Orthopaedic Department, University of Malaya, Kuala Lumpur, Malaysia.
J Shoulder Elbow Surg. 2012 Dec;21(12):1706-11. doi: 10.1016/j.jse.2012.04.004. Epub 2012 Jul 21.
To perform closed manual reduction of acute anterior shoulder dislocation using the traction-countertraction technique requires sedation (TCTS) and the participation of 2 people. We studied the modified Milch (MM) technique, a positional reductive maneuver that requires 1 operator, without patient sedation or analgesia.
The study comprised 56 prospective nonrandomized consecutive patients, of whom 31 were in group A (MM, nonsedated) and 25 in group B (TCTS).
The success rate of MM technique was 83.9% (26 of 31), which increased to 96.3% (26 of 27) when 4 patients with associated greater tuberosity fractures were excluded. The success rate was 100% in the TCTS group, with 5 patients with associated greater tuberosity fractures. The reduction in pain from the preprocedural to intraprocedural phases in MM group was significant (P < .001), at a reduction rate of 2.07 (29%) on the numeric rating scale pain score. There was a greater pain reduction rate of 2.43 (34%) on the numeric rating scale when patients with greater tuberosity fractures were excluded. The MM group had a significantly shorter hospital stay (mean, 35 minutes) than the TCTS group (mean, 4 hours). No postreduction neurovascular or fracture complications occurred in either group.
The results showed that the Milch technique was effective, safe, shortened hospital stay, and was well tolerated. We recommend the modified Milch technique as a first-line maneuver for acute anterior shoulder dislocations without associated fractures.
采用牵引对抗技术（TCTS）对急性前肩脱位进行闭合手动复位需要镇静（TCTS），并且需要 2 人参与。我们研究了改良米尔希（MM）技术，这是一种位置复位操作，只需要 1 名操作员，不需要患者镇静或镇痛。
该研究包括 56 例前瞻性非随机连续患者，其中 31 例为 A 组（MM，未镇静），25 例为 B 组（TCTS）。
MM 技术的成功率为 83.9%（31 例中的 26 例），当排除 4 例伴有大结节骨折的患者后，成功率增加至 96.3%（26 例中的 27 例）。TCTS 组的成功率为 100%，其中 5 例伴有大结节骨折。MM 组患者从术前到术中的疼痛减轻程度显著（P<0.001），数字评分量表疼痛评分降低 2.07（29%）。当排除大结节骨折的患者时，疼痛减轻程度更大，为 2.43（34%）。MM 组的住院时间明显短于 TCTS 组（平均 35 分钟比 4 小时）。两组均未发生复位后神经血管或骨折并发症。
结果表明，米尔希技术有效、安全、缩短了住院时间，且患者耐受性良好。我们建议将改良米尔希技术作为无伴发骨折的急性前肩脱位的一线操作方法。
