tailieunhanh - Phẫu thuật chỉnh hình vai

Bác sĩ phẫu thuật chỉnh hình cao cấp, chỉnh hình phẫu thuật, Trường Đại học Y khoa Hadassah-Hebrew, Jerusalem, Israel. Tiến sĩ Iannotti là Giáo sư và Chủ tịch, Khoa Phẫu thuật chỉnh hình, Cleveland Clinic Foundation, Cleveland Clinic Lerner Trường Y khoa Case Western Reserve University, Cleveland, OH. Không ai trong số các tác giả | Arthrodesis of the Shoulder Ori Safran MD Joseph P. lannotti MD PhD Dr. Safran is Senior Orthopaedic Surgeon Department of Orthopaedic Surgery Hadassah-Hebrew University Medical School Jerusalem Israel. Dr. Iannotti is Professor and Chairman Department of Orthopaedic Surgery The Cleveland Clinic Foundation Cleveland Clinic Lerner School of Medicine of Case Western Reserve University Cleveland OH. None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article Dr. Safran and Dr. Iannotti. Reprint requests Dr. Iannotti The Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland OH 44195. J Am Acad Orthop Surg 2006 14 145-153 Copyright 2006 by the American Academy of Orthopaedic Surgeons. Abstract Shoulder arthrodesis is an end-stage salvage option for the failing painful joint that cannot undergo or has failed reconstruction. It is indicated for irreversible and nonreconstructible massive rotator cuff tears and deltoid muscle denervation as well as for detachment of the deltoid from its origin. Rarely arthrodesis is done to stabilize the glenohumeral joint after many failed attempts at shoulder reconstruction. Arthrodesis for failed prosthetic arthroplasty or tumor resection presents additional challenges because of the associated bone loss on the humeral and or glenoid side of the joint. Primary arthrodesis requires rigid internal plate fixation and both an extra- and an intra-articular site of fusion. Depending on bone volume and quality needed the patient may require bracing for 8 to 10 weeks autogenous or allograft bone grafting or a vascularized fibular bone graft to reconstruct the bone deficiency along with prolonged spica cast immobilization. The optimal position for arthrodesis is 20 of forward flexion 20 of abduction and 40 of internal rotation with modifications based on patient body size or