The Treatment of Simple Elbow Dislocation in Adults
The Treatment of Simple Elbow Dislocation in Adults
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DOI：
10.3238/arztebl.2015.0311
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发表时间：
2015-05-01
影响因子：
7.7
通讯作者：
Mueller, Lars Peter
中科院分区：
文献类型：
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作者：
Hackl, Michael;Beyer, Frank;Mueller, Lars Peter
背景：单纯肘关节脱位是一种复杂的软组织损伤，可引起永久性症状。其发病率为每年每100 000人5至6例。其适当的治疗方法是有争议的;选择范围从固定在一个石膏手术intervention.Methods：我们系统地回顾了文献上的治疗单纯肘关节脱位，并进行了荟萃分析，主要是在临床评分的基础上，其次是关于疼痛，活动范围，并返回工作。一项随机对照试验（RCT）显示，与石膏固定相比，早期功能治疗的短期随访临床结果具有上级优势。然而，短暂的制动最初减轻了疼痛，早期活动和石膏固定的长期结果是相同的。我们的荟萃分析显示，早期活动使患者能够更早恢复工作（平均值差异-2.91，95%置信区间[CI] -3.18至-2.64），软组织损伤程度与临床结局相关（负相关;平均值差异-12.07，95% CI -23.88至-0.26）。在一项随机对照试验中比较了手术和保守治疗，结果无显著差异。两项回顾性比较研究的荟萃分析表明，立即韧带修复延迟surgic.Conclusion：早期功能治疗是单纯肘关节脱位的循证治疗标准没有优势。在过去的几年里，单纯肘关节脱位的手术治疗有了进一步的发展。需要进一步的研究来确定手术治疗肘关节脱位伴高度不稳定是否可以预防持续性疼痛、活动受限和慢性不稳定。
Background: Simple elbow dislocation is a complex soft-tissue injury that can cause permanent symptoms. Its incidence is 5 to 6 cases per 100 000 persons per year. Its proper treatment is debated; options range from immobilization in a cast to surgical intervention.Methods: We systematically reviewed the literature on the treatment of simple elbow dislocation and performed a meta-analysis, primarily on the basis of clinical scores and secondarily with respect to pain, range of motion, and return to work.Results: A randomized controlled trial (RCT) showed that clinical results at short-term follow-up were superior for early functional treatment compared to immobilization in a cast. Brief immobilization, however, reduced pain initially, and the long-term results of early mobilization and immobilization in a cast were the same. Our meta-analysis showed that early mobilization enables patients to return to work earlier (difference of mean values -2.91, 95% confidence interval [CI] -3.18 to -2.64), and that the extent of soft-tissue injury is correlated with the clinical outcome (inverse relationship; difference of mean values -12.07, 95% CI -23.88 to -0.26). Surgical and conservative treatment were compared in a single RCT, which revealed no significant difference in outcomes. A meta-analysis of two retrospective comparative studies showed no advantage of immediate ligament repair over delayed surgery.Conclusion: Early functional treatment is the evidence-based therapeutic standard for simple elbow dislocation. The past few years have seen further developments in surgery for simple elbow dislocation. Further study is needed to determine whether surgery for elbow dislocation with high-grade instability can prevent persistent pain, limitation of motion, and chronic instability.