急性肩关节前脱位的两种复位手法比较

Comparison of two reduction manipulations for acute anterior shoulder dislocation

摘要:

［目的］ 评价外展推顶复位手法与手牵足蹬法治疗肩关节前脱位的临床疗效。［方法］ 2017 年 5 月—2021 年 11 月， 对 126 例肩关节前脱位患者实施手法复位，其中，57 例采用外展推顶手法复位（外展推顶组），69 例采用手牵足蹬法复位（手牵足蹬组）。评估两组早期临床结果。［结果］一次复位成功率，外展推顶组为 85.51%，手牵足蹬组为 89.47%，两组间差异无统计学意义（P>0.05）。复位后即刻外展推顶组 ASES 评分明显优于手牵足蹬组（P<0.05），但两组间 VAS 评分差异无统计学意义（P>0.05）。两组患者均获随访 3 个月，随时间推移两组 VAS 和 ASES 评分均显著改善（P<0.05），相应时间点两组间差异无统计学意义（P>0.05）。随访过程中，两组患者均未发生再脱位。［结论］外展推顶复位手法与手牵足蹬法的一次复位成功率相近，但前者复位后的即时肩关节功能改善优于后者。

Abstract:

[Objective] To evaluate the clinical outcomes of abduction push-top manipulation (APT) versus hand-pull and foot-push manipulation (HPFP) for reduction of anterior shoulder dislocation. [Methods] From May 2017 to November 2021, 126 patients with anteri- or dislocation of shoulder joint were treated with manual reduction. Of them, 57 patients received APT, while the remaining 69 patients un- derwent HPFP. The clinical consequences were evaluated and compared between the two groups. [Results] The success rates of reduction at the first time was 89.5 % in the APT group, whereas 85.5 % in the HPFP group, which was not statistically significant (P>0.05) . Howev- er, the APT group proved significantly superior to the HPFP group in term of ASES score immediately after reduction (P<0.05) , despite of the fact that no a significant difference in term of VAS score was noticed between the two groups (P>0.05) . As time went during the follow up lasted for more than 12 weeks, the VAS and ASES scores significantly improved in both groups (P<0.05) , whereas which were not statis- tically significant between the two groups at any matching time points (P>0.05) . None re- dislocation was found in anyone of the both groups during the follow-up. [Conclusion] Although the success rate of reduction at the first time is similar between the two manipulations, the APT achieves better shoulder function recovery immediately after reduction than the conventional HPFP maneuver.