AcuteShoulderDislocationSurgeryEinoderAcuteanteriordislocationoftheshoulder第一页，共三十二页。AcuteShoulderDislocationSurgeryEinoderAnatomy•Stability:-ball&socket=compressioninconcavityeffect•Bone-bighead–smallcup=unstable•Menisci-labium=↑depthofcupby20%•Ligaments-glenohumeral&capsule•Muscles-rotatorcuff&biceps=holdsballincup•PrimaryMovers-Deltoid,Pec.major&Lat.Dorsy=subluxingforces•Dynamic-proprioceptivefeedback第二页，共三十二页。AcuteShoulderDislocationSurgeryEinoderPathophysiology(Lazarus1996)•Chondro-labraldefectcausesa65%reductioninstabilityinthedirectionofthedefect•Deficiencyoftheant.inf.capsulolabralcomplexFractureofant.lipofglenoid=15%•TopreventthepersistenceofthedefectitneedstoberepairedArthroscopicallyOpen第三页，共三十二页。AcuteShoulderDislocationSurgeryEinoderAcuteInjury•Somethingbreaksortearsandthereforecanberepaired.•Repairisbetterthanreconstruct•RepairiseasierthanreconstructChronic•Instabilityhasadditionalplasticdeformationofthecapsuleandglenohumeralligamentsthereforeneedstobeshortened•Restoringthenormalfunctionalanatomyisimpossible第四页，共三十二页。AcuteShoulderDislocationSurgeryEinoderConservativeTreatmentRowe–JBJS,1957324youngpatientwithant.dislocations•94%hadrecurrenceif<20yearsold•62%hadrecurrenceif<30yearsold•14%hadrecurrenceif>40yearsoldBurkhead&Rockwood(textbook)40patientswithacutedislocation&vigorousrehabilitation•Only16%hadgoodorexcellentresult(1in6)Deny&Drew–Injury,November2002•21%ofallpatientspresentingwithshoulderdislocationhadpreviousdislocationin1year•43%inpatients15-22yearshadre-dislocations第五页，共三十二页。AcuteShoulderDislocationSurgeryEinoderNonoperativetreatmentofshoulderdislocationinyoungathletes1.Arciera–JArthroscopy,19952.DeBeardino–JSouthOrthopaedicAss,19963.Haelen–JArchOrthopaedicTraumaSurgery,19904.Hovelius–JOrthopaedicScience,19995.Wheeler–JArthroscopy,19986.Kirkby–JArthroscopy,1999allover80%recurrencerateNonoperativetreatmentisunacceptable第六页，共三十二页。AcuteShoulderDislocation...
