外旋法、手牵足蹬法在治疗急性肩关节前脱位中的疗效分析  

Comparison of the external rotation and hippocratic methods in reducing acute anterior shoulder dislocations

作　　者：曹光磊[1] 沈惠良[1] 

机构地区：[1]首都医科大学宣武医院骨科,北京100053

出　　处：《中华临床医师杂志（电子版）》2013年第9期85-88,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的比较外旋法(External rotation)和手牵足蹬法(Hippocratic)在治疗急性单纯肩关节前脱位中的疗效。方法 2011年1～12月,急诊治疗急性肩关节前脱位患者78例,其中对于符合研究标准的67例患者随机分别入选外旋法和Hippocratic法两组进行闭合复位。手法复位过程中均未使用任何麻醉方式,两次复位不成功即视为失败,改用其他方法或结合全麻进行复位。对于患者的基本信息进行详细记录,包括患者从受伤到开始复位的间隔时间以及闭合复位时整个操作的持续时间等。并应用视觉模拟评分量表来评估闭合复位过程中患者的自觉疼痛程度。结果两组患者在年龄、性别以及受伤机制和伤后到开始复位的时间间隔上均有可比性。外旋法复位组患者34例,复位成功率91.2%。Hippocratic法组33例,复位成功率72.7%,统计分析结果有显著性差异(P<0.05);在闭合复位操作持续的时间以及患者在复位过程中的自觉疼痛程度上,外旋法均明显优于Hippocratic法,两组的差异有统计学意义(P<0.01)。其他病例改用不同方法或者是结合全麻后全部复位成功。两组患者中均未出现并发症。结论与Hippocratic法相比,外旋法在治疗单纯急性肩关节前脱位时更迅速、有效,并且患者自觉的痛苦程度小,这种方法可以由一名医师单独操作,相对简单,不需要联合麻醉来实施,更适合于急诊条件下应用。Objective To compare the external rotation and Hippocratic methods in treating acute anterior shoulder dislocation. Methods Between January and December 2011, a total of 78 patients with an acute anterior shoulder dislocation were enrolled in the study. 67 patients, who met all inclusion criteria, were randomly assigned to each groups（external rotation and Hippocratic）and underwent reduction of the dislocation by two senior doctors who were familiar with the different methods. All reductions were performed without sedation, anesthesia, or pain control. Each doctor was allowed to apply the same method of reduction twice;after that, the reduction was characterized as unsuccessful. Unsuccessful case was underwent other methods with or without anesthesia according to the doctor＇s choice. Following successful reduction of the dislocation, the doctor who performed the reduction completed a detailed data on the patient. The mechanism of injury ,the time interval between the injury and the treatment, the duration of the reduction etc. were all registered. Each patient was asked to rate the amount of pain that he or she felt during each reduction attempt with use of a visual analog scale. Results Demographical｜y,the groups were comparable in terms of age,gender,the mechanism of dislocation, and the mean time between the injury and the treatment. Reduction was achieved with the external rotation method in 91.2% of the patients, with the Hippocratic method in 72. 7%. This difference was significant, in favor of the external rotation method （ P 〈 0. 05 ）. The mean duration of the reduction maneuver was significantly shorter for the external rotation method than the Hippocratic method （ P 〈 0. 01 ）. The mean visual analog pain score was significantly lower for the external rotation method than the Hippocratic method（P 〈0.01 ）. No complications were noted in any group. Conclusion The external rotation method is a significantly more effective, faster, and less painful method of reduction of an anterior

关 键 词：肩脱位 手法复位 骨科 

分 类 号：R684[医药卫生—骨科学]