Chan Samuel Kl, Bentick Kieran R, Kuiper Jan H, Kelly Cormac P
The Hand and Upper Limb Unit, The Robert Jones and Agnes Hunt Hospital, Oswestry, UK.
Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire, UK.
Shoulder Elbow. 2019 Aug;11(4):256-264. doi: 10.1177/1758573218768521. Epub 2018 Apr 26.
Itoi et al. introduced the concept of bracing in abduction and external rotation to treat traumatic anterior shoulder dislocations. However, controversy remains as studies have reported variable results. Our study investigates whether there is a difference in outcomes between treatment with a conventional sling or external rotation brace.
A prospective, multi-centre randomised control trial was conducted between 2006 and 2010. The study was discontinued early with 72 (36 cases in each group) first-time anterior shoulder dislocations recruited.
The re-dislocation rate over 24 months was comparable 30% (95% CI: 17-47) sling vs. 24% (95% CI: 13-41) external rotation bracing. Sixteen percent (95% CI: 7-32) of sling patients and 12% (95% CI: 5-27) of external rotation-bracing patients had shoulder stabilisation surgery within 24 months of the initial dislocation (p > 0.05). There was no difference in OSI scores at 24 months between the two treatment groups and intolerability of the external rotation brace was high.
Recruitment to this study was difficult, and lost-to-follow-up rates were high leading to early discontinuation of the study. The results suggest that ER bracing is unlikely to provide clinical benefit in traumatic first-time anterior shoulder dislocation.
糸井等人提出了在外展和外旋位进行支具固定以治疗创伤性前肩关节脱位的概念。然而，由于研究报告的结果存在差异，争议仍然存在。我们的研究调查了使用传统吊带或外旋支具治疗在疗效上是否存在差异。
在2006年至2010年期间进行了一项前瞻性、多中心随机对照试验。该研究提前终止，共招募了72例首次前肩关节脱位患者（每组36例）。
24个月内的再脱位率相当，吊带组为30%（95%CI：17 - 47），外旋支具组为24%（95%CI：13 - 41）。吊带组16%（95%CI：7 - 32）的患者和外旋支具组12%（95%CI：5 - 27）的患者在初次脱位后24个月内接受了肩关节稳定手术（p＞0.05）。两个治疗组在24个月时的OSI评分没有差异，并且外旋支具的不耐受率较高。
本研究的招募工作困难，失访率高导致研究提前终止。结果表明，外旋支具固定在创伤性首次前肩关节脱位中不太可能带来临床益处。
