烧伤后上肢残留功能障碍修复2例报告

Materials Case 1:Female,16 years old,peasant was admitted to our hospital due to upper limbs dysfunction 1 year after left armpit burn.Physical examination showed good status,contractured hard scar (14 cm× 18 cm) with irregular surface in left armpit.Movement range of shoulder joint is 10 degrees under forward flexion position,5 degrees under backward extension position,5 degrees in outward extension.Preoperative X ray showed no abnormal changes in bone matrix of left shoulder joint.Scar was excised under pamplegia during selective date.Skin defect was repaired by scapular flap (about 15 cm× 10 cm)with vessel pedicle.Case 2:Male,20 years old,peasant.was admitted due to upper limbs dysfunction 1 years after right armpit burn.Physical examination showed good status,contractured scar(16 cm× 9 cm) in right armpit.Movement range of shoulder joint is 10 degrees under forward flexion position,10 degrees under backward extension position,5 degrees in outward extension.Preoperative X ray showed no abnormal changes in bone matrix of right shoulder joint.Scar was excised under pamplegia during selective date.Skin defect was repaired by scapular flap (about 17 cm× 10 cm)with vessel pedicle.

第二肩关节的影像解剖学研究进展

"第二肩关节"又被称之为肩峰下关节,其上为喙肩弓,下为肩袖及肱骨结节.它虽不具典型的关节结构,但从功能上应视为一个关节,其间大的肩峰下-三角肌下滑膜囊可视为关节腔[1].

Objective: To evaluate the results of 36unconstrained shoulder arthroplasties.Methods: In the series, 24 total and 12 hemiarthroplasties of the shoulders were performed with unconstrained shoulder prostheses in 29 patients who suffered from glenohumeral degenerative arthritis, rheumatoid arthritis, avascular necrosis and proximal fracture of humerus, respectively. Follow-up averaged 6.2years. All patients were evaluated pre- and post-operatively using the rating system of the Society of American Shoulder and Elbow Surgeons which assesses the severity of pain,strength of muscles around shoulder, stability, range of motion and functional activities of daily living. Radiolucent line and migration of prostheses were observed postoperatively on X-rays.Results: Postoperatively, the rate of pain relief was 91.3%, and active range of motion increased by 47° inforward flexion, 43° in abduction , 30° in external rotation,and 4 segments in internal rotation. Preoperatively the average points of 6 functional activities patients could perform was 0.8, and postoperatively 3.1. On postoperative X-ray, proximal migration of the humerus was seen in 8 shoulders, 6 of which had either a torn or absent rotator cuff. Radiolucent lines were seen around 1humeral component and 9 glenoid components. Onehumeral and 2 glenoid components loosened.Conclusions: These results suggest that unconstrained shoulder arthroplasty is a satisfactory and safe technique.