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肘关节运动损伤分析课件

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肘关节 运动 损伤 分析 课件
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肘关节运动损伤 福建医科大学 附属第一医院 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节运动损伤 n网球肘 n高尔夫球肘 n内侧副韧带损伤 n外侧副韧带损伤 n剥脱型骨软骨炎 n退行性骨关节炎 n肱二头肌远端断裂 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 网球肘 n发病年龄12 80岁 平均42岁 男女比例相 同 n急性发作多见于年轻运动员 网球运动员 慢性 顽固性多见于老年人 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 n起病隐袭 关节疼痛 n部位 外侧肘关节 n诱发 腕关节背伸 n放射 伸肌群 n伴随 腕关节力弱 持物困难 避免握手 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 分期 n根据临床症状及病理表现分为3期 临床表现病理表现治疗方法 期 轻度疼痛 劳累后诱发 可复性炎症 无血管纤维增生 保守治疗 期 疼痛较明显 偶有静息痛 休息后可恢复功能 血管纤维增生 不可逆性炎症 可有愈合反应 超过肌腱直径 一半的部分存 在病变需手术 治疗 期 静息痛 夜间痛 日常功能受限 广泛血管纤维增生 完全或部分肌腱断裂 手术治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n压痛点 桡侧腕短伸肌 ERCB 起点 伸肘位前臂旋前伸肘位前臂旋前伸肘位前臂旋前伸肘位前臂旋前 腕关节抗阻背伸腕关节抗阻背伸腕关节抗阻背伸腕关节抗阻背伸 伸肘位腕关节做伸肘位腕关节做伸肘位腕关节做伸肘位腕关节做 最大程度掌屈最大程度掌屈最大程度掌屈最大程度掌屈以以以以 及及及及前臂抗阻旋后前臂抗阻旋后前臂抗阻旋后前臂抗阻旋后 诱发疼痛诱发疼痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 伸肘位前臂旋前伸肘位前臂旋前伸肘位前臂旋前伸肘位前臂旋前 腕关节抗阻背伸腕关节抗阻背伸腕关节抗阻背伸腕关节抗阻背伸 伸肘位腕关节做最大程度伸肘位腕关节做最大程度伸肘位腕关节做最大程度伸肘位腕关节做最大程度 掌屈掌屈掌屈掌屈以及以及以及以及前臂抗阻旋后前臂抗阻旋后前臂抗阻旋后前臂抗阻旋后 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n握力较对侧下降 n用力握拳时诱发不适 n慢性病程出现轻度肘关节屈曲挛缩 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 注意 除外肱桡关节异常及桡神经卡压 n肱桡关节异常 屈肘时被动旋转前臂可诱发 肱桡关节处 疼痛 可触及增生的滑膜 n桡神经卡压 抗组旋后前臂或伸直中指可诱发疼痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nX线 部分可见外上髁周围出现钙化 可排除肘关节的合并 疾患 如 骨性关节炎 肘 关节后外侧旋转不稳定等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nB超与MRI B超特异性较高而敏感性远低于MRI 可 发现局部存在低回声区域 MRI并非必要 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 高尔夫球肘 n即肱骨内上髁炎 起病隐袭 40 50岁发病率最高 男 女比例相近 60 伴有尺神经病变 n病因 持续应力作用于内上髁或旋前肌 屈肌群的过度 使用 n表现 内侧肘关节痛 活动后加重 以反复强力旋前动 作为著 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 分期 n 期 轻微的炎症反应 短期内可消退 n 期 组织退变 幼稚血管 成纤维细胞异常增生 n 期 肌腱显微结构断裂 愈合不良 n 期 期病理表现 局部纤维瘢痕化 钙化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床体检 n局部压痛 压痛点 内上髁或沿旋前圆肌与桡侧屈腕肌走形 n早期肘关节活动正常 后逐渐出现屈腕挛缩 n可伴局部肿胀和皮温升高 注意 需除外尺神经及尺侧副韧带损伤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nX线片 常规拍摄X线平片 合并内侧不稳定可拍摄外 翻应力片 nMRI 对内上髁炎 内侧副韧带损伤及尺神经卡压有 高敏感性和特异性 但不做常规 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 高尔夫球肘MRI变现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 内侧副韧带损伤 n85 发生在没有进行适当热身运动后 n最常见的症状是投掷加速期的疼痛 其次是球 出手后的疼痛或击球 瞬间的疼痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 n急性损伤 肘内侧 砰 的响声 突发疼痛 无法活动 n慢性损伤 长期从事投掷运动 肘关节内侧反复发作局限 性疼痛 投掷时较明显 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n急性损伤可有血肿 慢性损伤可见屈肘畸形 n尺侧副韧带局部压痛 内上髁远端2cm n鉴别 屈肌损伤 无抗阻屈腕疼痛及疼痛位于屈肌起 点后方 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 特殊检查 n外翻应力试验阳性 n改良挤奶试验阳性 n运动外翻应力试验阳性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 特殊检查 n外翻应力试验阳性 n改良挤奶试验 n运动外翻应力试验 肘关节屈曲30 位外翻的同 时触及尺侧副韧带 存在 松弛 关节间隙改变大于 1mm 及压痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 特殊检查 n外翻应力试验 n改良挤奶试验阳性 n运动外翻应力试验 患者肩关节内收外旋位 屈肘 70 检查者握住患侧拇指外翻 肘关节可引起局部疼痛及内侧 间隙增大 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 特殊检查 n外翻应力试验 n改良挤奶试验 n运动外翻应力试验阳性 患者肩关节外展外旋 肘关节屈 曲运动过程中施以外翻应力 在 屈肘80 120 中出现固定疼痛 以及关节间隙改变 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nX线平片 可发现撕脱骨折 慢性患者常可发现继发性改 变如 韧带钙化 游离体 内侧髁增生及肱骨 小头的剥脱性骨软骨炎 鹰嘴后内方骨赘形 成 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial X线平片 内侧副韧带损伤普通X线表现 内侧副韧带损伤应力位X线表现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nB超和MRI B超和后斜冠状面造影MRI可提高诊断准确 率 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 外侧副韧带损伤 n20 30岁多见 n病因 主要 肘关节脱位 前臂旋后 腕背屈位着地 网球肘 处理不当 切除 组织过多或多次激素注射 长期肘内翻以及桡骨头切除 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 n明确骨折或脱位病史 n反复弹响 别卡感 交锁 关节脱开感 n伸肘旋后位症状明显 恐惧感 n自座椅中站起时上肢出现疼痛与力弱 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n外侧轴移试验 n后外抽屉试验 n扶手椅试验 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n外侧轴移试验阳性 n后外抽屉试验 n扶手椅试验 仰卧位 肩关节屈曲 患肢举 过头 肘关节屈曲 前臂旋后 施以轻柔的外翻应力以及轴 向压力 出现不稳定 患者出 现典型恐惧感 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n外侧轴移试验 n后外抽屉试验阳性 n扶手椅试验 屈肘90 及30 检查者握住患 肢前臂外侧 施以前后向的应 力 试图将肱尺关节脱位 前 臂外侧会以内侧为轴向后外方 旋转 出现不稳定 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n外侧轴移试验 n后外抽屉试验 n扶手椅试验阳性 患肢坐在扶手椅中 手掌冲内 扶着扶手椅坐起 出现症状为 阳性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nX线平片 内翻应力X线可显示外侧间隙增大 前臂旋后时可出现旋转半脱位 桡骨头与肱骨小头分离 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nMRI n斜冠位MRI或适当屈肘可辅助诊断 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 剥脱型骨软骨炎 n发病年龄在13岁以上 主力侧多发 男性多 见 n多有过度运动史 病灶累及主力侧肱骨小头 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 n起病隐袭 逐渐加重 n肿胀 疼痛 进行性屈曲畸形 15 n活动后加重 休息后减轻 若存在关节内游离体 则存在机械卡压症状 如 交锁 弹响 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n局部疼痛为主 较难确切定位 n肱桡关节存在压痛和摩擦感 可合并 15 20 的伸直活动受限 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nX线平片 早期 斑点状改变 后期 肱骨小头外形不规则 乳浊样改变 边缘硬化 晚期继发性改变 桡骨头骨骺肥大 桡骨头扁平 游 离体形成 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nMRI T1 肱骨小头上的低密度影 T2 肱骨小头不规则高密度影 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nCT 作常规检查 尤其是三维重建 对诊断及治疗 有重大意义 可协助判断软骨破坏面积及定位游离体 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 退行性骨关节炎 n临床表现 常有创伤 手术或长期重体力劳动史 不同程度疼痛 活动受限 腕管内骨质增生可有尺神经症状 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n肘关节通常存在肿胀 屈伸活动受限 n鹰嘴窝内存在骨赘或游离体 可出现撞击试 验阳性 撞击试验 患者上肢旋前位放于检查者肩上 用 力伸直时出现肘关节后方疼痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nX线平片 常规肘关节正侧位片可显示关节退变程度 骨赘 及游离体大小与位置 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 n三维CT 很好地判断关节破坏情况及游离体位置 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱二头肌远端断裂 n发病年龄平均为50岁 20 70岁 男性多 见 80 发生在主力侧 n表现 肘窝前方锐性疼痛 有撕裂感 出现 弹响 持续数小时后转为钝痛 常持续数 周 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 体检 n活动度正常 肘窝前方及内侧肿胀 淤血明显 屈肘时旋后力弱 n肘窝可触及空虚感 肱二头肌远端止点处压痛 大力水手征 二头肌腱向近端回缩 造成远端空 虚 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nX线平片 部分患者有桡骨结节形状变小 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 辅助检查 nB超与MRI 可协助判断肱二头肌远端损伤情况 尤其是MRI 可很好区分部分损伤与肌腱挫伤 Thank you Thank you
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