成人肩关节脱位的损伤机制及治疗手法的探讨

THE TRAUMATOGENIC MECHANIDM OF ADULT SHOULDER DISLOCATION AND AN EXPLORATION OF THERAPEUTIC MANIPULATIONS

报告了成人肩关节脱位３４例，通过对患者损伤时体位、症状、体征及Ｘ线片的综合分析和整复的实践，认为间接外力是导致此类损伤的主要原因，不同的创伤机制所导致的此类损伤的具体解剖没有明显的不同之处。根据“逆创伤机制复位”的治疗原则，总结出不用牵引的提送法利用杠杆原理整复成人肩关节脱位，经３４例观察，均１次复位成功，这效果满意。分析认为，无牵引的状态下，关节囊和肌肉处于松弛的状态，利用手指的指力在腋下提拉卡于关节盂或喙突处的肱骨头，使之移动到外方；然后再向内上方推送及旋转上臂，可使肱骨头顺利通过关节囊外口，原路复位。因此，该法可避免传统的对抗牵引整复法易引起局部软组织和神经血管再次损伤之不足。

Thirty four cases of adult shoulder dislocation are reported in the paper. Through a comprehensive analysis of the during injury posture, symptoms, signs and X rays of the patients and the manipulative reduction practice, it was believed that an indirect violence may be regarded as the main cause of this injury and there was no significant difference in the concrete anatomy of this injury caused by different traumatogenic mechanisms. According to the treatment principle of “counter traumatogenic mechanism reduction”, the authors developed lifting delivering manipulation for adult shoulder dislocatiion, which is performed under no traction, using the lever principle. Under no traction, the capsule and muscles are relaxed. From the subaxiliary lift and pull the humoral head entrapped between the glenoid cavity and the coracoid process by finger force and move it to the lateral, then push and deliver it inward and up and rotate the upper arm so that the humoral head could successfully pass through the lateral opening of the capsule and return to the original place by the original way. The manipulation could avoid the second injury of the local soft tissues, nerves and blood vessels caused by the conventional manipulative reduction under countertraction, according with the natural law of the repair process of this injury.