Sayegh Fares E, Kenanidis Eustathios I, Papavasiliou Kyriakos A, Potoupnis Michael E, Kirkos John M, Kapetanos George A
Papageorgiou General Hospital, Ring-Road, Nea Efkarpia, Thessaloniki, Greece.
J Bone Joint Surg Am. 2009 Dec;91(12):2775-82. doi: 10.2106/JBJS.H.01434.
There are several methods to reduce anterior shoulder dislocations, but few studies have compared the efficacy, safety, and reliability of the different techniques. As a result, deciding which technique to use is seldom based on objective criteria. The aim of the present study was to introduce a new method to reduce an anterior shoulder dislocation, which we have termed "FARES" (Fast, Reliable, and Safe), and to compare it with the Hippocratic and Kocher methods in terms of efficacy, safety, and the intensity of pain felt by the patient during reduction.
Between September 2006 and June 2008, a total of 173 patients with an acute anterior shoulder dislocation (with or without a fracture of the greater tuberosity) were enrolled in the study. One hundred and fifty-four patients, who met all inclusion criteria, were randomly assigned to one of the three study groups (FARES, Hippocratic, and Kocher) and underwent reduction of the dislocation by first or second-year orthopaedic surgery residents. A visual analog scale was used to determine the intensity of the pain felt by the patient during reduction.
Demographically, the groups were comparable in terms of age, male:female ratio, the mechanism of dislocation, and the mean time between the injury and the first attempt at reduction. Reduction was achieved with the FARES method in 88.7% of the patients, with the Hippocratic method in 72.5%, and with the Kocher method in 68%. This difference was significant, in favor of the FARES method (p = 0.033). The mean duration of the reduction maneuver was significantly shorter for the FARES method (2.36 +/- 1.24 minutes for the FARES method, 5.55 +/- 1.58 minutes for the Hippocratic method, and 4.32 +/- 2.12 minutes for the Kocher method; p < 0.001), and the mean visual analog pain score was significantly lower for the FARES method (1.57 +/- 1.43 for the FARES method, 4.88 +/- 2.17 for the Hippocratic method, and 5.44 +/- 1.92 for the Kocher method; p < 0.001). No complications were noted in any group.
The FARES method is a significantly more effective, faster, and less painful method of reduction of an anterior shoulder dislocation in comparison with the Hippocratic and Kocher methods. It is easily performed by only one physician, it is applicable to anterior shoulder dislocations as well as simple fracture-dislocations, and its use is associated with no more morbidity than that associated with the other two methods.
有多种方法可用于复位肩关节前脱位，但很少有研究比较不同技术的疗效、安全性和可靠性。因此，很少根据客观标准来决定使用哪种技术。本研究的目的是介绍一种复位肩关节前脱位的新方法，我们将其称为“FARES”（快速、可靠、安全），并在疗效、安全性以及复位过程中患者所感受到的疼痛强度方面，将其与希波克拉底法和科赫尔法进行比较。
在2006年9月至2008年6月期间，共有173例急性肩关节前脱位患者（伴有或不伴有大结节骨折）纳入本研究。154例符合所有纳入标准的患者被随机分配到三个研究组（FARES组、希波克拉底组和科赫尔组）之一，并由第一年或第二年的骨科住院医师进行脱位复位。使用视觉模拟量表来确定患者在复位过程中所感受到的疼痛强度。
在人口统计学方面，各研究组在年龄、男女比例、脱位机制以及受伤至首次尝试复位的平均时间方面具有可比性。FARES法使88.7%的患者复位成功，希波克拉底法为72.5%，科赫尔法为68%。这一差异具有统计学意义，FARES法更具优势（p = 0.033）。FARES法复位操作的平均持续时间显著更短（FARES法为2.36±1.24分钟，希波克拉底法为5.55±1.58分钟，科赫尔法为4.32±2.12分钟；p < 0.001），且FARES法的平均视觉模拟疼痛评分显著更低（FARES法为1.57±1.43，希波克拉底法为4.88±2.17，科赫尔法为5.44±1.92；p < 0.001）。任何一组均未观察到并发症。
与希波克拉底法和科赫尔法相比，FARES法是一种复位肩关节前脱位更有效、更快且疼痛更轻的方法。它仅由一名医生即可轻松操作，适用于肩关节前脱位以及单纯骨折脱位，并且其使用所带来的发病率并不高于其他两种方法。
