【doc】肩关节前方不稳的外科治疗进展
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[1]RockwoodCA,MatsenFA.Theshoulder [M].Vol2.Philadelphia:WBSaunders Company,1990.
[2]NeerCS2nd,FosterCR.Inferiorcapsular shiftforinvoluntaryinferiorandmultidirec2 tionalinstabilityoftheshoulder.Aprelimi2 naryreport[J].JBoneJointSurgAm, 1980,62(6):897-908.
[3]PollockRG,BiglianiLU.GlenohumeralIn2 stability:EvaluationandTreatment[J].J AmAcadOrthopSurg,1993,1(1):24
-32.
[4]BurgessB,SennettBJ.Traumaticshoulder instability.Nonsurgicalmanagementversus surgicalintervention[J].OrthopNurs, 2003,22(5):345-350;quiz351-
352.
[5]?m???6,???5??,??????.?,???G???? ???????,?V?????????6????[J].?k?? ?M?o?????z??,2005,7(2):166-171. [6]ItoiE,SashiR,MinagawaH,etal.Po2 sitionofimmobilizationafterdislocationof theglenohumeraljoint.Astudywithuseof magneticresonanceimaging[J].JBone JointSurgAm,2001,83-A(5):661
-667.
[7]ItoiE,HatakeyamaY,KidoT,etal.A newmethodofimmobilizationaftertraumatic anteriordislocationoftheshoulder:apre2 liminarystudy[J].JShoulderElbowSurg, 2003,12(5):413-415.
[8]ItoiE,LeeSB,BerglundLJ,etal.The effectofaglenoiddefectonanteroinferior stabilityoftheshoulderafterBankartrepair: acadavericstudy[J].JBoneJointSurg Am,2000,82(1):35-46.
[9]GillTJ,MicheliLJ,GebhardF,etal. Bankartrepairforanteriorinstabilityofthe shoulder.Long-termoutcome[J].J
BoneJointSurgAm,1997,79(6):850
-857.
[10]DetrisacDA,JohnsonLL.Arthroscopic shouldercapsulorrhaphyusingmetalstaples [J].OrthropClinNorthAm,1993,24 (1):71-88.
[11]ColeBJ,RomeoAA.Arthroscopicshoulder stabilizationwithsutureanchors:technique, technology,andpitfalls[J].ClinOrthop RelatRes,2001,390:17-30.
[12]???5??,????,?L??,??.?,???G???? ?????m??????????????[J].?k???? ???z??,2005,25(6):321-325.
[13]VangsnessCT,MitchellW,NimniM,et al.Collagenshortening.Anexperimental approachwithheat[J].ClinOrthopRelat R,,336
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nuson-tack
es19977:27-271.
14eorgeACurrell.
J.
2002:-1.
:200-09-0