Shoulder Arthroscopy
肩關(guān)節(jié)鏡
Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and repair problems inside a joint.
肩關(guān)節(jié)鏡是骨科醫(yī)生用來檢查，診斷和修復關(guān)節(jié)問題的一種手段。
The word arthroscopy comes from two Greek words,'arthro' (joint) and 'skopein' (to look). The term literally means 'to look within the joint.' During shoulder arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.
Arthroscopy（關(guān)節(jié)鏡）這個單詞來源于兩個希臘單詞'arthro' (關(guān)節(jié)) 和 'skopein' (看)。這個詞照字面意思解釋就是”在關(guān)節(jié)內(nèi)看”。在肩關(guān)節(jié)鏡檢查中，你的外科醫(yī)生將一個稱為關(guān)節(jié)鏡的小攝像頭插入到你的肩關(guān)節(jié)當中，這個攝像頭將關(guān)節(jié)內(nèi)的影像展示到電視屏幕上，這樣你的外科醫(yī)生就能利用這些影像來引導操作微型的手術(shù)器械。
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery. This results in less pain for patients, and shortens the time it takes to recover and return to favorite activities.
因為關(guān)節(jié)鏡和手術(shù)器械很小，你的外科醫(yī)生就能用很小的切口，而不是傳統(tǒng)開放手術(shù)的標準大切口。這就大大減少了病人的痛苦，并縮短了康復時間，使病人能更快地回到喜愛的運動中去。
Shoulder arthroscopy has been performed since the 1970s.It has made diagnosis, treatment, and recovery from surgery easier and faster than was once thought possible. Improvements to shoulder arthroscopy occur every year as new instruments and techniques are developed.
自從上世紀70年代開展肩關(guān)節(jié)鏡以來，肩部疾病的診斷、治療和康復變得更加容易和快捷，超乎了人們的想象。隨著新器械和新技術(shù)的發(fā)展，肩關(guān)節(jié)鏡領(lǐng)域的進展每年都層出不窮。
Anatomy
Your shoulder is a complex joint that is capable of more motion than any other joint in your body. It is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collar bone(clavicle).
肩關(guān)節(jié)是一個復雜的關(guān)節(jié)，相比身體其他的關(guān)節(jié)更加靈活。它由三塊骨頭組成：肱骨，肩胛骨和鎖骨。
Ball and socket. The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, frictionless surface that helps the bones glide easily across each other.
球和窩：肱骨頭與肩胛骨的一個圓形的窩相匹配，這個窩叫做關(guān)節(jié)盂。一種叫做關(guān)節(jié)軟骨的光滑組織覆蓋在球和窩的表面，創(chuàng)造出一個平滑的，無摩擦力的表面，使得骨與骨之間能夠輕易地滑動。
The glenoid is ringed by strong fibrous cartilage called the labrum. The labrum forms a gasket around the socket, adds stability, and cushions the joint.
關(guān)節(jié)盂被一種叫做盂唇的強有力的纖維軟骨所包繞，盂唇在窩的周圍形成了一個襯墊，增加了關(guān)節(jié)的穩(wěn)定性。
Shoulder capsule. The joint is surrounded by bands of tissue called ligaments. They form acapsule that holds the joint together. The undersurface of the capsule is lined by a thin membrane called the synovium. It produces synovial fluid that lubricates the shoulder joint.
肩關(guān)節(jié)囊：肩關(guān)節(jié)被叫一組韌帶的組織所包繞，它們組成了一個將肩關(guān)節(jié)包裹起來的囊。關(guān)節(jié)囊的下面由一種叫做滑膜的薄膜所覆蓋，它產(chǎn)生滑液來潤滑肩關(guān)節(jié)。
Rotator cuff. Four tendons surround the shoulder capsule and help keep your arm bone centered in your shoulder socket. This thick tendon material is called the rotator cuff. The cuff covers the head of the humerus and attaches it to your shoulder blade.
肩袖：4根包繞肩關(guān)節(jié)囊的肌腱組成，它們幫助保持你的上臂骨以肩關(guān)節(jié)窩為中心。這種厚的肌腱組織被叫做肩袖。肩袖覆蓋于肱骨頭表面，并把它連接到肩胛骨上。
Bursa. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa helps the rotator cuff tendons glide smoothly when you move your arm.
滑囊：有一種起潤滑作用的囊叫做滑囊，它位于肩袖和肩峰之間，當你運動手臂時，能幫助肩袖肌腱平滑地滑動。
Normal anatomy of the shoulder.正常肩關(guān)節(jié)解剖
When Shoulder Arthroscopy Is Recommended
什么時候推薦做肩關(guān)節(jié)鏡
Your doctor may recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical treatment.Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of your body's normal reactions to injury or disease. In an injured or diseased shoulder joint, inflammation causes swelling, pain, and stiffness.
如果你有疼痛的情況，經(jīng)過非手術(shù)治療無效，你的醫(yī)生可能會建議你做肩關(guān)節(jié)鏡。非手術(shù)治療包括休息，物理治療，藥物治療或者封閉注射以減輕炎癥。炎癥是一種身體對損傷或疾病產(chǎn)生的正常反應。在損傷或者有疾病的肩關(guān)節(jié)中，炎癥會引起腫脹，疼痛和僵硬。
Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum,articular cartilage, and other soft tissues surrounding the joint.
創(chuàng)傷，過度使用，和年齡相關(guān)的磨損是大多數(shù)肩關(guān)節(jié)問題的原因。肩關(guān)節(jié)鏡可以緩解許多問題如肩袖損傷、盂唇損傷、關(guān)節(jié)軟骨損傷和其他肩關(guān)節(jié)周圍的軟組織損傷所引起的疼痛癥狀。
Common arthroscopic procedures include:
通常的肩關(guān)節(jié)鏡手術(shù)包括：
Rotator cuff repair
Bone spur removal
Removal or repair of the labrum
Repair of ligaments
Removal of inflamed tissue or loose cartilage
Repair for recurrent shoulder dislocation
肩袖修補
骨刺去除
去除或修補盂唇
韌帶修補
去除發(fā)炎的組織或松動的軟骨
修復習慣性肩關(guān)節(jié)脫位
Less common procedures such as nerve release, fracture repair, and cyst excision can also be performed using an arthroscope. Some surgical procedures, such as shoulder replacement, still require open surgery with more extensive incisions.
不常見的手術(shù)如神經(jīng)減壓，骨折修復，囊腫切除也可以用關(guān)節(jié)鏡進行。但一些外科手術(shù)，如肩關(guān)節(jié)置換術(shù)，仍然需要行廣泛切開的開放手術(shù)。
These photos taken through an arthroscope show a normal shoulder joint lining (left) and an inflamed joint lining damaged by frozen shoulder.
這兩張關(guān)節(jié)鏡下圖片顯示了一個正常的肩關(guān)節(jié)（左邊）和一個因凍結(jié)肩造成發(fā)炎的肩關(guān)節(jié)。
Planning for Surgery
手術(shù)計劃
Your orthopaedic surgeon may ask you to see your primary doctor to make sure that you do not have any medical problems that need to be addressed before your surgery. Blood tests, an electrocardiogram, or chest x-ray may be needed to safely perform your surgery.
你的骨科醫(yī)生可能會讓你去看你的保健醫(yī)生，以確保你沒有任何其他需要在手術(shù)前解決的醫(yī)學問題。為了手術(shù)的安全，需要行血液檢查，心電圖，胸片等檢查。
If you have certain health risks, a more extensive evaluation may be necessary before your surgery. Be sure to inform your orthopaedic surgeon of any medications or supplements that you take. You may need to stop taking some of these prior to surgery.
如果你存在一定的健康風險，那么在手術(shù)前進行一次更深入廣泛的評估是十分必要的。記得告訴你的骨科醫(yī)生任何你正在服用的藥物或保健品，在手術(shù)之前你可能需要停用某些藥物。
If you are generally healthy, your arthroscopy will most likely be performed as an outpatient. This means you will not need to stay over night at the hospital.
如果你基本健康，你的關(guān)節(jié)鏡將很可能在門診進行，這意味著你將不需要住院。
The hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Make sure to follow the instructions on when to arrive and especially on when to stop eating or drinking prior to your surgery.
醫(yī)院或者手術(shù)中心在手術(shù)前將聯(lián)系并告知你關(guān)于手術(shù)具體的細節(jié)。確保根據(jù)指示來做，什么時間到達，尤其是手術(shù)前什么時候停止進食及飲水。
Before the operation, a member of the anesthesia staff will talk with you about anesthesia options. Shoulder arthroscopy is most commonly performed using regional nerve blocks which numb your shoulder and arm. This numbing medicine is injected in the base of your neck or high on your shoulder. This is where the nerves that control feeling in your shoulder and arm are located. In addition to its use as an anesthetic during surgery, a nerve block will help control pain for a few hours after the surgery is completed. Many surgeons combine nerve blocks with sedation or a light general anesthetic because patients can become uncomfortable staying in one position for the length of time needed to complete the surgery.
在手術(shù)之前，麻醉師會和你談麻醉方式的選擇。肩關(guān)節(jié)鏡手術(shù)大多數(shù)使用區(qū)域神經(jīng)阻滯的麻醉方法來使你的肩膀和手臂失去知覺。麻醉藥物注射在你頸部的基底或者肩部的上方，這是控制肩部及上肢感覺的神經(jīng)所在的位置。除了作為手術(shù)中的麻醉藥物，神經(jīng)阻滯也用來幫助控制術(shù)后數(shù)小時的疼痛。許多外科醫(yī)生會結(jié)合使用神經(jīng)阻滯和鎮(zhèn)靜劑或輕度的全麻藥物，因為病人在整個手術(shù)過程中維持一個姿勢會感到不舒服。
Most arthroscopic procedures take less than an hour,however, the length of your surgery will depend on what your surgeon finds and what repairs are required.
大多數(shù)關(guān)節(jié)鏡手術(shù)不到一小時，你的手術(shù)時間長度將取決于外科醫(yī)生術(shù)中的發(fā)現(xiàn)以及需要做什么樣的修復。
Surgical Procedure
手術(shù)過程
Positioning and Preparation
體位和準備
Once in the operating room, you will be positioned so that your surgeon can easily adjust the arthroscope to have a clear view of the inside of your shoulder. The two most common patient positions for arthroscopic shoulder surgery are:
一旦進入到手術(shù)室，你將被置于某種體位，以便你的外科醫(yī)生能輕易地調(diào)整關(guān)節(jié)鏡來獲得肩關(guān)節(jié)內(nèi)部清晰的視野。兩種最常見的肩關(guān)節(jié)鏡手術(shù)體位是：
· Beach chair position. This is a semi-seated position similar to sitting in a reclining chair.
· 沙灘椅位：這是一種半坐的體位，類似于坐在一張?zhí)梢紊?/span>
· Lateral decubitius position. In this position the patient lies on his or her side on an operating table.
· 側(cè)臥位：這種體位患者側(cè)臥在手術(shù)臺上
Each position has some slight advantages. Surgeons select positions based on the procedure being performed, as well as their individual training.
每一種體位都有一定的優(yōu)點，外科醫(yī)生基于手術(shù)的需要及個人的訓練情況挑選合適的體位。
Once you are positioned, the surgical team will remove hair, if needed, and then spread an antiseptic solution over your shoulder to clean the skin. They will cover your shoulder and arm with sterile drapes, and will most likely place your forearm in a holding device to ensure your arm stays still.
一旦體位擺好，你的手術(shù)團隊就會給你備皮，消毒肩部的皮膚，用無菌單覆蓋你的肩部和手臂，然后把你的前臂放置在牽引維持裝置上以確保手臂保持不動。
Procedure
手術(shù)過程
Your surgeon will first inject fluid into the shoulder to inflate the joint.This makes it easier to see all the structures of your shoulder through the arthroscope. Then your surgeon will make a small puncture in your shoulder(about the size of a button hole) for the arthroscope. Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing your surgeon the inside of your shoulder and any damage.
你的外科醫(yī)生會首先注射液體至肩關(guān)節(jié)中使關(guān)節(jié)膨脹開。這使得術(shù)者能夠更容易地通過關(guān)節(jié)鏡看到所有的肩關(guān)節(jié)結(jié)構(gòu)。然后你的外科醫(yī)生會在你的肩部做一個小的穿刺（大約一枚紐扣的大小）來建立關(guān)節(jié)鏡通道。液體流過關(guān)節(jié)鏡以保持視野清晰并控制出血。關(guān)節(jié)鏡采集的圖像傳輸?shù)斤@示屏上給你的外科醫(yī)生看你肩關(guān)節(jié)內(nèi)部及任何的損傷。
(Left) During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint. (Right) An arthroscopic view of the inside of the shoulder joint
（左）在肩關(guān)節(jié)鏡手術(shù)中，你的外科醫(yī)生將關(guān)節(jié)鏡和小的手術(shù)器械插入你的肩關(guān)節(jié)中。（右）關(guān)節(jié)鏡下所見的肩關(guān)節(jié)內(nèi)部結(jié)構(gòu)
Once the problem is clearly identified, your surgeon will insert other small instruments through separate incisions to repair it.Specialized instruments are used for tasks like shaving, cutting, grasping,suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone.
一旦問題清晰地被確認了，你的外科醫(yī)生就會通過另一個切口插入其他小的手術(shù)器械來修復。專門的手術(shù)器械被用來進行諸如刨削、切、抓、穿線、打結(jié)等操作。在許多的病例中，特殊的裝置被用來錨定縫線到骨頭里。
(Left) An arthroscopic view of a healthy shoulder joint. (Right) In this image of a rotator cuff tear,a large gap can be seen between the edge of the rotator cuff tendon and the humeral head.
（左）關(guān)節(jié)鏡下所見健康的肩關(guān)節(jié)。（右）肩袖撕裂的圖像，可以看到肩袖肌腱邊緣和肱骨頭之間巨大的間隙。
The tendon has been re-attached to the humeral head with sutures.
肌腱已經(jīng)被用縫線重新附著到肱骨頭上。
Your surgeon may close your incisions with stitches or steri-strips (small Band-Aids) and cover them with a large, soft bandage.
你的外科醫(yī)生可能用縫線或者免縫膠帶（小創(chuàng)可貼）來關(guān)閉你的切口，并用大的軟的紗布繃帶覆蓋切口。
Recovery
恢復
Postoperative
術(shù)后
After surgery, you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.
手術(shù)之后，你將在出院回家之前在恢復室內(nèi)停留1-2個小時。護士將監(jiān)測你的反應，如果需要的話還會提供鎮(zhèn)痛藥物。你將需要某個人開車送你回家并至少在第一個夜晚陪著你。
At Home
在家
Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks for your shoulder joint to completely recover.
盡管關(guān)節(jié)鏡術(shù)后恢復通常比開放手術(shù)快，但仍需要數(shù)周的時間來使你的肩關(guān)節(jié)完全康復。
You can expect some pain and discomfort for at least aweek after surgery. If you have had a more extensive surgery, however, it may take several weeks before your pain subsides. Ice will help relieve pain and swelling. Your doctor may prescribe pain medicine, if needed.
術(shù)后至少一周你可以會出現(xiàn)一些疼痛和不適。如果你經(jīng)歷了一個較大的手術(shù)，疼痛可能會持續(xù)數(shù)周。冰敷可以幫助減輕疼痛和腫脹。如果需要的話，你的醫(yī)生會給你開一些止痛藥。
Although it does not affect how your shoulder heals,lying flat may pull on your shoulder and cause discomfort. Some patients are more comfortable sleeping in a reclining chair or propped up in bed during the first days after surgery.
盡管這并不影響你肩關(guān)節(jié)的愈合，平躺會牽拉你的肩膀從而引起不適。一些病人會覺得在術(shù)后第一天睡在躺椅上或者在靠在床上會更加舒適。
A few days after surgery, you should be able to replace your large bandage with simple Band-Aids. You may shower once your wounds are no longer draining, but try not to soak or scrub your incisions.
術(shù)后數(shù)天，你可以用創(chuàng)可貼替換大的紗布繃帶。一旦你的傷口不再滲出你就可以淋浴了，但不要浸泡或者用力擦洗你的切口。
You will most likely need a sling or special immobilizer to protect your shoulder. Your surgeon will discuss with you how long the sling will be needed.
你將可能需要一個懸吊帶或者特殊的制動裝置來保護你的肩部。你的外科醫(yī)生將會和你討論懸吊帶需要使用多久。
Rehabilitation
康復
Rehabilitation plays an important role in getting you back to your daily activities. An exercise program will help you regain shoulder strength and motion. Your surgeon will develop a rehabilitation plan based on the surgical procedures you required.
康復在使你回到日常活動中起著非常重要的作用。一個訓練計劃將幫助你恢復肩部的力量和活動度。你的外科醫(yī)生將基于你手術(shù)的情況制定一個康復計劃。
If you have had a more complicated surgical repair, your surgeon may recommend a physical therapist to supervise your exercise program.
如果你經(jīng)歷了一個更加復雜的手術(shù)修復，你的外科醫(yī)生可能會推薦一個理療師來監(jiān)督指導你的訓練計劃。
It is important that you make a strong effort at rehabilitation in order for your surgery to succeed.
很重要的一點就是，為了手術(shù)的成功，你要非常努力地去進行康復訓練。
Complications
并發(fā)癥
Most patients do not experience complications from shoulder arthroscopy. As with any surgery, however, there are some risks. These are usually minor and treatable. Potential problems with arthroscopy include infection, excessive bleeding, blood clots, and damage to blood vessels ornerves.
大多數(shù)病人在肩關(guān)節(jié)鏡術(shù)后并不會出現(xiàn)并發(fā)癥。但是就像任何手術(shù)一樣，都會存在著一定的風險，但通常都是較小的可以治療的。關(guān)節(jié)鏡手術(shù)的潛在問題包括感染，出血過多，血栓形成，以及血管或神經(jīng)損傷。
Your surgeon will discuss the possible complications with you before your operation.
你的外科醫(yī)生在術(shù)前會和你討論這些可能發(fā)生的并發(fā)癥。
Long-Term Outcomes
遠期療效
Because patients have varied health conditions, complete recovery time is different for everyone.
因為每個病人都有不同的健康狀況，完全康復的時間因人而異。
If you have had a minor repair, you may not need a sling and your strength may return after a short period of rehabilitation. You may be able to return to work or school within a few days of your procedure.
如果你經(jīng)歷了一個較小的修復，你可能不需要使用懸吊帶并且你的力量可能在短期的康復后恢復。你可能可以在術(shù)后數(shù)天內(nèi)就回到工作或?qū)W校中去。
It takes longer to recover from more complicated procedures. Although the incisions are small in arthroscopy, extensive damage within the joint can be repaired with the procedure. Full recovery may take several months. Although it can be a slow process, following your surgeon's guidelines and rehabilitation plan is vital to a successful outcome.
更復雜的手術(shù)就需要花費更長的時間來康復。盡管關(guān)節(jié)鏡手術(shù)的切口非常小，但可以在術(shù)中修復關(guān)節(jié)內(nèi)廣泛的損傷。完全康復可能需要數(shù)月的時間。盡管這可能是一個漫長的過程，但為了獲得成功的療效，遵循你外科醫(yī)生的指導方針和康復計劃是至關(guān)重要的。
