Jordan Robert W, Saithna Adnan, Old Jason, MacDonald Peter
Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
Pan Am Clinic, Winnipeg, Manitoba, Canada University of Manitoba, Winnipeg, Canada.
Am J Sports Med. 2015 Sep;43(9):2328-33. doi: 10.1177/0363546514555661. Epub 2014 Nov 3.
External rotation (ER) bracing has been shown to improve labral reduction in cadaveric studies, but this has not translated to universal improvement in re-dislocation rates in clinical series.
To systematically review and critically appraise the literature that investigates how well the labrum is actually reduced by ER in patients who have had an anterior shoulder dislocation.
Systematic review.
We conducted a systematic review of the literature using the online databases Medline, EMBASE, and the Cochrane Controlled Trial Register. Studies were included if they reported on the difference in labral reduction after ER and internal rotation bracing in patients who had a traumatic anterior shoulder dislocation.
Of the 6 studies included, 5 assessed labral reduction on magnetic resonance imaging and 1 arthroscopically. Each study reported an overall improvement in labral reduction with ER, but anatomic reduction was not commonly achieved. This was despite the use of extreme positions that are unlikely to be well tolerated.
External rotation results in anatomic reduction of the labrum in only 35% of cases. We postulate that failure to reduce the labrum may be a contraindication to ER bracing and propose further study to determine whether acute MRI could be used to help identify patients in whom ER achieves labral reduction in a comfortable position. This approach also has the advantage of avoiding the significant inconvenience of ER bracing in those in whom the labrum does not reduce and are therefore theoretically less likely to benefit. However, it is a novel strategy with significant resource implications and therefore warrants further study.
尸体研究表明，外旋（ER）支具可改善盂唇复位，但这并未转化为临床系列中再脱位率的普遍改善。
系统回顾和批判性评价有关前肩关节脱位患者中ER实际能使盂唇复位程度的文献。
系统评价。
我们使用在线数据库Medline、EMBASE和Cochrane对照试验注册库对文献进行了系统评价。纳入的研究需报告创伤性前肩关节脱位患者使用ER支具和内旋支具后盂唇复位的差异。
纳入的6项研究中，5项通过磁共振成像评估盂唇复位情况，1项通过关节镜评估。每项研究均报告ER可使盂唇复位总体改善，但解剖复位并不常见。尽管使用了不太可能耐受良好的极端体位，但仍未实现解剖复位。
外旋仅在35%的病例中实现盂唇的解剖复位。我们推测未能使盂唇复位可能是ER支具治疗的禁忌证，并建议进一步研究以确定急性磁共振成像是否可用于帮助识别ER能在舒适体位实现盂唇复位的患者。这种方法还有一个优点，即避免了对盂唇未复位患者使用ER支具带来的极大不便，因此从理论上讲这些患者受益的可能性较小。然而，这是一种具有重大资源影响的新策略，因此值得进一步研究。
