shoulder arthroscopy

The rotator cuff injury is more common in middle-aged and shoulder joint trauma, and its incidence accounts for 17% to 41% of shoulder joint disease. In 1834, Smith first named "rotator cuff tear. Generally, rotator cuff injury is divided into three phases: The first period of rotator cuff hemorrhage edema. When the shoulder joint is abducted, the rotator cuff is repeatedly and slightly impacted and stretched by the shoulder and the shoulder arch, and the anterior and posterior humerus of the shoulder is formed, causing congestion of the rotator cuff. Edema, degeneration and even supraspinatus tendon rupture. It has also been found that rotator cuff tears increase with age, while subacromial bone changes are not related to age, so that impact syndrome is not the main cause of rotator cuff injury. , but the result of the combination of rotator cuff degeneration and trauma. Non-surgical treatments for rotator cuff injuries include: rest, NSAIDs with anti-inflammatory analgesics, physical therapy, partial closure, and a variety of comprehensive rehabilitation methods that are beneficial for muscle strength and functional recovery and exercise. Open surgical rotator cuff suture was used to repair patients with ineffective conservative treatment. Arthroscopic repair of the rotator cuff has small trauma, does not damage the deltoid muscle, and is conducive to functional rehabilitation. Treatment of diseases: septic arthritis osteoarthritis Indication Shoulder arthroscopy is a diagnostic method, so there is no absolute indication that non-use arthroscopy is not acceptable. However, some shoulder diseases can be further confirmed by arthroscopic examination and a clearer understanding of the pathological changes of the disease, and sometimes surgical treatment. Arthroscopic surgery can be considered in the following situations. 1. Free joints of the joint: clear diagnosis and removal of free bodies. 2. Painful joint instability (habitual dislocation or subluxation): clear joint capsule, labial injury site, feasible repair surgery. 3. Biceps rupture: Understand the extent of the fracture, remove the broken end, and relieve the pain. 4. rotator cuff rupture: acute complete rotator cuff injury, because the leaky joint capsule can not swell, it is not suitable for arthroscopy. For chronic rotator cuff rupture, the lesion can be clearly defined, and for incomplete injury, the stump can be trimmed to relieve pain. 5. Osteoarthritis: debridement, rinse. 6. Shoulder septic arthritis: clean up and rinse. 7. Acromion impact syndrome: Under the subacromial arthroscopy, shoulder ablation can also be performed. Contraindications 1. The soft tissue of the shoulder has suppurative inflammation. 2. There are contraindications for general anesthesia. Preoperative preparation 1. Detailed physical signs and X-ray examinations should be performed before surgery to roughly define the location of the lesion so that it can be observed during surgery. 2. Preoperative identification of the anatomical structure around the shoulder and shoulder joints with a marker, including the bony sign of the shoulder joint such as the condyle, shoulder, clavicle, and acromioclavicular joint, and the soft point behind the surgical entrance for the arthroscopic entrance, front The entrance is on the outside of the front of the condyle. 3. Surgical instruments and equipment are mostly 4.0cm 30° wide-angle arthroscopes, cold light sources, camera imaging systems, monitors, manual instruments, RF gasifiers and computer video imaging capture acquisition systems. 4. Normal saline 3000ml+1:1 00 adrenaline 1ml, suspended 150cm above the operating bed for lavage. Surgical procedure 1. Mark the bony marks on the anterior and posterior margins of the shoulder, the scapula, the outer clavicle, the condyle and the humeral head. Use the finger to touch the condyle, the thumb is placed in the posterior and posterior corner of the shoulder. Rotating the upper arm can feel the humeral head moving under the finger. The position of the thumb below the outer corner of the shoulder is the posterior approach point. Use a long needle to penetrate the joint cavity along the inward direction of the thumb edge (ie, the position of the condyle), and inject 35 to 50 ml of isotonic saline into the cavity until the liquid can push the needle out, and the joint capsule is swollen and the needle is pulled out. . 2. Traction the affected limb, insert the shoulder arthroscopy assistant to the upper side of the patient's foot to pull the upper limb, so that the shoulder flexion 20 ° and internal rotation of the humerus. Make a small incision in the needle at the needle, pierce it in the direction of the original needle with a sharp sleeve needle, enter the joint cavity through the deltoid muscle and the posterior rotator muscle, and pull out the sharp core after the fluid flows out from the sleeve outlet joint. Replace the blunt core to extend the sleeve into the joint cavity. Remove the needle and insert a 30° arthroscope with a diameter of 4 to 6 mm. Sometimes the joint contracture requires a 3.8mm sleeve and a 2.7mm arthroscope. The 30° arthroscope can examine most of the shoulder joint, and the 70° arthroscope can observe the posterior structure of the joint cavity. 3. The front side of the shoulder Located at the midpoint of the line from the condyle to the anterior lateral edge of the acromion. With a long needle, the joint capsule is pierced backward from this point, and the position of the needle is observed by an arthroscope entering the posterior approach. The needle is preferably inserted into the joint capsule from the inner side of the biceps tendon. Insert the sleeve in the same way as the posterior approach, in the direction of the puncture needle. The sleeve is connected to the inlet pipe to keep the joint capsule inflated. In the same way, the needle is inserted into the joint capsule from the outside of the biceps muscle, and a anterior approach can be established, and a surgical instrument such as a probe can be placed. 4. Shoulder arthroscopy The internal structure of the joint should be examined in order and its anatomical relationship should be known. The examination order is generally biceps tendon, humeral head articular cartilage, anterior joint labial humerus, patellar tendon, subscapularis tendon and crypt, deep rotator cuff, supraorbital crypt, posterior joint lip. (1) biceps long head: This is the positioning method. The proximal end of the biceps muscle is connected to the upper part of the glenoid. The tendon enters the biceps sulcus of the humeral head. The top is the rotator cuff and the surface is covered with a synovial membrane. Rotating the humeral head helps to observe the biceps tendon. Patients who have had surgery in the past have adhesions between the biceps and the rotator cuff. In the case of bone and joint, biceps tendon tears or extensive adhesions can be seen. When the biceps tendon is placed in front of the surface and the surface synovial membrane is thickened and fibrotic, the biceps tendon dislocation should be considered. (2) humeral head: Rotating the humeral head inside and outside can see most of the cartilage on the surface of the humeral head. It should be observed that there is a defect in the cartilage in the posterior aspect of the humerus. It is suspected that there has been a history of dislocation of the shoulder joint. The cartilage surface of patients with bone and joint can be eroded. (3) rotator cuff: the rotator cuff is above the biceps tendon and the surface is covered with a synovial membrane. The rotator cuff can be torn near the humeral head joint surface, which should be observed here. (4) Joint spasm: the arthroscope is extended below the biceps tendon, and the upper limb is pulled to widen the joint space. The lower margin of the anterior joint labrum and ankle is observed, and the normal anterior joint lip and biceps are stopped. Point connected. Use the probe to check the joint lip from the anterior side. If the anterior and posterior joints have tears, the surrounding joint capsules are thickened, and the lower iliac ligaments are removed together with the torn lips. Should consider habitual shoulder dislocation. . 5. Shoulder arthroscopy Shoulder surgery requires an experienced doctor. Young patients have loose shoulders and are more likely to enter the joints. Older patients, especially those with a history of "frozen shoulders", are quite difficult to enter the joints. (1) Free body removal: a small free body can be aspirated. The large free body is mostly located in the lower crypt or the subscapular muscle crypt. The posterior approach enters the arthroscope, the anterior approach is inserted into the instrument, and the free body is removed by the triangular technique. (2) rotator cuff tear cleaning: 30° arthroscope is placed in the posterior approach, the front side inlet is in the water, and the third approach is cleaned with an electric planer. (3) biceps tear cleaning: similar to the surgical method of rotator cuff tear. (4) Lip tear resection: 30° arthroscope is inserted into the posterior approach, the anterior approach is the influent channel, and the other side of the anterior side is used as a way to cut the ends of the tear piece with a knife and will tear The piece is taken out and the electric planer trims the stump. complication 1. The surgical instrument is broken. 2. The anterior approach of the shoulder joint may damage the cephalic vein. 3. The joint leaks too much, and the liquid flows into the surrounding soft tissue, which may cause nerve and blood vessel injury in the ankle. Excessive force on the upper limb can cause brachial plexus and radial nerve injury.