朋友們大家好！今天是2020年3月14日週六。歡迎您來到《聽高緒仁講肩關節那些事兒》第363期！知之者不如好之者，好之者不如樂之者。簡單的事情重復做，重復的事情堅持做，堅持的事情開心做！騏驥一躍，不能十步；駑馬十駕，功在不舍。鍥而舍之，朽木不折；鍥而不舍，金石可鏤。沒有天生的專家，為了我們的患者，唯有每天在一線堅韌不拔、堅持不懈地努力學習、實踐、思考、分享和提升。人生沒有白走的路，每一步都算數。相信持續的力量，將每天的平凡逐漸變成不平凡，只爭朝夕、不負韶華，不忘努力成為一名好醫生的初心，

六合彩即時開獎號碼

為我的患者助一臂之力！上圖：2020年3月13日星期五，膝肩髖關節關節鏡與人工關節置換手術及康復專家高緒仁在徐州醫科大學附屬醫院（徐醫附院）暨徐州二院骨科膝肩髖關節專家門診為肩關節疼痛肩袖損傷患者進行規範化體格檢查。今天有人問我一個問題：“高主任您好！什麼是J形雙皮質髂骨塊移植治療肩關節前下方復發性脫位手術技術？”這是一個非常好的問題！經常有復發性肩關節脫位的患者專門來找我治療。我們有很多治療肩關節前脫位的手術方法。其中有一種方法就是J形雙皮質髂骨塊移植治療肩關節前下方復發性脫位手術技術。奧地利骨科肩關節專家Alexander Auffarth在2008年的The American Journal of Sports Medicine（美國運動醫學雜志）和2011年的Oper Orthop Traumatol（骨科創傷手術雜志）上報道了這一手術技術。 上圖：測量復發性肩關節前脫位患者肩胛盂前下方骨缺損的程度。上圖：皮膚切口。上圖：走胸大肌三角肌入路。上圖：注意深層解剖。上圖：注意暴露清楚。上圖：注意顯露時拉鉤的配合。 上圖：肩關節前側切開探查見肩胛盂前下方骨缺損。 上圖：從髂骨上取帶有髂脊骨皮質和外板骨皮質的雙皮質髂骨塊，並修整成J形狀。注意要點：取髂骨時取包含髂脊皮質和髂骨外板皮質的骨塊。用擺鋸和高速磨鑽修成J形狀，留下一層皮質骨作為作為移植骨的龍骨。移植物時要寬12到15毫米、長15毫米、高5毫米。肩胛盂處為了容納這個骨塊，要在肩胛盂盂緣以內4毫米處做一骨槽。要和肩胛盂面呈30度的夾角。要使用1個15毫米寬的骨鑿做出一個10毫米深、15毫米寬、2毫米高的裂隙。但是要注意角度，

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以避免術中術後出現肩胛盂骨折。 上圖：取髂骨移植塊。 上圖：制作肩胛盂上的溝槽。 上圖：J型髂骨塊把持器。 上圖：帶刺的骨塊打入器。上圖：植入J形髂骨移植塊並打磨修整。 上圖：將J形狀髂骨雙皮質移植塊插入肩胛盂前下方做成的溝槽中。上圖：逐層閉合。上圖：如有必要，可以植入1到2枚空心螺釘加強固定. 上圖：術後11個月肩關節鏡探查見J形雙皮質髂骨移植塊已經和肩胛盂愈合好了。 他山之石，可以攻玉。勤學苦練，

4支刀技巧

造福患家。“借問肩痛去哪裡，路人遙指高緒仁”。全國各地肩關節損傷患者，

邁阿密熱火

如果您有任何關于肩關節的問題，歡迎您登錄高緒仁好大夫在線網站進行咨詢！網址鏈接https://gaoxurendr.haodf.com/謝謝！高緒仁 副主任醫師、副教授、醫學博士/博士後、骨科關節病方向碩士研究生導師徐州醫科大學附屬醫院骨科高緒仁膝肩髖關節醫療組徐州醫科大學附屬醫院骨科關節外科膝肩髖關節人工關節置換與關節鏡手術品牌專家已致力于膝肩髖關節疼痛的診斷、治療、康復、醫教研、科普宣教、社會服務22年參考文獻Auffarth A錛Schauer J錛Matis N錛Kofler B錛Hitzl W錛Resch H.The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation.Am J Sports Med. 2008 Apr;36(4):638-47.Auffarth A錛 Kralinger F錛 Resch H.Anatomical glenoid reconstruction via a J-bone graft for recurrent posttraumatic anterior shoulder dislocation.Oper Orthop Traumatol. 2011 Dec;23(5):453-61.高緒仁 高緒仁2014徐醫附院腔鏡論壇肩關節脫位關節鏡手術演講https://mip.haodf.com/zhuanjiaguandian/1937653636.htm高緒仁 肩關節脫位、半脫位、不穩、鬆弛分別是什麼意思？http://www.sohu.com/a/282735614_100281680高緒仁 Latarjet手術防止肩關節復發性脫位患者再發生肩關節脫位的三個機制是什麼？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1207977高緒仁 什麼是肩關節脫位恐怖三聯征？https://m.haodf.com/touch/zhuanjiaguandian/gaoxurendr_7212609033.htm高緒仁 高緒仁在江蘇鹽城市運動醫學研討會做肩關節復發性脫位講座http://wap.sciencenet.cn/blog-394169-1116476.html?mobile=1高緒仁 德國骨科醫生現在怎麼治療肩關節創傷性前脫位？http://www.360doc.com/content/17/0130/23/40056579_625529183.shtml高緒仁 如何像肩關節大師Gilles Walch一樣將Latarjet手術做的規範精準？http://www.orthonline.com.cn/node/129871高緒仁 肩關節鏡下Bankart修復打好SMC結後發現軟組織和骨面貼合不緊怎麼辦？介紹我們的一種雙抓線鉗解決策略 http://orth.cmt.com.cn/detail/1159503.html高緒仁 什麼是肩關節復發性脫位的HAGL損傷？http://www.sohu.com/a/298297728_100281680高緒仁 看到肩關節X片上燈泡征千萬不要漏診了肩關節後脫位！https://m.haodf.com/touch/zhuanjiaguandian/gaoxurendr_5402133909.htm高緒仁 從美國NBA籃球名將羅恩-貝克肩關節脫位看盂唇損傷http://wap.sciencenet.cn/blog-394169-1098073.html高緒仁 全身關節鬆弛的人比普通人更容易發生創傷性復發性肩關節脫位麼？http://blog.sciencenet.cn/blog-394169-614792.html高緒仁 我的肩關節脫位了為什麼多次復位都不能復位成功呀？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1071268高緒仁 肩關節囊韌帶鬆弛引發的肩關節前下方不穩脫位如何進行修復？http://www.sohu.com/a/297569531_100281680高緒仁 肩關節向下方脫位合並肩袖損傷、肱骨大結節骨折復位後又出現脫位怎麼辦？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1213153高緒仁 1952年美國紐約McLaughlin醫生創新性地提出了哪種治療肩關節後脫位的手術方式？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1208145高緒仁 手拉腳蹬法復位肩關節前下方脫位不成功怎麼辦？介紹一個方法。http://www.sohu.com/a/283957287_100281680高緒仁 肩關節脫位需手術治療的大Hill-Sachs損傷發生率？https://m.haodf.com/touch/zhuanjiaguandian/gaoxurendr_4956449612.htm高緒仁 肩關節不穩脫位選擇關節鏡微創還是切開手術？再脫位風險高麼https://m.haodf.com/touch/zhuanjiaguandian/gaoxurendr_5442487169.htm高緒仁 肩關節初次前脫位http://blog.sciencenet.cn/blog-394169-608812.html高緒仁 肩關節復發性前脫位用Latarjet手術還是髂骨塊移植手術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1211228高緒仁 高緒仁在徐醫附院康復科分享肩關節復發性脫位診療經驗http://blog.sciencenet.cn/blog-394169-1116380.html高緒仁 什麼是治療肩關節後脫位Neer改良的Mclaughlin手術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1157293高緒仁 如何取自己的髂骨治療存在肩胛盂前下方骨缺損的復發性肩關節前脫位？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1208752高緒仁 肩關節鏡微創手術如何治療肩關節復發性脫位Bankart損http://www.sohu.com/a/297340867_100281680高緒仁 美國人每年肩關節後脫位的發生率是多少？http://blog.sciencenet.cn/blog-394169-1156756.html高緒仁 什麼是肩關節復發性前脫位Perthes損傷？http://blog.sciencenet.cn/blog-394169-1165416.html高緒仁 什麼是肩關節復發性前脫位GLAD損傷？http://blog.sciencenet.cn/blog-394169-1165251.html高緒仁 什麼是治療肩關節後脫位的Mclaughlin手術？http://blog.sciencenet.cn/blog-394169-1156928.html高緒仁 高緒仁徐州二院骨科講座：微創治療肩關節前下方復發性脫位http://blog.sciencenet.cn/blog-394169-1116459.html高緒仁 什麼是肩關節復發性前脫位ALPSA損傷？http://blog.sciencenet.cn/blog-394169-1165672.html高緒仁 肩關節前脫位後出現肩關節疼痛的原因有可能是肱骨頭壞死麼？https://m.haodf.com/touch/zhuanjiaguandian/gaoxurendr_7326306388.htm高緒仁 兒童青少年創傷性肩關節前脫位怎麼治療？http://blog.sciencenet.cn/blog-394169-1165077.html高緒仁 介紹葡萄牙一種使用了20餘年的治療存在肩胛盂骨缺損的復發性肩關節前脫位的方法http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1202634高緒仁 如何用帶線錨釘修肩關節復發脫位Hill-Sachs損傷 http://www.sohu.com/a/298297811_100281680高緒仁 肩胛下肌折疊縫合法治療肩關節肩後脫位不穩http://www.sohu.com/a/289451880_100281680高緒仁 什麼是肩胛骨肩胛盂骨折的Goss-Ideberg分型？http://wap.sciencenet.cn/blog-394169-1217925.html高緒仁 肩關節盂肱中韌帶在哪裡？https://m.haodf.com/touch/zhuanjiaguandian/gaoxurendr_7674263167.htm高緒仁 什麼是Oxford Instability Shoulder Score牛津肩關節不穩評分問卷？http://blog.sciencenet.cn/blog-394169-1218366.html高緒仁 什麼是治療肩關節前向脫位的肩峰固定肱骨軸向牽引手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1218961高緒仁 什麼是治療肩關節前向脫位的Bokor-Billmann屈肩屈肘內收內旋手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1218979高緒仁 如何借助一把椅子來復位肩關節前脫位？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219021高緒仁 什麼是肩關節前向脫位按摩放鬆肌肉的Cunningham法和Sool法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219156高緒仁 我肩關節脫臼了，

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出不了門，

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能否教給我一招自己在家肩關節脫位復位絕招？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219298高緒仁 介紹台灣高雄醫學大學醫院骨科肩關節前向脫位用肘關節復位的新技術http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219349高緒仁 介紹一種不需要椅子、不需要床、在地上就能進行肩關節前向脫位的丹麥愛斯基摩復位法http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219362高緒仁 什麼是不需要牽拉上臂的外旋法肩關節前脫位復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219483高緒仁 介紹一種肩關節前脫位的希臘FARES（快速、可靠、安全）復位法http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219527高緒仁 抓著床邊欄桿就能肩關節脫臼自己復位了!介紹日本肩關節脫位GONAIS自我復位法。http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219540高緒仁 什麼是肩關節前脫位最古老又煥發著生機的復位技術？Hippocratic希波克拉底法http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219625高緒仁 什麼是美國紐約羅徹斯特大學Janecki前舉復位手法治療肩關節前脫位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219642高緒仁 什麼是源自3200年前古埃及壁畫的Kocher肩關節前脫位復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219688高緒仁 什麼是美國堪薩斯城Legg肩關節前脫位復位手法？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219807高緒仁 什麼是大名鼎鼎的美國紐約肩關節前脫位Milch手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1219846高緒仁 什麼是肩關節前脫位美國新澤西Nicola手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1220029高緒仁 什麼是肩關節前脫位的推拿肩胛骨復位手法Scapular manipulation？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1220227高緒仁 什麼是肩關節前脫位澳大利亞Spaso復位手法？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1220390高緒仁 什麼是肩關節前脫位Stimson手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1220564高緒仁 什麼是美國Rockwood牽引/床單對抗牽引法復位肩關節前/後脫位手法技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1220738高緒仁 什麼是美國加州洛杉磯Zahiri肩關節前脫位手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1220929高緒仁 什麼是雙床單三方向牽拉肩關節前脫位復位手法技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1221386高緒仁 什麼是肩關節後脫位美國加州洛杉磯Wilson復位手法技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1221437高緒仁 什麼是DePalma槓桿法肩關節後脫位手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&quickforward=1&id=1221609高緒仁 什麼是源于拍攝遊泳者位X片的Caudal traction向尾側牽引法肩關節後脫位手法復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1221648高緒仁 什麼是3人兩床單牽引對抗牽引法肩關節下脫位復位技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1221733高緒仁 什麼是3人兩床單牽引對抗牽引法肩關節下脫位復位技術？ http://blog.sciencenet.cn/blog-394169-1221733.html高緒仁 Shoulder Pacemaker肩關節啟動器（肩關節起搏器）能助肩關節不穩、疼痛、抬不起來的患者一臂之力麼？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1223128高緒仁 什麼是肩關節前向不穩脫位的ASA手術:Arthroscopic subscapularis augmentation? http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1223174高緒仁 什麼是英國Hutchinson自體三皮質髂骨移植治療肩關節復發性前脫位手術技術？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1223372高緒仁 意大利米蘭肩關節專家E. Taverna肩關節鏡下三皮質髂骨塊移植治療前下方脫位的髂骨塊怎麼放的？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1223377高緒仁 美國哈佛肩關節中心肩關節專家JP Warner三皮質髂骨塊移植治療前下方脫位的髂骨塊怎麼放的？http://blog.sciencenet.cn/home.php?mod=space&uid=394169&do=blog&id=1223383關鍵詞：肩關節脫位 髂骨移植 兩皮質髂骨塊 J形骨塊 手術 高緒仁肩關節疼痛 肩膀疼 肩膀痛 怎麼辦 怎麼治療 肩關節疼痛的原因 肩膀疼肩痛不等于肩週炎 肩週炎 凍結肩 肩關節粘連 肩關節損傷 肩關節骨折 肱骨近端骨折 肩胛骨骨折肩胛盂骨折 肩關節脫位 肩關節不穩 肩鎖關節損傷 肩袖損傷 盂唇損傷 SLAP損傷 Bankart損傷 肱二頭肌長頭腱 肩關節撞擊征 肩峰下撞擊征 炎症 損傷 撕裂 肱骨頭壞死 肩關節鏡微創手術 反式人工肩關節及置換手術 康復鍛鍊指導 中國 江蘇 徐州 肩關節專家 聽高緒仁講肩關節那些事兒AI的未來：教會機器-學會方法（learning and search），而不是學會技術強化學習的奠基人理查德·S·薩頓 (Richard S. Sutton）提出AI的未來是教會機器（計算機）學會能夠靠自己學習的方法，而不是學會按照人類思考設計出的一門技術。而那些方法，

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主要靠機器自己的計算，而不是人類自己腦力計算的遷移。而目前證明能夠更好work的方法是：讓機器自己learning和search。Deep learning 的成功就是這樣的例子。也就是，人類負責的是設計這些機器使用的方法，而不是具體的一門門技術。未來，應該讓讓機器放手一搏，

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讓它們自己找到適合機器自己的技術（通過人類設計的方法）。 PS： 當然，這讓人類增加了越來越多的不安全感，我們仍然擔心，未來機器會控制人類社會。但至少目前，

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這似乎是讓AI繼續發展的一種方向。因為，

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機器（計算機）似乎也說：“授之于魚不如授之于漁”。PS : 文章原文The Bitter LessonRich SuttonMarch 13錛 2019The biggest lesson that can be read from 70 years of AI research is that general methods that leverage computation are ultimately the most effective錛 and by a large margin. The ultimate reason for this is Moore's law錛 or rather its generalization of continued exponentially falling cost per unit of computation. Most AI research has been conducted as if the computation available to the agent were constant (in which case leveraging human knowledge would be one of the only ways to improve performance) but錛 over a slightly longer time than a typical research project錛 massively more computation inevitably becomes available. Seeking an improvement that makes a difference in the shorter term錛 researchers seek to leverage their human knowledge of the domain錛 but the only thing that matters in the long run is the leveraging of computation. These two need not run counter to each other錛 but in practice they tend to. Time spent on one is time not spent on the other. There are psychological commitments to investment in one approach or the other. And the human-knowledge approach tends to complicate methods in ways that make them less suited to taking advantage of general methods leveraging computation.There were many examples of AI researchers' belated learning of this bitter lesson錛 and it is instructive to review some of the most prominent.In computer chess錛 the methods that defeated the world champion錛 Kasparov錛 in 1997錛 were based on massive錛 deep search. At the time錛 this was looked upon with dismay by the majority of computer-chess researchers who had pursued methods that leveraged human understanding of the special structure of chess. When a simpler錛 search-based approach with special hardware and software proved vastly more effective錛 these human-knowledge-based chess researchers were not good losers. They said that “brute force" search may have won this time錛 but it was not a general strategy錛 and anyway it was not how people played chess. These researchers wanted methods based on human input to win and were disappointed when they did not.A similar pattern of research progress was seen in computer Go錛 only delayed by a further 20 years. Enormous initial efforts went into avoiding search by taking advantage of human knowledge錛 or of the special features of the game錛 but all those efforts proved irrelevant錛 or worse錛 once search was applied effectively at scale. Also important was the use of learning by self play to learn a value function (as it was in many other games and even in chess錛 although learning did not play a big role in the 1997 program that first beat a world champion). Learning by self play錛 and learning in general錛 is like search in that it enables massive computation to be brought to bear. Search and learning are the two most important classes of techniques for utilizing massive amounts of computation in AI research. In computer Go錛 as in computer chess錛 researchers' initial effort was directed towards utilizing human understanding (so that less search was needed) and only much later was much greater success had by embracing search and learning.In speech recognition錛 there was an early competition錛 sponsored by DARPA錛 in the 1970s. Entrants included a host of special methods that took advantage of human knowledge-knowledge of words錛 of phonemes錛 of the human vocal tract錛 etc. On the other side were newer methods that were more statistical in nature and did much more computation錛 based on hidden Markov models (HMMs). Again錛 the statistical methods won out over the human-knowledge-based methods. This led to a major change in all of natural language processing錛 gradually over decades錛 where statistics and computation came to dominate the field. The recent rise of deep learning in speech recognition is the most recent step in this consistent direction. Deep learning methods rely even less on human knowledge錛 and use even more computation錛 together with learning on huge training sets錛 to produce dramatically better speech recognition systems. As in the games錛 researchers always tried to make systems that worked the way the researchers thought their own minds worked-they tried to put that knowledge in their systems-but it proved ultimately counterproductive錛 and a colossal waste of researcher's time錛 when錛 through Moore's law錛 massive computation became available and a means was found to put it to good use.In computer vision錛 there has been a similar pattern. Early methods conceived of vision as searching for edges錛 or generalized cylinders錛 or in terms of SIFT features. But today all this is discarded. Modern deep-learning neural networks use only the notions of convolution and certain kinds of invariances錛 and perform much better.This is a big lesson. As a field錛 we still have not thoroughly learned it錛 as we are continuing to make the same kind of mistakes. To see this錛 and to effectively resist it錛 we have to understand the appeal of these mistakes. We have to learn the bitter lesson that building in how we think we think does not work in the long run. The bitter lesson is based on the historical observations that 1) AI researchers have often tried to build knowledge into their agents錛 2) this always helps in the short term錛 and is personally satisfying to the researcher錛 but 3) in the long run it plateaus and even inhibits further progress錛 and 4) breakthrough progress eventually arrives by an opposing approach based on scaling computation by search and learning. The eventual success is tinged with bitterness錛 and often incompletely digested錛 because it is success over a favored錛 human-centric approach. One thing that should be learned from the bitter lesson is the great power of general purpose methods錛 of methods that continue to scale with increased computation even as the available computation becomes very great. The two methods that seem to scale arbitrarily in this way are search and learning. The second general point to be learned from the bitter lesson is that the actual contents of minds are tremendously錛 irredeemably complex; we should stop trying to find simple ways to think about the contents of minds錛 such as simple ways to think about space錛 objects錛 multiple agents錛 or symmetries. All these are part of the arbitrary錛 intrinsically-complex錛 outside world. They are not what should be built in錛 as their complexity is endless; instead we should build in only the meta-methods that can find and capture this arbitrary complexity. Essential to these methods is that they can find good approximations錛 but the search for them should be by our methods錛 not by us. We want AI agents that can discover like we can錛 not which contain what we have discovered. Building in our discoveries only makes it harder to see how the discovering process can be done.，