Itoi Eiji, Kitamura Toshio, Hitachi Shin, Hatta Taku, Yamamoto Nobuyuki, Sano Hirotaka
Tohoku University School of Medicine, Sendai, Japan
Kumamoto Orthopaedic Hospital, Kumamoto, Japan.
Am J Sports Med. 2015 Jul;43(7):1731-6. doi: 10.1177/0363546515577782. Epub 2015 Apr 8.
Shoulder dislocation often recurs, especially in the younger population. Immobilization in external rotation, in which a Bankart lesion is displaced in the anterior, medial, and inferior directions, was introduced as a new method of nonoperative treatment, but its clinical efficiency is controversial. In terms of reducing the lesion, it is reasonable to incorporate not only external rotation, which makes the anterior soft tissues tight to push the lesion posteriorly and laterally, but also abduction, which makes the inferior soft tissues tight to push the lesion superiorly.
Abducting the arm during immobilization in external rotation will improve the reduction of a Bankart lesion.
Controlled laboratory study.
There were 37 patients with initial shoulder dislocation enrolled in this study. After reduction, MRI was taken in 4 positions of the shoulder: adduction and internal rotation (Add-IR), adduction and external rotation (Add-ER), 30° of abduction and 30° of external rotation (Abd-30ER), and 30° of abduction and 60° of external rotation (Abd-60ER). On radial slices, the separation, displacement of the labrum, and opening angle of the capsule were measured.
Add-ER improved the reduction of the anterior labrum but not the inferior labrum when compared with Add-IR. Both Abd-30ER and Abd-60ER improved the reduction of the inferior labrum as compared with Add-IR. Furthermore, Abd-60ER improved the reduction more than Add-ER.
Among the 4 positions tested, Abd-60ER is the best position in terms of reducing the Bankart lesion.
Abducting the shoulder during immobilization in external rotation is demonstrated to improve the reduction of the Bankart lesion. Therefore, this position is expected to reduce the recurrence rate after initial dislocation of the shoulder. Future clinical trials are necessary.
肩关节脱位常复发，尤其是在年轻人群中。外旋位固定作为一种新的非手术治疗方法被引入，在该体位下，肩胛下肌盂唇损伤向前、内侧和下方移位，但其临床疗效存在争议。就复位损伤而言，不仅采用外旋位（可使前方软组织紧张，将损伤向后外侧推挤），还采用外展位（可使下方软组织紧张，将损伤向上推挤）是合理的。
在外旋位固定期间外展上肢将改善肩胛下肌盂唇损伤的复位。
对照实验室研究。
本研究纳入37例初次肩关节脱位患者。复位后，在肩关节的4个位置进行MRI检查：内收内旋（Add-IR）、内收外旋（Add-ER）、外展30°且外旋30°（Abd-30ER）以及外展30°且外旋60°（Abd-60ER）。在桡侧层面上，测量盂唇的分离、移位以及关节囊的开口角度。
与Add-IR相比，Add-ER改善了前方盂唇的复位，但未改善下方盂唇的复位。与Add-IR相比，Abd-30ER和Abd-60ER均改善了下方盂唇的复位。此外，Abd-60ER比Add-ER的复位改善更明显。
在测试的4个位置中，就复位肩胛下肌盂唇损伤而言，Abd-60ER是最佳位置。
在外旋位固定期间外展肩关节可改善肩胛下肌盂唇损伤的复位。因此，该体位有望降低初次肩关节脱位后的复发率。未来有必要进行临床试验。
