Shoulder Arthroscopy
肩关节镜
Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and repair problems inside a joint.
肩关节镜是骨科医生用来检查，诊断和修复关节问题的一种手段。
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（关节镜）这个单词来源于两个希腊单词'arthro' (关节) 和 'skopein' (看)。这个词照字面意思解释就是”在关节内看”。在肩关节镜检查中，你的外科医生将一个称为关节镜的小摄像头插入到你的肩关节当中，这个摄像头将关节内的影像展示到电视屏幕上，这样你的外科医生就能利用这些影像来引导操作微型的手术器械。
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.
因为关节镜和手术器械很小，你的外科医生就能用很小的切口，而不是传统开放手术的标准大切口。这就大大减少了病人的痛苦，并缩短了康复时间，使病人能更快地回到喜爱的运动中去。
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.
自从上世纪70年代开展肩关节镜以来，肩部疾病的诊断、治疗和康复变得更加容易和快捷，超乎了人们的想象。随着新器械和新技术的发展，肩关节镜领域的进展每年都层出不穷。
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).
肩关节是一个复杂的关节，相比身体其他的关节更加灵活。它由三块骨头组成：肱骨，肩胛骨和锁骨。
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.
球和窝：肱骨头与肩胛骨的一个圆形的窝相匹配，这个窝叫做关节盂。一种叫做关节软骨的光滑组织覆盖在球和窝的表面，创造出一个平滑的，无摩擦力的表面，使得骨与骨之间能够轻易地滑动。
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.
关节盂被一种叫做盂唇的强有力的纤维软骨所包绕，盂唇在窝的周围形成了一个衬垫，增加了关节的稳定性。
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.
肩关节囊：肩关节被叫一组韧带的组织所包绕，它们组成了一个将肩关节包裹起来的囊。关节囊的下面由一种叫做滑膜的薄膜所覆盖，它产生滑液来润滑肩关节。
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根包绕肩关节囊的肌腱组成，它们帮助保持你的上臂骨以肩关节窝为中心。这种厚的肌腱组织被叫做肩袖。肩袖覆盖于肱骨头表面，并把它连接到肩胛骨上。
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：有一种起润滑作用的囊叫做滑囊，它位于肩袖和肩峰之间，当你运动手臂时，能帮助肩袖肌腱平滑地滑动。
Normal anatomy of the shoulder.正常肩关节解剖
When Shoulder Arthroscopy Is Recommended
什么时候推荐做肩关节镜
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.
如果你有疼痛的情况，经过非手术治疗无效，你的医生可能会建议你做肩关节镜。非手术治疗包括休息，物理治疗，药物治疗或者封闭注射以减轻炎症。炎症是一种身体对损伤或疾病产生的正常反应。在损伤或者有疾病的肩关节中，炎症会引起肿胀，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.
创伤，过度使用，和年龄相关的磨损是大多数肩关节问题的原因。肩关节镜可以缓解许多问题如肩袖损伤、盂唇损伤、关节软骨损伤和其他肩关节周围的软组织损伤所引起的疼痛症状。
Common arthroscopic procedures include:
通常的肩关节镜手术包括：
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
肩袖修补
骨刺去除
去除或修补盂唇
韧带修补
去除发炎的组织或松动的软骨
修复习惯性肩关节脱位
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.
不常见的手术如神经减压，骨折修复，囊肿切除也可以用关节镜进行。但一些外科手术，如肩关节置换术，仍然需要行广泛切开的开放手术。
These photos taken through an arthroscope show a normal shoulder joint lining (left) and an inflamed joint lining damaged by frozen shoulder.
这两张关节镜下图片显示了一个正常的肩关节（左边）和一个因冻结肩造成发炎的肩关节。
Planning for Surgery
手术计划
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.
你的骨科医生可能会让你去看你的保健医生，以确保你没有任何其他需要在手术前解决的医学问题。为了手术的安全，需要行血液检查，心电图，胸片等检查。
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风险，那么在手术前进行一次更深入广泛的评估是十分必要的。记得告诉你的骨科医生任何你正在服用的药物或保健品，在手术之前你可能需要停用某些药物。
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，你的关节镜将很可能在门诊进行，这意味着你将不需要住院。
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.
医院或者手术中心在手术前将联系并告知你关于手术具体的细节。确保根据指示来做，什么时间到达，尤其是手术前什么时候停止进食及饮水。
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.
在手术之前，麻醉师会和你谈麻醉方式的选择。肩关节镜手术大多数使用区域神经阻滞的麻醉方法来使你的肩膀和手臂失去知觉。麻醉药物注射在你颈部的基底或者肩部的上方，这是控制肩部及上肢感觉的神经所在的位置。除了作为手术中的麻醉药物，神经阻滞也用来帮助控制术后数小时的疼痛。许多外科医生会结合使用神经阻滞和镇静剂或轻度的全麻药物，因为病人在整个手术过程中维持一个姿势会感到不舒服。
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.
大多数关节镜手术不到一小时，你的手术时间长度将取决于外科医生术中的发现以及需要做什么样的修复。
Surgical Procedure
手术过程
Positioning and Preparation
体位和准备
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:
一旦进入到手术室，你将被置于某种体位，以便你的外科医生能轻易地调整关节镜来获得肩关节内部清晰的视野。两种最常见的肩关节镜手术体位是：
· Beach chair position. This is a semi-seated position similar to sitting in a reclining chair.
· 沙滩椅位：这是一种半坐的体位，类似于坐在一张躺椅上
· Lateral decubitius position. In this position the patient lies on his or her side on an operating table.
· 侧卧位：这种体位患者侧卧在手术台上
Each position has some slight advantages. Surgeons select positions based on the procedure being performed, as well as their individual training.
每一种体位都有一定的优点，外科医生基于手术的需要及个人的训练情况挑选合适的体位。
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.
一旦体位摆好，你的手术团队就会给你备皮，消毒肩部的皮肤，用无菌单覆盖你的肩部和手臂，然后把你的前臂放置在牵引维持装置上以确保手臂保持不动。
Procedure
手术过程
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.
你的外科医生会首先注射液体至肩关节中使关节膨胀开。这使得术者能够更容易地通过关节镜看到所有的肩关节结构。然后你的外科医生会在你的肩部做一个小的穿刺（大约一枚纽扣的大小）来建立关节镜通道。液体流过关节镜以保持视野清晰并控制出血。关节镜采集的图像传输到显示屏上给你的外科医生看你肩关节内部及任何的损伤。
(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）在肩关节镜手术中，你的外科医生将关节镜和小的手术器械插入你的肩关节中。（右）关节镜下所见的肩关节内部结构
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.
一旦问题清晰地被确认了，你的外科医生就会通过另一个切口插入其他小的手术器械来修复。专门的手术器械被用来进行诸如刨削、切、抓、穿线、打结等操作。在许多的病例中，特殊的装置被用来锚定缝线到骨头里。
(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）关节镜下所见健康的肩关节。（右）肩袖撕裂的图像，可以看到肩袖肌腱边缘和肱骨头之间巨大的间隙。
The tendon has been re-attached to the humeral head with sutures.
肌腱已经被用缝线重新附着到肱骨头上。
Your surgeon may close your incisions with stitches or steri-strips (small Band-Aids) and cover them with a large, soft bandage.
你的外科医生可能用缝线或者免缝胶带（小创可贴）来关闭你的切口，并用大的软的纱布绷带覆盖切口。
Recovery
恢复
Postoperative
术后
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.
手术之后，你将在出院回家之前在恢复室内停留1-2个小时。护士将监测你的反应，如果需要的话还会提供镇痛药物。你将需要某个人开车送你回家并至少在第一个夜晚陪着你。
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.
尽管关节镜术后恢复通常比开放手术快，但仍需要数周的时间来使你的肩关节完全康复。
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.
术后至少一周你可以会出现一些疼痛和不适。如果你经历了一个较大的手术，疼痛可能会持续数周。冰敷可以帮助减轻疼痛和肿胀。如果需要的话，你的医生会给你开一些止痛药。
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.
尽管这并不影响你肩关节的愈合，平躺会牵拉你的肩膀从而引起不适。一些病人会觉得在术后第一天睡在躺椅上或者在靠在床上会更加舒适。
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.
术后数天，你可以用创可贴替换大的纱布绷带。一旦你的伤口不再渗出你就可以淋浴了，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.
你将可能需要一个悬吊带或者特殊的制动装置来保护你的肩部。你的外科医生将会和你讨论悬吊带需要使用多久。
Rehabilitation
康复
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.
康复在使你回到日常活动中起着非常重要的作用。一个训练计划将帮助你恢复肩部的力量和活动度。你的外科医生将基于你手术的情况制定一个康复计划。
If you have had a more complicated surgical repair, your surgeon may recommend a physical therapist to supervise your exercise program.
如果你经历了一个更加复杂的手术修复，你的外科医生可能会推荐一个理疗师来监督指导你的训练计划。
It is important that you make a strong effort at rehabilitation in order for your surgery to succeed.
很重要的一点就是，为了手术的成功，你要非常努力地去进行康复训练。
Complications
并发症
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.
大多数病人在肩关节镜术后并不会出现并发症。但是就像任何手术一样，都会存在着一定的风险，但通常都是较小的可以治疗的。关节镜手术的潜在问题包括感染，出血过多，血栓形成，以及血管或神经损伤。
Your surgeon will discuss the possible complications with you before your operation.
你的外科医生在术前会和你讨论这些可能发生的并发症。
Long-Term Outcomes
远期疗效
Because patients have varied health conditions, complete recovery time is different for everyone.
因为每个病人都有不同的健康状况，完全康复的时间因人而异。
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.
如果你经历了一个较小的修复，你可能不需要使用悬吊带并且你的力量可能在短期的康复后恢复。你可能可以在术后数天内就回到工作或学校中去。
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.
更复杂的手术就需要花费更长的时间来康复。尽管关节镜手术的切口非常小，但可以在术中修复关节内广泛的损伤。完全康复可能需要数月的时间。尽管这可能是一个漫长的过程，但为了获得成功的疗效，遵循你外科医生的指导方针和康复计划是至关重要的。
联系客服
