椅背屈肘复位法与手牵足蹬复位法治疗肩关节前脱位的疗效比较  

A clinical comparison of chair-back-bent-elbow reduction versus Hippocrates reduction for treatment of anterior dislocation of shoulder joints

作　　者：徐平[1] 陈选宁[1] 张汉庆[1] 董晓俊[1] 奚海翔[1] 李彦锦[1] 鲁周同[1] XU Ping;CHEN Xuanning;ZHANG Hanqing;DONG Xiaojun;XI Haixiang;LI Yanjin;LU Zhoutong(Wuhan Hospital of Traditional Chinese Medicine,Wuhan430014,Hubei,China)

机构地区：[1]湖北省武汉市中医医院,湖北武汉430014

出　　处：《中医正骨》2018年第12期9-12,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较椅背屈肘复位法与手牵足蹬复位法治疗肩关节前脱位的临床疗效。方法:将60例肩关节前脱位患者随机分为2组,每组30例。分别采用椅背屈肘复位法和手牵足蹬复位法治疗,复位结束后肩关节均外敷中药截血膏,每日1次,连续外敷1周。比较2组患者的一次复位成功率、复位时间、复位过程中肩部疼痛视觉模拟量表(visual analogue scale,VAS)评分及Con-stant-Murley肩关节功能评分。结果:椅背屈肘组30例患者均一次复位成功,手牵足蹬组30例患者中9例未一次复位成功,二次复位时采用了丙泊酚静脉麻醉。椅背屈肘组的一次复位成功率高于手牵足蹬组(χ~2=10. 588,P=0. 001),复位时间短于手牵足蹬组[(1. 80±1. 20) min,(4. 50±2. 10) min,t=-6. 120,P=0. 021],复位过程中肩部疼痛VAS评分低于手牵足蹬组[(3. 13±0. 57)分,(6. 24±1. 11)分,t=-13. 650,P=0. 015]。所有患者均获随访,随访时间2～8个月,中位数5个月。末次随访时,2组患者的Constant-Murley肩关节功能评分比较,椅背屈肘组的疼痛评分高于手牵足蹬组[(13. 51±2. 10)分,(12. 12±1. 81)分,t=2. 746,P=0. 012],2组患者的日常活动能力评分、肩关节活动度评分、肌力评分、总分的组间差异均无统计学意义[(17. 11±2. 20)分,(16. 48±1. 23)分,t=-1. 369,P=0. 280;(35. 21±3. 25)分,(35. 65±3. 12)分,t=0. 726,P=0. 276;(23. 36±1. 13)分,(22. 12±1. 77)分,t=-3. 234,P=0. 721;(90. 34±5. 28)分,(87. 82±3. 60)分,t=-2. 160,P=0. 122]。结论:采用椅背屈肘复位法治疗肩关节前脱位,比采用手牵足蹬复位法复位时间短、一次复位成功率高、患者肩部疼痛程度轻,但两种方法治疗后患者的肩关节功能恢复无差异。Objective:To compare the clinical curative effects of chair-back-bent-elbow reduction versus Hippocrates reduction for treatment of anterior dislocation of shoulder joints.Methods:Sixty patients with anterior dislocation of shoulder joints were randomly divided into 2 groups,30 cases in each group,and were treated with chair-back-bent-elbow reduction(group A)and Hippocrates reduction(group B)respectively.After the reduction,the traditional Chinese medicine Jiexuegao(截血膏)was externally applied to the shoulder joints of patients in the 2 groups,once a day for consecutive 1 week.The success rate of one-time reduction,reduction time,shoulder pain visual analogue scale(VAS)scores during the reduction process and constant-murley shoulder function scores were compared between the 2 groups.Results:The one-time reduction was finished successfully in all patients of group A and unfinished successfully in 9 patients of group B,and the second reduction was performed under the intravenous anesthesia with propofol.The success rate of one-time reduction was higher,the reduction time was shorter and the shoulder pain VAS scores during the reduction process were lower in group A compared to group B(χ^2=10.588,P=0.001;1.80+/-1.20 vs 4.50+/-2.10 minutes,t=-6.120,P=0.021;3.13+/-0.57 vs 6.24+/-1.11 points,t=-13.650,P=0.015).All patients in the 2 groups were followed up for 2-8 months with a median of 5 months.At the last follow-up,the evaluation results of constant-murley shoulder function scores showed that the pain scores were higher in group A compard to group B(13.51+/-2.10 vs 12.12+/-1.81 points,t=2.746,P=0.012)and there was no statistical difference in activity of daily living(ADL)scores,shoulder range of motion(ROM)scores,muscle strength scores and total scores between the 2 groups(17.11+/-2.20 vs 16.48+/-1.23 points,t=-1.369,P=0.280;35.21+/-3.25 vs 35.65+/-3.12 points,t=0.726,P=0.276;23.36+/-1.13 vs 22.12+/-1.77 points,t=-3.234,P=0.721;90.34+/-5.28 vs 87.82+/-3.60 points,t=-2.160,P=0.122).Conclusion:The chair-back-bent

关 键 词：肩脱位 肩关节 正骨手法 椅背屈肘复位法 手牵足蹬复位法 临床试验 

分 类 号：R274.9[医药卫生—中西医结合]