Fabian Plachel, Stephan Pauly, Markus Scheibel, Marvin Minkus p68–78 Published online: August 1, 2019 Open Access Full-Text HTML PDF Supplemental Materials Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi–beach chair position 《半沙滩椅位人工肩关节置换手术时的脑部氧灌足评价》 Justin H. Chan, Hector Perez, Harrison Lee, Matthew Saltzman, Guido Marra p79–85 Published online: August 9, 2019 Full-Text HTML PDF Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty 《反式人工肩关节置换手术后和内旋相关的日常生活不便之处》 Myung Seo Kim, Ho Yeon Jeong, Jong Dae Kim, Kyung Han Ro, Sung-Min Rhee, Yong Girl Rhee p86–94 Published online: August 16, 2019 Full-Text HTML PDF Type V superior labral anterior-posterior (SLAP) lesion in recurrent anterior glenohumeral instability 《复发性盂肱关节不稳中的V型SLAP损伤》 Amr Abdel-Mordy Kandeel p95–103 Published online: August 27, 2019 Full-Text HTML PDF Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up 《肩关节镜下Latarjet手术后至少2年随访时的肩胛下肌结构完整性和功能》 María Valencia, Gloria Fernández-Bermejo, María D. Martín-Ríos, Javier Fernández-Jara, Diana Morcillo-Barrenechea, Ismael Coifman-Lucena, Antonio M. Foruria, Emilio Calvo p104–112 Published online: August 10, 2019 Full-Text HTML PDF Predictors of failure after conservative treatment of symptomatic partial-thickness rotator cuff tear 《有症状的肩袖部分撕裂保守治疗的失败预测因素》 Morteza Nakhaei Amroodi, Mostafa Salariyeh p113–120 Published online: August 6, 2019 Full-Text HTML PDF Elbow 肘关节部分 Cost analysis of Tommy John surgery for Major League Baseball teams 《美国全国棒球协会棒球球队队员进行TommyJohn手术的成本效益分析》 Jason E. Meldau, Karan Srivastava, Kelechi R. Okoroha, Christopher S. Ahmad, Vasilios Moutzouros, Eric C. Makhni p121–125 Published online: October 23, 2019 Full-Text HTML PDF Long-term outcomes after Instrumented Bone Preserving total elbow arthroplasty: a radiostereometric study with a minimum follow-up of 10 years 《结构骨保留的人工全肘关节置换手术的长期临床疗效：一个至少随访10年的放射立体摄相测量分析》 Bart ten Brinke, Nienke M. Kosse, Petra E. Flikweert, Marco van der Pluijm, Denise Eygendaal p126–131 Published online: September 26, 2019 Full-Text HTML PDF Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear 《单独的移位性II型部分关节的桡骨头骨折：术前影像和术中发现外侧尺侧副韧带撕裂之间的关系》 Luigi Tarallo, Giuseppe Porcellini, Giovanni Merolla, Andrea Pellegrini, Andrea Giorgini, Fabio Catani p132–138 Published online: September 11, 2019 Full-Text HTML PDF Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players 《优秀青年棒球运动员腿跨步髋关节内旋受限和肩肘关节疼痛相关》 Takuya Sekiguchi, Yoshihiro Hagiwara, Yutaka Yabe, Masahiro Tsuchiya, Nobuyuki Itaya, Shinichiro Yoshida, Toshihisa Yano, Yasuhito Sogi, Kazuaki Suzuki, Eiji Itoi p139–145 Published online: September 11, 2019 Full-Text HTML PDF Basic Science基础研究 Single Assessment Numeric Evaluation scores correlate positively with American Shoulder and Elbow Surgeons scores postoperatively in patients undergoing rotator cuff repair 《在评估肩袖损伤修复手术后患者时,简化评估量化评价评分和美国肩肘外科医生评分具有正相关性》 Julia S. Retzky, Matthew Baker, Casey V. Hannan, Uma Srikumaran p146–149 Published online: August 7, 2019 Full-Text HTML PDF Validity and internal consistency of the thoracic outlet syndrome indexfor patients with thoracic outlet syndrome 《对于胸廓出口症患者胸廓出口症评分指数的有效性和内部一致性研究》 Martti Vastamäki, Niina Ruopsa, Heidi Vastamäki, Katri Laimi, Leena Ristolainen, Mikhail Saltychev p150–156 Published online: August 29, 2019 Full-Text HTML PDF Supplemental Materials A prospective study comparing tendon-to-bone interface healing using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair in sheep 《在羊身上进行的使用一个间置性的生物可再吸收支架及带孔锚钉修复初次肩袖撕裂的前瞻性研究以比较腱骨界面愈合情况》 Jeremiah Easley, Christian Puttlitz, Eileen Hackett, Cecily Broomfield, Lucas Nakamura, Michael Hawes, Charles Getz, Mark Frankle, Patrick St. Pierre, Robert Tashjian, P. Dean Cummings, Joseph Abboud, Derek Harper, Kirk McGilvray p157–166 Published online: August 7, 2019 Open Access Full-Text HTML PDF Density distribution of the type E2 glenoid in cuff tear arthropathy 《肩袖关节病E2型肩胛盂的骨量分布情况》 Matthew D. Mahaffy, Nikolas K. Knowles, Carolyn Berkmortel, Sejla Abdic, Gilles Walch, James A. Johnson, George S. Athwal p167–174 Published online: August 28, 2019 Full-Text HTML PDF Posterior shoulder tightness can be a risk factor of scapular malposition: a cadaveric biomechanical study 《肩关节后侧紧可能是肩胛骨位置不亮的一个风险因素：一个在尸体上的生物力学研究》 Teruhisa Mihata, Michelle H. McGarry, Masaki Akeda, Alexander B. Peterson, Ross C. Hunter, Lauren Nguyen, Masashi Neo, Thay Q. Lee p175–184 Published online: August 13, 2019 Full-Text HTML PDF Three-dimensional in vivo scapular kinematics and scapulohumeral rhythm: a comparison between active and passive motion 《体内三维肩胛骨运动学几肩胛肱骨节律：主动和被动活动的比较》 Bonggun Lee, Doosup Kim, Younghwan Jang, Hanbin Jin p185–194 Published online: August 7, 2019 Full-Text HTML PDF Relation between preoperative electromyographic activity of the deltoid and upper trapezius muscle and clinical results in patients treated with reverse shoulder arthroplasty 《反式人工肩关节置换手术患者术前三角肌和上斜方肌肌电图和术后临床疗效之间的关系》 HongRi Li, Seung-hyun Yoon, Doohyung Lee, Heewoong Chung p195–201 Published online: August 13, 2019 Full-Text HTML PDF Review Article 综述 Reverse total shoulder arthroplasty in the younger patient (≤65 years): a systematic review 65岁以下 患者的反式人工肩关节置换手术：一个系统综述 Seline Y. Vancolen, Rawaan Elsawi, Nolan S. Horner, Timothy Leroux, Bashar Alolabi, Moin Khan p202–209 Published online: September 3, 2019 Full-Text HTML PDF Supplemental Materials Online Articles在线文章 Pyrocarbon interposition shoulder arthroplasty in young arthritic patients: a prospective observational study 热解碳复合结构间置的人工肩关节置换在年轻的肩关节关节炎患者中的应用：一个前瞻性观察研究 Hugo Barret, Marc-Olivier Gauci, Tristan Langlais, Olivier van der Meijden, Laurie Tran, Pascal Boileau e1–e10 Published online: August 23, 2019 Full-Text HTML PDF Application of a new polyester patch in arthroscopic massive rotator cuff repair—a prospective cohort study 《在肩关节镜下巨大肩袖撕裂修复手术中应用一种新的聚酯纤维补片：一个前瞻群组研究》 Daniel Smolen, Nicolas Haffner, Rainer Mittermayr, Florian Hess, Christoph Sternberg, Jan Leuzinger e11–e21 Published online: August 9, 2019 Full-Text HTML PDF Mortality after inpatient stay for proximal humeral fractures 《肱骨近端骨折患者住院期间的死亡率》 John Adam, Mohannad Basil Ammori, Iliyasu Isah, Muthu Jeyam, Usman Butt e22–e28 Published online: August 26, 2019 Full-Text HTML PDF Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials 《对于肩胛骨运动功能障碍的患者运动疗法可能会影响肩胛骨的位置及运动：一个临床试验的系统综述》 Afsun Nodehi Moghadam, Leila Rahnama, Shohreh Noorizadeh Dehkordi, Shima Abdollahi e29–e36 Published online: August 13, 2019 Full-Text HTML PDF Supplemental Materials “借问肩痛去哪里，路人遥指高绪仁”。如果您有任何关于肩关节的问题，欢迎您登录高绪仁好大夫在线网站进行咨询！网址链接 https://gaoxurendr.haodf.com/ 谢谢！ 高绪仁 副主任医师、副教授、医学博士/博士后、骨科关节病方向硕士研究生导师 徐州医科大学附属医院骨科高绪仁膝肩髋关节医疗组 徐州医科大学附属医院骨科关节外科膝肩髋关节人工关节置换与关节镜手术品牌专家 关键词：美国肩肘外科杂志 肩关节 肘关节 关节镜 关节置换 高绪仁 肩关节疼痛 肩膀疼肩痛不等于肩周炎 肩周炎 冻结肩 肩关节粘连 肩袖损伤 肱二头肌长头腱 炎症 损伤 撕裂 肩关节镜微创手术 反式人工肩关节及置换手术 中国 江苏 徐州 肩关节专家 听高绪仁讲肩关节那些事儿
人工全关节置换(total joint arthroplasty)是处理严重退行性关节疾病的最终选项。随着技术的成熟，人工全关节置换现在被看做是外科史上最成功的干预形式之一。可是，人工关节植入所引起的关节假体周围感染(periprostheticjoint infection, PJI)却是骨整形学面临的最严峻的挑战。 仅在美国，每年关节假体周围感染病例就高达33000，据估计，到2020年这一数字可能将上升到70000例。PJI构成了如今膝关节置换失败原因的25%，髋关节置换失败原因的15%，估计2030年，PJI将构成关节置换失败原因的60%。 PJI病例数不断升高的原因是多方面的。首先，开展这一手术的人数在急剧增加，而且在可预见的未来，这一趋势不会改变；其次，选择关节置换者常并发有肥胖，糖尿病和心血管疾病等高感染风险因素；再次，导致关节置换周围感染的微生物对抗生素的抗性在增高，例如，在很多医疗机构中，MRSA构成了超过一半的PJI病例；最后，随着诊断技术和能力的提升，越来越多的感染能通过先进的检测手段确诊。 PJI病因与诊断 PJI发病原因涉及移植体，患者免疫系统和侵犯的微生物三者间复杂的相互作用。研究发现，只需少量的微生物即可引起PJI。微生物粘附在移植假体上形成生物被膜(biofilm)，这种菌膜能够帮助致病微生物逃避检测，常规抗微生物药物和宿主免疫系统的攻击。形成生物被膜的微生物在行为上与单个个体或浮游菌不同，其微生物在如抗生素等环境应激情况下依旧能顽强的存活。 正确区分开PJI和其它导致关节假体移植失败的因素十分重要。PJI最常见的症状为疼痛，急性期多在局部呈现红肿热疼等炎症经典症状；而慢性炎症下的症状并不典型，可能只表现为疼痛，并可能主诉在骨移植界面移植假体的松动感。总之，无论是急性还是慢性感染，所呈现的症状都难于和其它类型炎症呈现的症状区分。骨整形外科中用于诊断PJI所用影像学手段包括MRI，PET扫描，骨扫描和铟标记WBC扫描等，但这些方法所获结果常常并不理想，成像手段并不能直接确认PJI；而PJI的实验室检测多都有参考意义，却未能解决诊断特异性的问题，指标包括红细胞沉降率(ESR)，血清C反应蛋白(CRP)，滑膜液中白细胞数和类型，白细胞酯酶检测试剂(LeukocyteEsterase Test Strip)等。滑膜液细菌培养常常失败，可能与抗生素使用，细菌数量偏低和培养技术有限等有关。 诊断的新手段：α-防御素(alpha-defensin) 滑膜液中PJI的生物标志物包括炎症蛋白，细胞因子，抗菌肽等在宿主免疫反应中具有重要的作用。CDDiagnostics致力于通过关节液分析研发关节疾病的诊断技术，他们在超过50个生物标志物的基础上使用系列的滑膜液生物标志物研究和评价，确定了更准确的用于PJI诊断用生物标志物，结合运用一种叫做α-防御素的抗菌肽和CRP的检测方法Synovasure™。Synovasure试剂检测α-防御素在滑膜液中浓度，其在PJI下急剧升高，对PJI的敏感性和特异性分别高达97%和96%；结合滑膜液中CRP水平，能更好的排斥假阳性情况，给临床医师更高的PJI诊断准确率。 相应学术论文：Deirmengian C1, Kardos K,Kilmartin P, Gulati S, Citrano P, Booth RE Jr. The Alpha-defensin Test forPeriprosthetic Joint Infection Responds to a Wide Spectrum of Organisms. ClinOrthop Relat Res. 2015 Jan 29. 摘要： Abstract BACKGROUND: The alpha-defensin test has beenpreviously demonstrated to be highly accurate in the diagnosis of prostheticjoint infection (PJI), nearly matching the Musculoskeletal Infection Societydefinition for PJI. However, the relationship between alpha-defensin levels anddiffering infecting organism has not yet been investigated. QUESTIONS/PURPOSES: The purpose of this study is to describethe breadth of organisms that can trigger a positive synovial fluidalpha-defensin test result in the setting of PJI and also to assess themagnitude of the alpha-defensin result in terms of various pathogencharacteristics. METHODS: Between December 2012 and March 2014,one laboratory processed 2319 synovial fluid samples for alpha-defensintesting. The present study reviewed the results of the 1937 samples thatsimultaneously had a synovial fluid culture performed; these came from 418surgeons in 42 states. The overall culture-positive rate was 49% (244 of 498)among alpha-defensin-positive synovial fluids and 1% (19 of 1439) amongalpha-defensin-negative synovial fluids. The organisms recovered from 244alpha-defensin-positive, culture-positive fluids were recorded and groupedbased on various characteristics, including Gram type, species, virulence, oralpathogenicity, and source joint. Alpha-defensin-negative samples served asuninfected controls. Median alpha-defensin levels were calculated for eachgroup, and Dunn's multiple comparison test for nonparametric data was used toidentify any statistically significant (p 0.05) organism-specificdifferences in the alpha-defensin level. RESULTS: The alpha-defensin test for PJI waspositive in the setting of a wide spectrum of organisms typically causing PJI.The median alpha-defensin level for all 244 alpha-defensin-positive, culture-positivesamples (4.7 ) was higher than negativecontrols (0.26 ) with a median difference of 4.4 (p 0.001). There were no differences in the median alpha-defensin levels whenperforming a multiple comparison test among Gram-positive organisms (4.7 ), Gram-negative organisms (4.8 ), yeast (4.1 ), virulent organisms (4.7 ), less virulent organisms(4.8 ), oral pathogens (4.5 ), knees (4.7 ), hips (4.9 ), or shoulders (5.3 ) withall comparisons having a p 0.999. CONCLUSIONS: The alpha-defensin test providesconsistent results regardless of the organism type, Gram type, species, orvirulence of the organism and should be seriously considered to be a standarddiagnostic tool in the evaluation for PJI. Future research should focus on theperformance of this test in specific clinical scenarios such as the immediatepostoperative period in the setting of severe immunocompromise and in thesetting of a native joint. 群晓科苑 qbioscience.com
新西兰的Masters S医生和 Burley S医生在2007年7月的Aust Fam Physician（澳大利亚家庭医生）杂志上撰文，分析了肩关节疼痛的诊断和治疗。 文中称，在全科医师的门诊中，经常可以遇到肩关节疼痛的患者。肩关节疼痛常可由急性疼痛转变为慢性肩关节疼痛。肩关节疼痛患者的临床表现常包括：疼痛、无力或僵硬，有的患者也是以上两到三种症状同时出现。该文总结了一条诊断和治疗肩关节疼痛及肩关节周围组织结构疼痛的流程。全面采集病史（包括患者的社会、心理情况）和熟练的肩关节体格检查技能非常重要。其他专门的检查对全科医师诊断肩关节疼痛时的影像不大。肩关节急性疼痛可能转变为慢性疼痛的趋势（生物方面和心理方面都是这个转变的危险因素）意味着医生在从多种治疗方法中选择合适的治疗方法时要采用个体化、以病人为中心的方法。 参考链接： 1、全文链接： http://www.racgp.org.au/afp/200706/200706masters.pdf 2、Pubmed链接： http://www.ncbi.nlm.nih.gov/pubmed/17565397 Aust Fam Physician . 2007 Jun;36(6):414-6, 418-20. Shoulder pain. Masters S , Burley S . Source University of Otago, New Zealand. Abstract BACKGROUND: Shoulder pain is common in general practice and is a condition that frequently becomes chronic. Presentation includes either pain, weakness and stiffness, or a combination of these symptoms. OBJECTIVE: This article presents a systematic approach to diagnosing and managing disorders of the shoulder joint and surrounding structures. DISCUSSION: Thorough history taking (including psychosocial aspects) and skilled examination are essential; special investigations rarely affect the general practitioner's management of shoulder pain. The tendency toward chronicity of shoulder pain (increased by certain biological and psychosocial risks) means that the clinician should adopt a patient centred approach in choosing from a wide range of treatment modalities. 江苏省徐州医学院附属医院骨科 关节镜、 膝关节外科、 骨科运动医学 方向 高绪仁 编译 高绪仁：每天以解决膝、肩关节问题为乐：） 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩关节问题，更是给其带来希望、未来和新生！
印度芒格洛尔 的影像学医师Priyank S Chatra在2012年1月份的Indian J Radiol Imaging（印度放射影像学）杂志上撰文，归纳总结了膝关节周围常见的滑囊及其核磁共振MRI影像学表现。 滑囊是一种充满液体的囊性组织结构。滑囊多位于皮肤和肌腱之间或肌腱和骨骼之间。滑囊主要的功能是减少附近相邻可运动性结构之间的摩擦。膝关节周围的滑囊可分为髌骨周围滑囊和其它位置的滑囊。 该文中，作者描述了最常见的各种膝关节周围滑囊病变及其核磁共振MRI影像学表现。 参考链接： 1、全文链接： http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354353/?tool=pubmed 2、Pubmed链接： http://www.ncbi.nlm.nih.gov/pubmed/22623812 Indian J Radiol Imaging. 2012 Jan;22(1):27-30. Bursae around the knee joints . Chatra PS . Source Department of Radiology, Yenepoya Medical College, Mangalore, Karnataka, India. Abstract A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. The main function of a bursa is to reduce friction between adjacent moving structures. Bursae around the knee can be classified as those around the patella and those that occur elsewhere. In this pictorial essay we describe the most commonly encountered lesions and their MRI appearance. 江苏省徐州医学院附属医院骨科 关节镜、 膝关节外科、 骨科运动医学 方向 高绪仁 编译 高绪仁：每天以解决膝、肩关节问题为乐：） 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩关节问题，更是给其带来希望、未来和新生！
澳大利亚昆士兰运动医学专家Shane Brun于2012年4月份的Australian Family Physician（澳大利亚家庭医生杂志）上撰文，提出了肩关节损伤的初步病情评估流程。 在澳大利亚的初级保健医疗机构（社区医院），肩关节损伤的患者很多。然而对于开业的全科医生而言，在诊断肩关节疼痛时知识往往不够，故常显得不够自信。本文总结了一个对肩关节损伤的患者进行初步病情评估时的框架流程图。深刻理解肩关节的解剖和肩关节的独特特点对于准确把握肩关节各种损伤非常重要。全面准确把握患者的病史对于探究损伤的机制、功能障碍的类型和疼痛的根源是非常必要的。 在进行肩关节的体格检查时，要特别注意：1、双肩是否不对称？2、肩关节压痛的位置在哪里？3、肩关节的活动范围如何？ 参考链接： 1、全文链接： http://www.racgp.org.au/afp/201204/201204brun1.pdf 2、Pubmed链接： http://www.ncbi.nlm.nih.gov/pubmed/22472683 Aust Fam Physician. 2012 Apr;41(4):217-20. Initial assessment of the injured shoulder . Brun S . Source Musculoskeletal Sports Medicine, Clinical Skills Unit, School of Medicine and Dentistry, James Cook University, Queensland. Abstract BACKGROUND: Shoulder injuries are common in the primary care setting, yet general practitioners may feel unequipped to confidently assess the patient presenting with shoulder pain. OBJECTIVE: This article provides a framework for the initial assessment of a patient presenting with an injured shoulder . DISCUSSION: A solid understanding of the anatomy and unique features of the shoulder is important to adequately assess any injury. A focused history needs to particularly explore the mechanism of injury, the type of dysfunction and the nature of the pain. On examination, particular attention should be paid to loss of symmetry, localisation of tenderness and the range of movement. 江苏省徐州医学院附属医院骨科 关节镜、 膝关节外科、 骨科运动医学 方向 高绪仁 编译 高绪仁：每天以解决膝、肩关节问题为乐：） 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩关节问题，更是给其带来希望、未来和新生！
以色列的一家关节镜与运动医学中心Haviv B医生于2012年3月的Harefuah（以色列医学会医学杂志）上撰文，对具有症状的肩关节肩袖损伤进行了归纳总结。 文中称，肩关节肩袖损伤在中老年患者中非常常见。肩关节肩袖损伤会导致肩关节慢性疼痛。五十几岁、六十几岁、七十几岁和八十几岁人群中肩关节肩袖损伤的发生率分别为12.8%, 25.6%, 45.8% 和50%。 肩袖损伤的病因机理可分为两类。即：1、内源性原因（如：反复的微创伤）；2、外源性原因（如：肩峰下撞击）。对于有症状的肩袖损伤患者来说，肩峰下滑囊可能是致痛来源。因为无症状的肩袖损伤很多，所以现在还不能确定是不是肩袖损伤本身就能够引起疼痛。肩关节疼痛和无力的症状是逐渐增加的，然而，受到一个创伤后，肩关节疼痛和无力的症状会突然急性发作。肩袖损伤常出现上肢上举过头困难，并常出现夜间疼痛。对肩关节肌肉肌力的评估可以初步诊断出来是不是肩袖损伤撕裂。普通的肩关节X线片对排除肩关节其它诊断是很重要的。超声检查和核磁共振MRI检查能够进一步确诊肩袖的撕裂，然而，当对指导治疗有必要时再进行超声检查和核磁共振检查。外科手术治疗的常见适应症是：相对年轻和活动多的患者的急性肩袖撕裂；或者是当对慢性撕裂治疗采用其它治疗方法无效的时候。 现在，大部分的肩袖损伤都是在全关节镜下完成的。肩关节镜治疗肩袖损伤具有创伤小、康复快、疼痛轻的特点。 参考链接： http://www.ncbi.nlm.nih.gov/pubmed/22741212 Harefuah. 2012 Feb;151(2):102-6, 126. . Haviv B , Bronak S , Thein R . Source Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel. Abstract Rotator cuff tears of the shoulder are common in the middle age and elderly population and can cause chronic pain. The prevalence of rotator cuff tears in people in their 50s, 60s, 70s, and 80s is 12.8%, 25.6%, 45.8% and 50% respectively. Etiological theories for tear evolvement are divided into intrinsic (e.g. recurrent microtrauma) and extrinsic (e.g. subacromial impingement). The subacromial bursa is probably the source of pain in symptomatic patients with rotator cuff tear. It is uncertain whether the tear itself can produce pain because of the high prevalence of asymptomatic tears. The symptoms are of gradual increase in shoulder pain and weakness, however, it can happen acutely due to an injury. Difficulties in overhead activities and night pain are common. Evaluation of shoulder muscle strength can imply on cuff tear. Shoulder radiograph is essential specifically to rule out other diagnosis. Imaging such as ultrasound and magnetic resonance can further define the tear, however they should be used only if they will affect the management of the condition. Common indications for surgical repair are acute tear in a relatively young and active patient or when the treatment of symptomatic patient with chronic tear had failed. Most repairs are currently performed in an all arthroscopic technique which is minimally invasive with easier rehabilitation and less pain. 江苏省徐州医学院附属医院骨科 关节镜、 膝关节外科、 骨科运动医学 方向 高绪仁 编译 高绪仁：每天以解决膝、肩关节问题为乐：） 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩关节问题，更是给其带来希望、未来和新生！
美国俄亥俄州立大学骨科的Bellisari Greg等在2011年3月份的Sports medicine and arthroscopy review（运动医学和关节镜评论）杂志上撰文，总结了儿童膝关节半月板损伤撕裂的情况。 随着骨科未发育成熟儿童、青少年参加体育活动的机会增加，随着医生对半月板损伤认识的加深，儿童、青少年发生半月板损伤检出率在增加。因为在年轻的患者，半月板损伤会产生长期的后续不良后果，所以加强对半月板损伤的认识和提高半月板损伤的治疗效果是非常重要的。 本文中作者总结了膝关节半月板的解剖、膝关节半月板的发育，回顾了半月板撕裂损伤的分类和诊断方法，讨论了膝关节半月板损伤各种治疗方法的选择及各种治疗方法的治疗效果情况，并重点讨论了儿童膝关节外侧盘状半月板和半月板囊肿。 参考链接：1、杂志链接 http://journals.lww.com/sportsmedarthro/toc/2011/03000 2、Pubmed链接 http://www.ncbi.nlm.nih.gov/pubmed/21293238 Sports Med Arthrosc. 2011 Mar;19(1):50-5. Meniscus tears in children. Bellisari G , Samora W , Klingele K . Source Department of Orthopaedics, The Ohio State University, Columbus, OH, USA. Abstract Increased athletic participation by the skeletally immature athlete and a heightened suspicion by physicians have contributed to an increase in the incidence of meniscal injuries in children and adolescents. In young patient, meniscal injury could have long-term consequences, so an understanding of recognition and treatment is essential. We review the anatomy and development of the menisci, review classification and diagnosis of meniscal tears, discuss management options and outcomes of treatment, and focus on discoid lateral meniscus and meniscal cysts . 江苏省徐州医学院附属医院骨科 关节镜、 膝关节外科、 骨科运动医学 方向 高绪仁 编译 高绪仁：每天以解决膝、肩关节问题为乐：） 每天努力提高自己的技术和服务水平 不仅仅是解决其膝、肩关节问题，更是给其带来希望、未来和新生！
标签: 关节置换
