Orthopedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
Orthopedic Department, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Bone Joint Surg Am. 2018 Mar 7;100(5):375-380. doi: 10.2106/JBJS.17.00687.
There are many different techniques for reducing acute anterior dislocations of the shoulder, and their use depends on surgeon preference. The objective of this study was to compare the pain experienced by a patient performing a self-reduction technique with the pain felt during a reduction performed by a trained physician.
The study was carried out at the emergency department of a tertiary referral center. Patients between 18 and 60 years of age with an acute anterior shoulder dislocation were randomly allocated into 2 groups. In 1 group the emergency doctor actively guided the reduction process with the Spaso technique (Sp group), and in the other group the patient used the Boss-Holzach-Matter (also known as Davos or Aronen) self-reduction technique (BHM group). The pain experienced by the patient during the reduction was recorded by means of a visual analogue scale (VAS) ranging from 0 to 10. Other recorded data included demographic characteristics, reduction time, and success rate.
Of 378 patients assessed for eligibility from May 2015 until February 2017, 197 did not meet the inclusion criteria, 58 met exclusion criteria, 22 declined to participate, and 41 withdrew before randomization. Sixty acute anterior shoulder dislocations were randomized into the Sp group (n = 30) or the BHM group (n = 30). The BHM group experienced significantly less pain during reduction than the Sp group (p = 0.047), with mean pain scores of 3.57 (standard deviation [SD] = 2.1]) and 5.26 (SD = 2.9), respectively. No significant difference between groups was found with respect to reduction time (105 seconds [range, 10 to 660 seconds] in the Sp group and 90 seconds [range, 5 to 600 seconds] in the BHM group; p = 0.6) or success rate (67% and 77%, respectively; p = 0.39).
The self-reduction technique results in less pain than, and is as efficient in achieving reduction of anterior shoulder dislocations as, the Spaso technique. These findings favor the use of the self-assisted method as an effective first-line treatment for shoulder dislocations seen in the emergency department as well as its use by patients with recurrent dislocation.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
有许多不同的技术可用于减少急性前脱位的肩部，其使用取决于外科医生的偏好。本研究的目的是比较患者进行自我复位技术时的疼痛与经过训练的医生进行复位时的疼痛。
该研究在一家三级转诊中心的急诊科进行。将 18 至 60 岁之间的急性前肩脱位患者随机分配到 2 组。一组由急诊医生使用 Spaso 技术（Sp 组）积极引导复位过程，另一组患者使用 Boss-Holzach-Matter（也称为 Davos 或 Aronen）自我复位技术（BHM 组）。通过视觉模拟量表（VAS）记录患者在复位过程中的疼痛程度，范围从 0 到 10。其他记录的数据包括人口统计学特征、复位时间和成功率。
从 2015 年 5 月至 2017 年 2 月，对 378 名符合条件的患者进行评估，其中 197 名不符合纳入标准，58 名符合排除标准，22 名拒绝参与，41 名在随机分组前退出。60 例急性前肩脱位随机分为 Sp 组（n = 30）或 BHM 组（n = 30）。BHM 组在复位过程中经历的疼痛明显少于 Sp 组（p = 0.047），疼痛评分分别为 3.57（标准差[SD] = 2.1）和 5.26（SD = 2.9）。Sp 组的复位时间为 105 秒（范围为 10 至 660 秒），BHM 组的复位时间为 90 秒（范围为 5 至 600 秒），两组之间差异无统计学意义（p = 0.6）；复位成功率分别为 67%和 77%（p = 0.39）。
与 Spaso 技术相比，自我复位技术可减轻疼痛，且对前肩脱位复位同样有效。这些发现支持将自我辅助方法作为急诊科急性肩部脱位的有效一线治疗方法，也支持反复脱位患者使用。
治疗性 I 级。有关证据水平的完整说明，请参见作者指南。
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