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美国芝加哥大学医学中心医院肩关节专家Lewis Shi肩关节镜下巨大肩袖损伤肩胛上神经松解手术技术
GaoXurenKnee 2019-10-27 20:59
朋友们大家好!今天是2019年10月27日周日。开卷有益!欢迎您来到《听高绪仁讲肩关节那些事儿》第146期!没有天生的专家,唯有每天坚持不懈地努力学习、实践和提升! 上图:2019年10月27日星期天,高绪仁在徐州医科大学附属医院暨徐州二院骨科关节外科住院部病房为肩关节疼痛、肩袖损伤的患者进行规范化体格检查。 今天有患者问我:“高主任您好,我肩袖损伤,除了修复肩袖损伤,还需要松解肩胛上神经么?” 这是一个很好的问题。 正好昨天我去上海参加中国美国运动医学专家肩关节镜学术交流周活动Shoulder Elite Club,来至美国芝加哥大学中心医学医院的肩关节专家Lewis Shi教授分享了他处理肩胛上神经的经验。 上图:2019年10月26日周六,高绪仁(右)在上海参加中国美国运动医学专家肩关节镜学术交流周活动Shoulder Elite Club与上海同济大学附属第十人民医院骨科运动医学肩关节专家程飚教授(左)、美国芝加哥大学肩关节专家 Lewis Shi教授(中)交流留念。 肩胛上神经主要是从颈5、颈6神经根发出来的一根神经。主要起到支配冈上肌、冈下肌运动的功能,同时也具有支配肩关节上面和后面及冈上肌、冈下肌对应位置的皮肤的感觉。肩袖损伤的患者大多肩关节疼痛的位置在三角肌及肩前面疼痛,一般不会出现肩关节上面和后面的疼痛。所以如果有较大的肩袖损伤,并且存在肩关节上方和后方疼痛的时候,我们要想到有可能存在肩胛上神经的卡压。 为什么肩袖损伤会影响到神经呢? 因为巨大肩袖损伤后由于冈上肌和冈下肌的退缩会导致肩胛上神经走行的道路会发生变化,拉着肩胛上神经,就可能出现肩关节疼痛、力弱。 肩袖损伤时做肩胛上神经松解的适应症是什么? 巨大的肩袖损伤修复时如果不能完全拉到大结节处进行很好的覆盖,那么此时可以进行肩胛上神经松解手术。 如何做这个手术呢? 一般可以从外侧入路进行观察,先找到喙突外侧的位置,再另外在上后面做一个入路,用关节镜钝头先沿着喙突找到靠近喙突基底部的上横韧带,然后切断。 上图:探查到上横韧带,然后剪断。 上图:松解后可见到被减压的肩胛上神经。 综上,对于巨大的撕裂退缩明显的肩袖损伤,修复后足印区如果不能得到很好的覆盖,可以考虑肩胛上神经松解术。 “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 参考文献: 1.Freehill MT,Shi LL,Tompson JD,Warner JJ.Suprascapular neuropathy: diagnosis and management.Phys Sportsmed. 2012 Feb;40(1):72-83. doi: 10.3810/psm.2012.02.1953. 2.Shi LL,Freehill MT,Yannopoulos P,Warner JJ.Suprascapular nerve: is it important in cuff pathology?Adv Orthop. 2012;2012:516985. doi: 10.1155/2012/516985. Epub 2012 Nov 1. 3.Shi LL,Boykin RE,Lin A,Warner JJ.Association of suprascapular neuropathy with rotator cuff tendon tears and fatty degeneration.J Shoulder Elbow Surg. 2014 Mar;23(3):339-46. doi: 10.1016/j.jse.2013.06.011. Epub 2013 Sep 20. 4.Leclere LE,Shi LL,Lin A,Yannopoulos P,Higgins LD,Warner JJ.Complete Fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy.Arthroscopy. 2014 May;30(5):639-44. doi: 10.1016/j.arthro.2014.01.010. Epub 2014 Mar 14. 关键词: 肩袖损伤 肩胛上神经松解 Lewis Shi 高绪仁 江苏省 徐州医科大学附属医院 徐医附院 徐州二院 骨科 肩关节 关节外科 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 听高绪仁讲肩关节那些事儿
个人分类: 听高绪仁讲肩关节那些事儿|3333 次阅读|0 个评论
Selected English readings for recitation: Lewis Carroll
josh 2012-8-6 16:54
The Hunting of the Snark :An Agony in Eight Fits By Lewis Carroll With nine illustrations by Henry Holiday SEE: http://ebooks.adelaide.edu.au/c/carroll/lewis/snark/
个人分类: The Art of Learning and Research|1897 次阅读|0 个评论
Zhang Lewis acid strengths predicted “Pyridine Compositions”
baijiab 2010-1-17 09:37
Yonghe Zhang ionocovalent theory applications (19) Zhang Lewis acid strengths predicted Pyridine Compositions SYNTHESIS AND CHARACTERIZATION OF MIXED OXIDES CONTAINING COBALT,COPPER AND IRON AND STUDY OF THEIR CATALYTIC ACTIVITY THOMAS MATHEW CATALYSIS DIVISION NATIONAL CHEMICAL LABORATORY, PUNE , INDIA 2.4.4 .4. Correlation between theoretical and experimental results In the following an attempt has been made to correlate experimental results with theoretical (empirical) quantities. According to Lewis definition, acidity and basicity are electron accepting and electron donating properties that could contribute to the formation of a covalent bond. Larger the electronegativity, the stronger the electron accepting power can be considered as a first approximation . According to Sanderson the electronegativity of the metal ion would be expected to change linearly with its charge. Later Zhang has proposed a numerical scale for the acid strengths Z of cations and he defined it as Z = P - 7.7Xz + 8 (7) where P andXz are the polarizing power and electronegativity of the ion respectively. The advantage of such a scale is the predictive power for thermochemical and physical properties that obviously depend on the nature of the chemical bond established between the acid cation and the basic anion. In the case of inorganic compounds, this bond is called iono-covalent, meaning that this bond involves simultaneously electrostatic force (ionic part) and covalent forces resulting from the combination of atomic orbitals. To express this duality, for a given cation, Zhang took into account (a) the polarizing power and (b) the electronegativity for the covalent part. He calculated the polarizing power, electronegativity and acid strength of various cations and it is note d that the acid strength of cations relevant to our compositions are in the order Fe3+Fe2+Co2+Cu2+Cu+. When an organic molecule like electron donating pyridine adsorbs on the surface, cations get reduced due to charge transfer. Thus the easily reducible metal ions like Cu2+ undergo fast reduction to Cu+ and hence the stability of metal ion-pyridine complex decreases. From the acid strength of various cations it is clear that reduced Cu+ has very poor acidity. In other words, for a given ligand, corresponding stability constants of metal ions are in the order Fe3+ Co2+ Cu2+ and hence the acidity of these ions also follow the same order, as shown earlier. J. Kijenski and A. Baiker, Catal. Today, 5 (1989) 1. R.T. Sanderson, Inorganic Chemistry, Reinhold: New York , p. 136 (1967). Y. Zhang, Inorg. Chem., 21 (1982) 3889.
个人分类: 科研成果|582 次阅读|0 个评论
A Relation between Zhang Lewis Acid Strengths and Dopant Elements
baijiab 2010-1-13 12:36
Yonghe Zhang ionocovalent theory applications (15) A Relation between Zhang Lewis AcidStrengths and Dopant Elements Marcel et al. established a relation between the Zhang Lewis acid strength of the dopant element and its scattering cross section : LSn 4+ /LGe 4+ QGe 4+ /QSn 4+ : In fact, we have recently shown(2,3,4) that the ideal doping cation must have a low electronegativity and a small ionic radius (r) associated with high effective nuclear charge (Z*). Indeed , such a cation having high value of Z*/r 2 will polarize the electron cloud of oxygen 2p6 valence band more strongly, thereby screening its charge so as to weaken it as a scattering center. Moreover, a low electrronegativity for the dopant cation accounts for a weak interaction between the conduction band electrons and the dopant cation. Zhang established an empirical equation relating the Lewis acid strength of the cation, L its electronegtativity, and the Z*/r 2 value as L = Z*/r 2 7.7X + 8.0 (1) Under such a circumstance, a high L value of the doping cation necessarily means a reduced scattering effect (and thereby a reduced scattering cross section) of the doping cation with regard to the conduction band electrons. Therefore, when the factor dominating the mobility is the scattering of electrons from the ionized donor centers, higher (lower) mobilities will occur for semiconductors doped with donor elements having higher (lower) L values (2,3,4). Following this guideline, it appeared that the use of Ge4+ as a doping element in ITO (partially or totally substituted to Sn4+) could induce an enhancement in the mobility since L Ge 4+ = 3.06 L Sn 4+ = 1.62 (2) Consequently , we can obtain the following expression after simple transformation Q Ge 4+ /Q Sn 4+ = 0.55 (3) It is interesting to note that for similarly heavily doped ITO and IGO (such as f and k) the value obtained above is close to the ratio calculated based on the Lewis acid strengths . Using relation (2) we get L Sn 4+ /L Ge 4+ = 0.53 (4) This result confirms the expected close relation between the scattering cross section of the dopant ion and its Lewis acid strength. It appears that when the factor dominating the mobility is the scattering of electrons from the ionized donor centers, L roughly varies inversely as Q. We note here that the concepts we have put forward also apply for other degenerate oxides having a predominant ionic-bond character as we have recently investigated. C. Marcel, J. Salardenne, S. Y. Huuang, G. Campet, and J. Portier, Active and Passive Elec.Comp.1997, Vol. 19, 217-223 S. J. Wen, G. Campet, J. Portier and J. Goodenough Mat.Science and Eng. , 1992, B. 14, 115. G. Campet, S. D. Han, S. J.Wen, J. P. Manaud, J. Portier, Y. Xu and J. Salardenne, Mat. Sci. and Eng. , B (accepted for publication 1995). S. J. Wen, doctoral thesis, University of Bordeaux I, 1992. Y. Zhang. Inorg. Chem., 1982, 21, 3886, 3889 .
个人分类: 科研成果|542 次阅读|0 个评论
Zhang Electronegativity Derived Brown Lewis Acid Strengths
baijiab 2010-1-8 12:12
Yonghe Zhang ionocovalent theory applications (11) Zhang Electronegativity Derived Brown Lewis Acid Strengths Brown derived an alternative Lewis acid strength S a from Zhang electronegativity X z . : The average Lewis-acid strengths given in Table 2 can be seen to increase with the electronegativity. The correlation between the two quantities is shown in Fig.4 using the Zhang (1982) electronegativities that are specific to oxidation state. The line corresponds to the equation X z = 1.118S a + 0.771 which can be rewritten as S a = 1.18 X z -0.653 where X z is Zhang electronegativity, which gave S a a solid definition and physical significance. I.D. Brown, Acta Cryst. B, 44, 545-553, 1988 Y. Zhang, (1982). Inorg. Chem., 21, 3886.
个人分类: 科研成果|526 次阅读|0 个评论
Zhang's Scale for Strengths of Lewis Acids Published in ACS
baijiab 2009-12-31 09:12
Yonghe Zhang ionocovalent theory applications (7). I. Methods Zhang's Scale for Strengths of Lewis Acids Published in ACS: Y. Zhang, Inorg, Chem.,21 (1982)3889
个人分类: 科研成果|548 次阅读|0 个评论

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