过顶复位法治疗肩关节前脱位36例临床观察

Shoulder Over the Top Reset Treatment Anterior Dislocation Clinical Observation of 36 Cases

[目的]观察过顶复位法治疗肩关节前脱位疗效。[方法]使用前瞻性设计,将36例门诊患者按仰卧位,患侧肩部及上肢皮肤裸露,放松肌肉,轻柔按摩肩部及上臂肌肉,固定躯干,抓腕,无抵抗下慢慢前屈患肩直至上举至100°,外旋上臂并轻柔牵引1~2min,左手抓患肢,右手拇指顶住肱骨头,慢慢放下患肢并内收,听到肱骨头入臼的声音,检查肩峰下饱满,搭肩试验阴性,即表明复位成功。部分无入臼响声,但检查搭肩试验满意即可。复位后术者左手扶住患者肩部,右手托住患者肘部,各方向活动肩关节,行理筋手法,感觉肩关节无明显活动受限,伴大结节骨折可在活动肩关节的时候用左手拇指按住大结节位置,可使大结节骨折块得到良好复位。术后三角巾悬吊患肢2~3周。用健侧手托住患侧肘部早期开始被动肩关节活动功能锻炼。治疗1次为1疗程。三周内每周复诊一次。观测临床症状、肩关节位置、不良反应。治疗1疗程,判定疗效。[结果]显效33例,有效3例,无效0例,总有效率100.00%。[结论]过顶复位法治疗肩关节前脱位疗效满意,无严重不良反应,值得推广。

[Objective]To observe the treatment of shoulder over the top reset anterior dislocation of efficacy.[Method]Using a prospective design,36 outpatients press supine,ipsilateral shoulder and upper limb exposed skin,relax the muscles,gently massage the shoulder and upper arm muscles,fixed trunk,grab the wrist,slowly flexion without resistance suffering from shoulder to give up on 100°.external rotation of the upper arm and gently draw 1-2min,left hand grasping the limb,the right thumb against the humeral head,and slowly lower limb adduction,hear the voice of the humeral head into the acetabulum,checking subacromial full,stand on another test was negative,that indicate a successful reset.No part of the mortar sound,but check stand on another test can be satisfied.After reattachment surgery patients who left held onto the shoulder,right elbow boosting the patient,shoulder in all directions activities,row tendon approach,feeling no shoulder limited mobility,with greater tuberosity fractures when the active shoulder Hold down the left hand thumb position the greater tuberosity,greater tuberosity fracture fragments can get a good reset.Limb sling suspension after 2 to 3 weeks.Ipsilateral elbow with the contralateral hand to support the early passive shoulder mobility exercise.1 treatment course of treatment.Three weeks visit once a week.Observation of clinical symptoms,shoulder position,adverse reactions.One course of treatment,to determine efficacy.[Result]33 cases markedly effective in 3 cases,0 cases,the total efficiency of 100.00%.[Conclusion]Over the top repositioning satisfaction Treatment anterior dislocation effect,no serious adverse reactions,is worth promoting.