足蹬外旋复位法治疗肩关节前脱位的病例对照研究

目的：介绍足蹬复位法（Hennipen）外旋治疗肩关节前脱位的特点及其临床疗效。方法：2007年3月至2010年3月采用Hennipen外旋法治疗肩关节前脱位28例（Hennipen组），男17例，女11例；年龄21-72岁，平均（39．2＋5．1）岁；其中喙突下脱位8例，盂下脱位16例，锁骨下脱位4例。同期采用足蹬法复位法治疗肩关节前脱位44例（Hippocratic组），男32例，女12例；年龄15-68岁，平均（36．8＋3．4）岁；其中喙突下脱位12例，盂下脱位29例，锁骨下脱位3例。所有患者均根据临床表现和肩关节X线片确诊，手法复位后行搭肩位肘胸绷带固定3～4周。比较两组患者复位过程、并发症及功能恢复情况（采用UCLA肩关节功能评分标准）。结果：Hippocratic组复位操作在2-5min完成平均（3．9＋1．2）rain]，其中32例接受静脉麻醉；Hennipen组复位操作在0．5-2rain完成平均（1．3±0．7）min]，3例患者需在麻醉下复位；两组复位时间差异有统计学意义（P〈0．05）。Hippocratic组1例老年患者复位过程中发生肱骨大结节撕脱骨折，1例发生肋骨骨折；Hennipen组无明显并发症发生。复位3-4周后随访，Hippocratic、Hennipen组患者肩关节UCIA评分分别为（34．2±2．1）分和（33．8±1．6）分，差异无统计学意义（P〉0．05）。结论：足蹬法复位法和Hennipen外旋法治疗肩美节前脱位均能获得良好的疗效．但HenniDen外旋法操作简单．并发症少．尤其适干急诊寅位操作。

Case-control study on Hennipen external rotation procedure for reduction of 28 patients with acute anterior shoulder dislocation

Objective: To introduce the characteristics and its clinical effects of Hennipen external rotation procedure for reduction of acute anterior shoulder dislocation. Methods: From March 2007 to March 2010, 72 patients with acute anterior shoulder dislocation were treated with manipulative reduction in our department. All the patients were divided into two groups:the Hippocratic group with 44 patients receiving regular Hippocratic procedure, and the Hennipen group with 28 patients receiving Hennipen external rotation procedure. Clinical manifestation and radiology were used to diagnose. After reduction procedures, external fixation was applied for another 3 to 4 weeks. The reduction course, complication and function recovery at follow-up were recorded and compared. The student test was used to analyze the difference between groups. Results: Thirty-two patients in the Hippocratic group and 3 in Hennipen received intravenous anesthesia. Manipulation time of the Hippocratic group ranged from 2 to 5 minutes with a mean of(3. 9±1. 2) minutes, obviously different from that of Hennipen, which ranged from 0. 5 to 2 minutes with a mean of(1. 3±0. 7) minutes. Complications occurred in 2 cases of the Hippocratic group and none of the Hennipen group. The UCLA scores of shoulder joint at follow-up were 34. 2±2. 1 and 33. 8±1. 0 respectively in two groups, with no significant difference. Conclusion: Compared with Hippocratic procedure, Hennipen external rotation procedure is easier to manipulate, bring less complications and the same effect. It is worth further clinical applications.