Department of Orthopaedic Surgery, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Am J Sports Med. 2013 May;41(5):1126-32. doi: 10.1177/0363546513480620. Epub 2013 Mar 22.
Immobilization in external rotation is one of the treatment options for an initial dislocation of the shoulder. However, it remains unclear how long it takes for a Bankart lesion to heal.
Protection of a healing Bankart lesion from stretching would promote the healing process and decrease the recurrence rate after an initial dislocation of the shoulder.
Randomized controlled trial; Level of evidence, 2.
This was a multicenter, prospective randomized study. Between January 2005 and August 2009, 109 patients (71 male and 38 female; mean age, 30 years) with an initial traumatic dislocation of the shoulder were enrolled. After 3 weeks of immobilization in external rotation, a shoulder motion restriction band designed to avoid stretching the anteroinferior shoulder capsule was used for 0 weeks (36 patients), 3 weeks (37 patients), or 6 weeks (36 patients). After using the band, patients were allowed to use their shoulders freely, but they were advised to avoid vigorous sport activities for at least 3 months after the injury. Any recurrent dislocation and return to sports were assessed at 2-year follow-up.
Of 109 patients, 90 were followed up for 2 years. The compliance rates were 60% to 72% among the groups (P = .54). The recurrence rate of dislocation was 28% in the 0-week group, 33% in the 3-week group, and 32% in the 6-week group (P = .88) according to the intention-to-treat analysis, and they were a respective 24%, 28%, and 27% according to the per-protocol analysis (P = .95). Based on the sport activity level, the recurrence rates for patients involved in contact sports (7/15, 47%) and those involved in noncontact sports (19/51, 37%) were significantly higher than for those not involved in sport activities (2/24, 8.3%) (P = .0076). Among the 3 groups, there were no significant differences in the recurrence rates. There was no significant difference in the rate of return to sports (P = .39).
No difference in the recurrence rate was seen with the use of a shoulder motion restriction band after 3 weeks of immobilization in external rotation after an initial dislocation of the shoulder.
外旋固定是初次肩关节脱位的治疗选择之一。然而，Bankart 损伤愈合需要多长时间仍不清楚。
保护正在愈合的 Bankart 损伤免受拉伸会促进愈合过程，并降低初次肩关节脱位后的复发率。
随机对照试验；证据水平，2。
这是一项多中心前瞻性随机研究。2005 年 1 月至 2009 年 8 月，共纳入 109 例初次创伤性肩关节脱位患者（71 例男性，38 例女性；平均年龄 30 岁）。在外旋固定 3 周后，使用一种设计用于避免前下肩关节囊拉伸的肩部运动限制带，分别使用 0 周（36 例）、3 周（37 例）或 6 周（36 例）。使用该带后，允许患者自由使用肩部，但建议他们在受伤后至少 3 个月内避免剧烈运动。在 2 年随访时评估任何复发性脱位和重返运动情况。
109 例患者中，90 例获得 2 年随访。3 组的依从率分别为 60%~72%（P=.54）。根据意向治疗分析，0 周组、3 周组和 6 周组的脱位复发率分别为 28%、33%和 32%（P=.88），根据方案分析，分别为 24%、28%和 27%（P=.95）。根据运动水平，参与接触性运动的患者（15 例中有 7 例，47%）和非接触性运动的患者（51 例中有 19 例，37%）的复发率明显高于不参与运动的患者（24 例中有 2 例，8.3%）（P=.0076）。在 3 组中，复发率无显著差异。重返运动的比例无显著差异（P=.39）。
初次肩关节脱位后外旋固定 3 周后使用肩部运动限制带，复发率无差异。
