Differential Diagnosis ntawm Lub xub pwg Joint Dislocation thiab Lub xub pwg Joint Subluxation
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Differential Diagnosis ntawm Lub xub pwg Joint Dislocation thiab Lub xub pwg Joint Subluxation.
Lub xub pwg sib koom ua ke yog tsim los ntawm rau lub pob qij txha, uas tau muab faib ua lub xub pwg -humeral joint, glenohumeral joint, acromioclavicular joint, sternoclavicular joint, coracoclavicular joint, thiab scapular chest wall joint. Vim hais tias lub taub hau humeral yog loj thiab kheej kheej, lub glenoid yog ntiav thiab me me, lub xub pwg ob leeg tsuas yog nyob ib ncig ntawm 1/3 ntawm lub taub hau humeral, thiab cov pob qij txha yog nyias thiab slack, yog li lub xub pwg ob leeg yog qhov loj tshaj thiab hloov tau yooj yim sib koom ua ke. tib neeg lub cev. Ua flexion, extension, adduction, abduction, internal rotation, sab nraud rotation, thiab looping. Txawm li cas los xij, txawm hais tias cov yam ntxwv ntawm lub xub pwg sib koom ua kom nws yooj yim, nws qhov ruaj khov thiab ruaj khov yog qis dua lwm cov pob qij txha, thiab nws yog qhov tsis ruaj khov tshaj plaws ntawm cov pob qij txha loj ntawm tag nrho lub cev. Vim yog cov yam ntxwv ntawm cov qauv, lub xub pwg sib koom ua ke yog nquag mus rau dislocation thiab subluxation vim yog sab nraud.
Traumatic lub xub pwg dislocation yog muab faib ua anterior dislocation thiab posterior dislocation raws li txoj hauj lwm ntawm humeral taub hau. Kev sib hloov ntawm lub xub pwg nyom feem ntau tshwm sim, feem ntau tshwm sim los ntawm kev ua phem tsis ncaj, xws li kev nyiag thiab kev sib hloov sab nraud ntawm sab sauv sab sauv thaum ntog, xibtes lossis lub luj tshib kov hauv av, sab nraud quab yuam cuam tshuam raws li qhov ntev ntawm lub humerus, thiab humerus lub taub hau nyob nruab nrab ntawm lub subscapularis thiab lub voj voog loj Qhov tsis muaj zog ntawm qhov sib koom ua ke ntawm cov tshuaj ntsiav thiab prolapsed rau pem hauv ntej thiab nqes mus rau sab nrauv dislocation. Lub taub hau ntawm humerus raug thawb nyob rau hauv cov txheej txheem coracoid ntawm scapula los tsim subcoracoid dislocation. Yog tias muaj kev kub ntxhov ntau dua, lub taub hau humeral tau txav mus rau hauv subclavian los tsim subclavian dislocation. Posterior dislocation yog tsis tshua muaj, feem ntau vim hais tias lub xub pwg ob leeg raug ua nruj ua tsiv los ntawm pem hauv ntej mus rau sab nraum qab los yog txhais tes kov av thaum nws ntog thaum lub xub pwg ob leeg yog retracted. Posterior dislocation tuaj yeem muab faib ua subscapular spine thiab subacromial dislocation. Yog hais tias lub xub pwg nyom dislocation tsis kho zoo nyob rau hauv thawj theem, ib txwm dislocation yuav tshwm sim.
Lub xub pwg sib koom ua ke subluxation feem ntau tshwm sim hauv cov neeg mob hemiplegia. Tam sim no, cov ntsiab lus tseem ceeb yog raws li hauv qab no: 1. Kev ua haujlwm ntawm cov leeg ntawm lub xub pwg nyom, feem ntau yog cov leeg supraspinatus thiab deltoid; 2. Kev so thiab kev puas tsuaj ntawm lub xub pwg capsule thiab ligament Thiab prolongation tshwm sim los ntawm ntev -lub sij hawm stretching; 3, tuag tes tuag taw ntawm cov leeg nyob ib ncig ntawm lub scapula, lub scapula tshwm sim los ntawm spasm rotates downwards. 4. Nyob rau hauv thaum ntxov laus ntawm lub sab sauv ceg ntawm hemilegic sab, nrog rau kev kho mob posture, kev ua hauj lwm kev cob qhia thiab posture hloov tsis tau zoo.
Traumatic shoulder dislocation has a history of obvious trauma, shoulder pain, swelling and dysfunction. The injured limb is elastically fixed in mild abduction and internal rotation, elbow flexion, and the affected side forearm is supported with the healthy hand. The appearance is a "square shoulder" deformity, the acromion is prominent, and the acromion is empty. The humerus and head can be felt under the armpit, under the coracoid process, or under the collarbone. The injured limb is slightly abducted and cannot be close to the chest wall. For example, when the elbow is attached to the chest, the palm of the hand cannot touch the contralateral shoulder at the same time (Dugas sign, which is a positive shoulder test). A ruler placed on the outer side of the upper arm can simultaneously contact the acromion and the lateral upper ankle of the humerus (straight rule test).
Lub xub pwg subluxation tsis tshwm sim tam sim tom qab hemiplegia, tab sis tshwm sim hauv Bronnstrom theem I II dystonia, feem ntau tshwm sim hauv 1 lub hlis tom qab tus kab mob. Nws tau pom ntau dua tom qab pib qhov kev ua si zaum. Cov neeg mob thaum ntxov yuav tsis hnov qhov tsis xis nyob, thiab qee cov neeg mob yuav muaj kev tsis xis nyob los yog mob thaum lub sab sauv ntawm lub cev cuam tshuam hangs ntev rau sab ntawm lub cev. Thaum lub sab sauv sab sauv txhawb nqa lossis nqa, cov tsos mob saum toj no tuaj yeem txo qis lossis ploj mus. Thaum lub sij hawm, mob lub xub pwg nyom hnyav yuav tshwm sim.
Txoj kev tshuaj xyuas ntawm lub xub pwg dislocation:
1. Abnormal features of shoulder joint X-ray and CT examination report: ① Due to the forced internal rotation of the humerus head, even if the forearm is in the neutral position, the humerus neck can be found to be "shortened" or "disappeared", and the large and small nodules overlap ; ② The gap between the inner edge of the humeral head and the anterior edge of the scapula is widened. It is generally considered that the gap is greater than 6mm, which can be diagnosed as abnormal; The relationship is asymmetric, showing high or low, and it is not parallel to the front edge of the glenoid.
2. Thaum lub xub pwg dislocation yog heev xav tias yuav tsum tau ntxiv ib zaj duab xis axillary los yog ib tug thoracic zaj duab xis, thiab humeral taub hau prolapse nyob rau sab nraum qab ntawm lub scapula. Yog tias tsim nyog, CT scan ntawm lub xub pwg nyom tuaj yeem ua kom pom tseeb tias lub taub hau ntawm lub taub hau sib koom yog tig rov qab thiab tawm ntawm ntug ntug ntawm glenoid; Qee lub sij hawm lub taub hau ntawm lub taub hau tuaj yeem pom thiab tsim kom muaj kev sib haum xeeb nrog lub ntsej muag tom qab ntawm glenoid, uas cuam tshuam rau qhov txo qis, los yog glenoid Fracture ntawm ntug ntug.
3. Lub xub pwg sib koom ua ke yuav tsum tau kuaj xyuas qhov tsis sib xws, kwv yees li 30 mus rau 40 feem pua ntawm cov neeg mob ntawm lub xub pwg nyom dislocation ua ke nrog cov pob txha loj, humeral phais caj dab pob txha, lossis humeral taub hau compression fractures, qee zaum ua ke nrog kev sib koom ua ke los yog scapular glenoid tawg los ntawm qhov txuas pem hauv ntej, kev kho tsis zoo tuaj yeem ua rau ib txwm muaj kev cuam tshuam. Lub taub hau ntev ntawm lub biceps brachii tuaj yeem plam rov qab, uas tuaj yeem ua rau muaj kev cuam tshuam rau kev sib koom ua ke. Cov paj hlwb axillary los yog brachial plexus paj hlwb medial pob tuaj yeem raug compressed lossis rub los ntawm lub taub hau humeral, ua rau cov hlab ntsha tsis ua haujlwm, thiab tuaj yeem ua rau cov hlab ntsha axillary puas.
Kev tshuaj xyuas txoj kev ntawm lub xub pwg subluxation:
1. Lub xub pwg sib koom ua ke subluxation qhia tau hais tias lub cev qhuav dej ntawm cov leeg deltoid ntawm lub xub pwg nyom, loosening ntawm cov pob qij txha capsule, thiab downward txav ntawm lub taub hau humeral, qhia me ntsis square lub xub pwg deformity. Kev sib koom ua ke Meng yog khoob, thiab tuaj yeem pom muaj kev nyuaj siab ntawm acromion thiab lub taub hau humeral, uas tuaj yeem ua tau raws li 1--2 ntiv tes hla. Raws li cov leeg nqaij nce thiab lub cev muaj zog ua haujlwm nce, cov cim saum toj no tuaj yeem txo qis lossis txawm ploj mus. Cov neeg mob feem ntau tsuas yog qhia tau tias muaj kev pab ib ntus thiab ploj mus thaum tuav cov ceg tawv sab sauv lossis thaum lawv ntxhov siab, ua haujlwm, thiab tawv, thiab tseem qhia pom pom tseeb subluxation thaum cov ceg tawv sab sauv tau so thiab tsis txhawb nqa hauv qhov chaw zaum.
