背景:肩关节脱位的生物力学复位技术已显示出较高的复位成功率,患者的疼痛体验有限。我们推测,生物力学复位技术与最短住院时间的结合也将具有最低的疼痛体验和最高的首次复位成功率。
方法:进行了一项随机多中心临床试验,以比较不使用侵入性疼痛缓解治疗前肩关节脱位的不同生物力学复位技术。能够进行手臂内收的患者被随机分配到坎宁安,改良的米尔奇,和肩胛骨操纵技术。那些无法做到这一点的人被随机分配到改良的Milch和肩胛骨操纵技术。主要结果是急诊科住院时间和减少过程中经历的疼痛,通过数字疼痛评定量表测量。次要结果是减少时间,减少成功,使用镇痛药或镇静剂,和并发症。
结果:纳入了三百八位患者,其中134人属于内收组。在这两组中,两组治疗组之间在急诊科住院时间和经历的疼痛方面没有差异.在内收组中,改良的Milch技术具有最高的首次复位成功率52%(p=0.016),在协议中61%(p=0.94),并在ED100%(-)中使用镇静剂。在无内收组中,改良的Milch也是最成功的主要还原技术,成功率为51%(p=0.040),协议内66%(p=0.90),并在ED98%的镇静(p=0.93)。在任何技术中都没有记录到并发症。
结论:生物力学技术的组合导致在急诊科的住院时间相似,疼痛评分相似,总体复位成功率较高。在这两组中,改良后的Milch首减成功率最高。
背景:荷兰试验注册NTR5839-2016年4月1日。荷兰北部道德委员会,CCMO编号为NL54173.094.15。
BACKGROUND: Biomechanical reduction techniques for shoulder dislocations have demonstrated high reduction success rates with a limited pain experience for the patient. We postulated that the combination of biomechanical reduction techniques with the shortest length of stay would also have the lowest pain experience and the highest first reduction success rate.
METHODS: A randomized multicenter clinical trial was performed to compare different biomechanical reduction techniques in treating anterior shoulder dislocations without the use of invasive pain relief. Patients who were able to perform adduction of the arm were randomly assigned to Cunningham, the modified Milch, and the scapular manipulation technique. Those who were not able to do so were randomly assigned to modified Milch and the scapular manipulation technique. Primary outcomes were emergency department length of stay and pain experienced during the reduction process, measured by the numeric pain rating scale. Secondary outcomes were reduction time, reduction success, use of analgesics or sedatives, and complications.
RESULTS: Three hundred eight patients were included, of whom 134 were in the adduction group. In both groups, no differences in emergency department length of stay and experienced pain were observed between the treatment arms. In the adduction group, the modified Milch technique had the highest first reduction success rates 52% (p = 0.016), within protocol 61% (p = 0.94), and with sedation in the ED 100% ( -). In the no-adduction group, the modified Milch was also the most successful primary reduction technique with 51% success (p = 0.040), within protocol 66% (p = 0.90), and with sedation in the ED 98% (p = 0.93). No complications were recorded in any of the techniques.
CONCLUSIONS: A combination of biomechanical techniques resulted in a similar length of stay in the emergency department and showed similar pain scores with an overall high success rate of reduction. In both groups, the modified Milch had the highest first-reduction success rate.
BACKGROUND: Netherlands Trial Register NTR5839-1 April 2016. Ethical committee Noord-Holland with the CCMO-number NL54173.094.15.