Furuhata Ryogo, Kamata Yusaku, Matsumura Noboru, Kono Aki, Morioka Hideo
Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
J Shoulder Elbow Surg. 2021 Feb;30(2):306-311. doi: 10.1016/j.jse.2020.06.005. Epub 2020 Jun 27.
Although anterior glenohumeral dislocations are common, the reduction procedure is often difficult, requiring sedation or anesthesia. To date, the risk factors for reduction failure without sedation have not been fully investigated. This study aimed to clarify the predictive factors that render the reduction of anterior glenohumeral dislocation without sedation difficult by use of multivariate analyses.
We retrospectively reviewed 156 patients who underwent attempted reduction of anterior glenohumeral dislocation between 2006 and 2019. Patients were included based on the following criteria: traumatic dislocation, undergoing attempted reduction using the traction-countertraction method, and acute dislocation in which reduction was attempted within 2 days of the injury. The dependent variable was set as an irreducible glenohumeral dislocation without sedation, which was defined as a reduction failure in this study. Explanatory variables included age, sex, side of injury, recurrent dislocation, axillary nerve injury, time from dislocation to attempted reduction, greater tuberosity fracture, humeral neck fracture, glenoid rim fracture, and glenohumeral osteoarthritis. We evaluated these outcomes from radiographs and clinical notes. Univariate and multivariate analyses were performed. Baseline variables, which were observed to be significant in the univariate analysis, were included in multivariate models, which used logistic regression to identify independent predictors of reduction failure.
Of the 156 patients, 25 (16.0%) experienced reduction failure. Multivariate analyses showed that older age (≥55 years) (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-10.4; P = .036), greater tuberosity fractures (OR, 3.6; 95% CI, 1.1-12.2; P = .033), and glenoid rim fractures (OR, 11.5; 95% CI, 1.5-87.7; P = .018) were risk factors for reduction failure.
Our results demonstrated that multiple factors were associated with unsuccessful reduction of anterior glenohumeral dislocation without sedation. In elderly patients or patients with concurrent greater tuberosity fractures and glenoid rim fractures, reduction failure could occur in the absence of sedation; thus, the administration of sedatives or anesthesia should be considered.
尽管肩关节前脱位很常见，但复位过程通常很困难，需要镇静或麻醉。迄今为止，未使用镇静剂时复位失败的危险因素尚未得到充分研究。本研究旨在通过多变量分析阐明导致无镇静情况下肩关节前脱位复位困难的预测因素。
我们回顾性分析了2006年至2019年间156例尝试进行肩关节前脱位复位的患者。纳入患者的标准如下：创伤性脱位、采用牵引-对抗牵引法尝试复位、以及在受伤后2天内尝试复位的急性脱位。因变量设定为无镇静情况下无法复位的肩关节脱位，在本研究中定义为复位失败。解释变量包括年龄、性别、受伤侧、复发性脱位、腋神经损伤、脱位至尝试复位的时间、大结节骨折、肱骨干骨折、关节盂边缘骨折和肩关节骨关节炎。我们通过X线片和临床记录评估这些结果。进行了单变量和多变量分析。在单变量分析中观察到具有显著性的基线变量被纳入多变量模型，该模型使用逻辑回归来确定复位失败的独立预测因素。
156例患者中，25例（16.0%）复位失败。多变量分析显示，年龄较大（≥55岁）（比值比[OR]，3.4；95%置信区间[CI]，1.1 - 10.4；P = 0.036）、大结节骨折（OR，3.6；95% CI，1.1 - 12.2；P = 0.033）和关节盂边缘骨折（OR，11.5；95% CI，1.5 - 87.7；P = 0.018）是复位失败的危险因素。
我们的结果表明，多种因素与无镇静情况下肩关节前脱位复位失败有关。在老年患者或同时存在大结节骨折和关节盂边缘骨折的患者中，无镇静时可能发生复位失败；因此，应考虑给予镇静剂或麻醉。
