加强肩关节疾病诊疗误区陷阱与对策的研究

Reinforcing attention to the pitfalls in shoulder surgery and their countermeasures

摘要:

近十几年关节镜技术在诊疗肩关节疾病与损伤方面迅猛发展。由于部分临床医师过于注重手术技术本身，而忽视了准确的临床诊断；在没有全面掌握手术技能的情况下，扩大手术指征；在一定程度上导致了漏诊、误诊和误治。因此，有必要对肩关节镜及肩关节手术的误区进行深入探讨。本期《中国矫形外科杂志》分析了肩关节疾病和损伤诊治中的并发症和不良事件，涉及肩关节不稳、肩关节骨折脱位合并血管和神经损伤、肩关节脱位合并肩袖撕裂、盂唇撕裂、肩关节感染、脊髓空洞继发不稳；探讨复发性肩关节不稳、肩袖再撕裂、锚钉固定不稳定、Latarjet 手术失败及肩关节骨折内固定并发症的相关因素； 并就上述困境的护理、康复和相关的基础研究进行了讨论；以期提醒广大临床医师注意肩手术临床实践中的错误和陷阱，防止不良后果的发生。本文还提出加强临床基本功，减少误诊漏诊；严把手术适应证关，避免并发症；关注创新与新技术开展，避免手术技术“秀”；加强继续教育，提高诊疗水平，患者功能至上的理念。

Abstract:

The techniques of shoulder arthroscopy and shoulder surgery for shoulder disorders and injuries has been developing rapid- ly in recent years. As some clinicians pay more attention to surgical technique itself, while ignore to accurate clinical diagnosis; expand the surgical indication without comprehensive master of required skill, the missed diagnosis, misdiagnosis and mistreatment happened frequent- ly in some extent. Therefore, it is necessary to discuss the pitfalls in shoulder arthroscopy and shoulder surgery deeply. In this issue of Or- thopedic Journal of China, the complications and adverse events in the diagnosis and treatment of shoulder disease and injury were ana- lyzed, involving shoulder instability, shoulder fracture dislocation complicated with injuries to blood vessels and nerve, shoulder dislocation complicated with rotator cuff tear, labral tear, infection, instability secondary to syringomyelia. Furthermore, relevant factors are searched re- garding to the occurrence of recurrent shoulder instability, re-torn rotator cuff, unstable anchor fixation, failure of Latarjet procedure, and complications of internal fixation of shoulder fractures. Moreover, the nursing and rehabilitation, as well as relative basic researches are dis- cussed regarding abovementioned dilemmas, in order to remind the large number of clinicians to caution the mistakes and pitfalls in clini- cal practice of shoulder arthroscopy and surgery to prevent adverse consequences. In addition, this article also proposed some suggestions, including strengthening the clinical training to reduce misdiagnosis and missed diagnosis, executing the operation indications to avoid com- plications, paying attention to innovation and new technology development to avoid surgical technique "show"; enhancing continuing educa- tion to improve the level of diagnosis and treatment, and follow the concept of function first.