Smith Stuart L F
The Emergency Department, The Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, Adelaide, South Australia 5112, Australia.
Int Emerg Nurs. 2009 Jan;17(1):38-46. doi: 10.1016/j.ienj.2008.09.004. Epub 2008 Nov 25.
This paper reports on the findings of a quantitative, retrospective service evaluation. It compared a new, conscious, sedation-free technique to reduce anterior glenohumeral dislocations with the traditional methods of reduction (TMR) currently implemented.
The first objective for this study was to examine whether a new method, used at an Emergency Department (ED) in the south of England, of glenohumeral dislocation reduction, called the Oxford Chair Technique (OCT) can reduce anterior glenohumeral dislocations and to compare the success rates of reduction with the TMR. Secondary objectives examined how the OCT compared, using four set factors, against the TMR currently used. The fundamental comparisons being analysed was in terms of time taken for treatments.
A retrospective service evaluation was performed using data collected from the Patient Administration System (PAS) software and the Picture Archiving and Communications System (PACS) on patients who presented to an ED in the South of England with an anterior glenohumeral dislocation between March 2005 and August 2006.
Of the 61 cases in which the OCT was used over the sampling period, 38 attempts to reduce the dislocation were successful, with 23 being unsuccessful. An overall success rate of 62% was obtained with the OCT. There were no complications reported with the OCT. Statistically significant differences were found with the mean time from arrival to discharge (OCT 141 v. TMR 254 min, p<0.001); mean time between the first diagnostic X-ray and post reduction X-ray (OCT 70 v. TMR 102 min, p<0.003) and the mean time between the post reduction X-ray and discharge (OCT 51 v. TMR 119 min, p<0.001). No patients treated with the OCT required conscious sedation compared to 90% of patients treated with TMR (p<0.001). Only 38% of patients treated with the OCT had morphine administered compared to 90% of patients treated with TMR (p<0.001).
Overall, the success rate for reduction using the OCT was good in view of this being a new treatment to the ED. While the OCT had a lower success rate of reduction compared to TMR, when reduction was successful using the OCT, there were overwhelming time-saving benefits to the patient with subsequent logistical benefits to the ED. The use of conscious sedation and morphine was also significantly less for the OCT group compared to TMR.
本文报告了一项定量回顾性服务评估的结果。它将一种新的、无需清醒镇静的减少肩肱关节前脱位的技术与目前实施的传统复位方法（TMR）进行了比较。
本研究的首要目的是检验在英格兰南部一家急诊科使用的一种名为牛津椅技术（OCT）的肩肱关节脱位复位新方法是否能减少肩肱关节前脱位，并将复位成功率与TMR进行比较。次要目的是使用四个既定因素来检验OCT与目前使用的TMR相比情况如何。所分析的基本比较是在治疗所需时间方面。
使用从患者管理系统（PAS）软件和图像存档与通信系统（PACS）收集的数据，对2005年3月至2006年8月期间在英格兰南部一家急诊科就诊的肩肱关节前脱位患者进行回顾性服务评估。
在抽样期间使用OCT的61例病例中，38次脱位复位尝试成功，23次失败。OCT的总体成功率为62%。未报告OCT有并发症。在从到达至出院的平均时间（OCT为141分钟，TMR为254分钟，p<0.001）、首次诊断性X线检查与复位后X线检查之间的平均时间（OCT为70分钟，TMR为102分钟，p<0.003）以及复位后X线检查与出院之间的平均时间（OCT为51分钟，TMR为119分钟，p<0.001）方面发现了统计学上的显著差异。与90%接受TMR治疗的患者相比，接受OCT治疗的患者无需清醒镇静（p<0.001）。接受OCT治疗的患者中只有38%使用了吗啡，而接受TMR治疗的患者中这一比例为90%（p<0.001）。
总体而言，鉴于OCT对急诊科来说是一种新的治疗方法，其复位成功率良好。虽然与TMR相比，OCT的复位成功率较低，但当使用OCT成功复位时，对患者有显著的省时益处，随后对急诊科也有后勤方面的益处。与TMR相比，OCT组使用清醒镇静和吗啡的情况也明显较少。
