Vavken Patrick, Sadoghi Patrick, Quidde Julia, Lucas Robert, Delaney Ruth, Mueller Andreas M, Rosso Claudio, Valderrabano Victor
Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland; Division of Sports Medicine & Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA; Center for Population and Development Studies, Harvard School of Public Health, Boston, MA, USA.
Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria.
J Shoulder Elbow Surg. 2014 Jan;23(1):13-9. doi: 10.1016/j.jse.2013.07.037. Epub 2013 Sep 30.
The objective of this study was to systematically review and quantitatively synthesize the data on recurrence rates after shoulder immobilization in internal versus external rotation in first-time, traumatic shoulder dislocations.
We performed a systematic search of the keywords "(((external rotation) OR internal rotation) AND immobilization) AND shoulder" in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. Random-effects models were used to calculate the cumulatively pooled risk ratios (RRs) of recurrent shoulder dislocations. All analyses were also stratified by age.
We included 5 studies with a total of 471 patients (230 internal rotation and 241 external rotation) published between 2001 and 2011 in English. The pooled random-effects RR for recurrence of shoulder dislocations at all ages was 0.74 (95% confidence interval [CI], 0.44-1.27; P = .278). The RR was 0.70 (95% CI, 0.38 to 1.29; P = .250) for patients aged 30 years or younger and 0.78 (95% CI, 0.32 to 1.88; P = .579) for those aged older than 30 years.
The current best evidence does not support a relative effectiveness of immobilization in external rotation compared with internal rotation to avoid recurrent shoulder dislocations in patients with traumatic anterior shoulder dislocations.
本研究的目的是系统回顾并定量综合首次创伤性肩关节脱位后内旋与外旋位固定后复发率的数据。
我们在在线数据库PubMed、EMBASE、CINAHL（护理学与健康相关文献累积索引）和Cochrane图书馆中对关键词“(((外旋)或内旋)且固定)且肩关节”进行了系统检索。采用随机效应模型计算复发性肩关节脱位的累积合并风险比（RRs）。所有分析也按年龄分层。
我们纳入了2001年至2011年间以英文发表的5项研究，共471例患者（230例内旋和241例外旋）。各年龄段肩关节脱位复发的合并随机效应RR为0.74（95%置信区间[CI]，0.44 - 1.27；P = 0.278）。30岁及以下患者的RR为0.70（95% CI，0.38至1.29；P = 0.250），30岁以上患者的RR为0.78（95% CI，0.32至1.88；P = 0.579）。
目前的最佳证据不支持在创伤性前肩关节脱位患者中，与内旋位固定相比，外旋位固定在避免复发性肩关节脱位方面具有相对有效性。
