Dong Huan, Jenner Edward A, Theivendran Kanthan
Trauma and Orthopaedic Department, Sandwell & West Birmingham Hospitals NHS Trust, Lyndon, West Bromwich, Birmingham, West Midlands, B71 4HJ, UK.
Eur J Trauma Emerg Surg. 2021 Apr;47(2):407-421. doi: 10.1007/s00068-020-01427-9. Epub 2020 Jun 30.
Anterior shoulder dislocations are the most common type of joint dislocation with the majority treated with closed reduction. Reduction methods can be grouped into their principle mode of action: traction-countertraction, leverage and scapular manipulation. The best method has yet to be identified and our aim was to find the most effective, safe and least painful method of closed reduction for acute anterior shoulder dislocations.
A search of the online databases of CENTRAL, MEDLINE and Embase was performed to identify randomised control trials (RCTs) comparing closed reduction methods for anterior shoulder dislocations. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Twelve eligible RCTs were included with a total of 1055 patients. Our meta-analysis showed traction-countertraction methods are marginally less painful than leverage methods by 0.86 points on the VAS scale but leverage methods are quicker by 20 s. Amongst traction-countertraction methods, the Spaso technique was the least painful and quickest, albeit with no difference in overall success rate. A meta-analysis was not possible for comparisons involving scapular manipulation due to the paucity of studies, but within two studies, scapular manipulation was significantly less painful than both leverage and traction-countertraction methods by 1.5 and 2.3 points (VAS), respectively.
Traction-countertraction methods are less painful but slower than leverage methods with no difference in complication rates. However, there was no difference in overall reduction success rate between any of the groups.
I.
肩关节前脱位是最常见的关节脱位类型，大多数通过闭合复位进行治疗。复位方法可根据其主要作用方式分为：牵引 - 对抗牵引、杠杆作用和肩胛骨手法。目前尚未确定最佳方法，我们的目的是找到急性肩关节前脱位最有效、安全且疼痛最轻的闭合复位方法。
检索CENTRAL、MEDLINE和Embase在线数据库，以识别比较肩关节前脱位闭合复位方法的随机对照试验（RCT）。按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价和Meta分析。
纳入12项合格的RCT，共1055例患者。我们的Meta分析表明，在视觉模拟评分（VAS）量表上，牵引 - 对抗牵引方法的疼痛程度比杠杆作用方法略低0.86分，但杠杆作用方法更快，快20秒。在牵引 - 对抗牵引方法中，Spaso技术疼痛最轻且速度最快，尽管总体成功率没有差异。由于研究数量少，无法对涉及肩胛骨手法的比较进行Meta分析，但在两项研究中，肩胛骨手法的疼痛程度分别比杠杆作用和牵引 - 对抗牵引方法低1.5分和2.3分（VAS）。
牵引 - 对抗牵引方法疼痛较轻，但比杠杆作用方法慢，并发症发生率无差异。然而，各组之间总体复位成功率没有差异。
I级
