俯位改良Hippocrates法整复肩关节脱位

目的:探讨肩关节前脱位复位方法,评价俯位改良Hippocrates法治疗效果。方法:1998年2月至2011年4月,应用俯位改良Hippocrates法整复肩关节前脱位1028例,男689例,女339例;年龄11～86岁,平均38.3岁;其中32例曾因Hippocrates法复位失败;86例合并肱骨大结节撕脱性骨折。复位方法:患者取俯卧位,术者立于患侧,双手握患侧腕部,足蹬于患侧腋下(左侧脱位用右足,右侧脱位用左足),另一足立地支撑;复位时,双手持缓用力牵引腕部约半分钟,足蹬腋下加以对抗,并且逐渐由畸形位置变为外展、外旋及后伸位;牵引同时发挥足跟的杠杆支点作用进行收展时轻轻摇晃患肢并内旋外旋进行复位。结果:1027例患者1次复位成功,平均复位时间50s;1例因合并肱骨外科颈骨折后行手术治愈。86例合并肱骨大结节撕脱性骨折中84例达到解剖复位或近解剖复位,2例较大骨片者复位后不稳定,行经皮克氏针内固定痊愈。按Neer评分:优1012例,良15例。结论:俯位改良Hippocrates法整复肩关节脱位成功率高,复位时不需麻醉,患者痛苦少,费用低,复位时间短,易掌握值得广泛应用。

Treatment of dislocation of shoulder with manipulation of proneposition modified Hippocrates method

Objective:To explore the method of reduction of anterior dislocation of shoulder joint,evaluate the clinical effects of proneposition modified Hippocrates methods. Methods:From February 1998 to April 2011,1 028 patients,689 males and 339 females,with anterior dislocation of shoulder joint were treated with manipulation of proneposition modified Hippocrates methods. The average age was 38.3 years(ranged from 11 to 86 years). Thirty-two cases by Hippocrates method failure to reset success,86 cases combined with geater tuberosity tore of humerus. Results:One thousand and twenty-seven example applications,it took average 50 s,1 case was cured due to a combination of humerus surgical neck fracture. Eighty-six cases combined with greater tuberosity tore of humerus,84 cases reached anatomical reattachment or nearly anatomical reattachment,2 cases of large bone pieces instability were reduced by percutaneous needle. According to Neer score,there are 1 012 excellent cases,15 good cases. Conclusion:Proneposition modified Hippocrates method is better than Hippocrates. It has the advantage of anesthesia,lower expense,short replacement,less pain,easier to master,and worth applying widely.