Это обсуждение из англоязычной конференции, оно показалось очень интересным - вопрос был задан о современном протоколе после вправления вывиха плеча.
В ответ приведены результаты МРТ-исследования 19 пациентов с вывихами плеча после вправления, которое показало преимущество иммоблизации в наружной ротации. Конечно, нужно еще подтверждение клиническими данными о меньшей встречаемости рецидивов и хронической нестабильности при таком ведении, но и на сейчас выводы выглядят довольно убедительно... Вот уж что казалось классическим и незыблемым...
On 5/4/03 9:33 AM, "Dr Harpal Singh Selhi" wrote:
> Dear All,
> I wish to know the latest protocol regarding the immobilisation of the
> shoulder after reduction of a dislocation?????
The latest study that I am aware of suggests that immobilization in external rotation may be best. The abstract is below. I am not aware of a clinical series that shows whether immobilzation at all, or the position of immobilization, has any significant effect on the rate of recurrentdislocations.
Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging.Itoi E; Sashi R; Minagawa H; Shimizu T; Wakabayashi I; Sato K J Bone Joint Surg Am (United States), May 2001, 83-A(5) p661-7
ABSTRACT: BACKGROUND: Glenohumeral dislocations often recur, probably because a Bankart lesion does not heal sufficiently during the period of immobilization. Using magnetic resonance imaging, we assessed the position of the Bankart lesion, with the arm in internal and external rotation, in shoulders that had had a dislocation. METHODS: Coaptation of a Bankartlesion was examined with use of magnetic resonance imaging, with the arm held at the side of the trunk and positioned first in internal rotation (mean, 29 degrees) and then in external rotation (mean, 35 degrees), in nineteen shoulders. Six shoulders (six patients) had had an initial anterior dislocation, and thirteen shoulders (twelve patients) had had recurrentanterior dislocation. Fast-spin-echo T2-weighted axial images were made when the dislocation had occurred less than two weeks earlier, and spin-echo T1-weighted axial images after intra-articular injection of gadolinium-diethylenetriamine pentaacetic acid were made when the dislocation had occurred more than two weeks earlier. Separation and displacement of the anteroinferior portion of the labrum from the glenoid rim were measured on the axial images, and coaptation of the anterior partof the capsule to the glenoid neck was assessed by measurement of the detached area, opening angle, and detached length. RESULTS: Separation and displacement of the labrum were both significantly less (p = 0.0047 and p =0.0017, respectively) when the arm was in external rotation than when it was in internal rotation. The detached area and the opening angle of the anteroinferior portion of the capsule were both significantly smaller (p =0.0003 and p < 0.0001, respectively), and the detached length was significantly shorter (p < 0.0001) with the arm in external rotation.CONCLUSION: Immobilization of the arm in external rotation better approximates the Bankart lesion to the glenoid neck than does the conventional position of internal rotation.
-- Andrew H. Schmidt, M.D.
Faculty, Hennepin County Medical Center
Assoc. Professor, Univ. of Minnesota
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