Campbell Clinic-University of Tennessee Department of Orthopaedics, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA.
J Bone Joint Surg Am. 2010 Dec 15;92(18):2924-33. doi: 10.2106/JBJS.J.00631.
Immobilization after closed reduction has long been the standard treatment for primary anterior dislocation of the shoulder. To determine the optimum duration and position of immobilization to prevent recurrent dislocation, a systematic review of the relevant literature was conducted.
Of 2083 published studies that were identified by means of a literature review, nine Level-I and Level-II studies were systematically reviewed. The outcome of interest was recurrent dislocation. Additional calculations were performed by pooling data to identify the ideal length and position (external or internal rotation) of immobilization.
Six studies (including five Level-I studies and one Level-II study) evaluated the use of immobilization in internal rotation for varying lengths of time. Pooled data analysis of patients younger than thirty years old demonstrated that the rate of recurrent instability was 41% (forty of ninety-seven) in patients who had been immobilized for one week or less and 37% (thirty-four of ninety-three) in patients who had been immobilized for three weeks or longer (p = 0.52). An age of less than thirty years at the time of the index dislocation was significantly predictive of recurrence in most studies. Three studies (including one Level-I and two Level-II studies) compared recurrence rates with immobilization in external and internal rotation. Analysis of the pooled data demonstrated that the rate of recurrence was 40% (twenty-five of sixty-three) for patients managed with conventional sling immobilization in internal rotation and 25% (twenty-two of eighty-eight) for those managed with bracing in external rotation (p = 0.07).
Analysis of the best available evidence indicates there is no benefit of conventional sling immobilization for longer than one week for the treatment of primary anterior shoulder dislocation in younger patients. An age of less than thirty years at the time of injury is significantly predictive of recurrence. Bracing in external rotation may provide a clinically important benefit over traditional sling immobilization, but the difference in recurrence rates did not achieve significance with the numbers available.
闭合复位后固定一直是治疗原发性肩关节前脱位的标准治疗方法。为了确定预防复发性脱位的最佳固定时间和位置，对相关文献进行了系统回顾。
通过文献回顾，共确定了 2083 篇已发表的研究，其中 9 项为 I 级和 II 级研究。主要观察指标为复发性脱位。通过数据合并来确定最佳的固定长度和位置（外旋或内旋），以进一步计算结果。
6 项研究（包括 5 项 I 级研究和 1 项 II 级研究）评估了不同时间内采用内旋固定的效果。对年龄小于 30 岁的患者进行的汇总数据分析显示，1 周或更短时间内固定的患者脱位复发率为 41%（97 例中的 40 例），3 周或更长时间内固定的患者为 37%（93 例中的 34 例）（p = 0.52）。在索引脱位时年龄小于 30 岁是大多数研究中复发的显著预测因素。3 项研究（包括 1 项 I 级研究和 2 项 II 级研究）比较了外旋和内旋固定的复发率。对汇总数据的分析表明，在传统吊带内旋固定的患者中，复发率为 40%（63 例中的 25 例），在外旋支具固定的患者中为 25%（88 例中的 22 例）（p = 0.07）。
对最佳现有证据的分析表明，对于年轻患者的原发性肩关节前脱位，传统吊带固定超过 1 周并无益处。受伤时年龄小于 30 岁是复发的显著预测因素。与传统吊带固定相比，外旋支具固定可能具有重要的临床益处，但由于现有病例数的限制，复发率的差异没有达到统计学意义。
