桡骨小头半脱位

1、桡骨头半脱位,邢台县医院 骨科 许浈铖,Whats 桡骨头半脱位？,专业回答,牵拉肘，也被称作环状韧带移位或桡骨头半脱位，是儿童常见的骨科损伤。 In the United States, the incidence of emergency department visits for pulled elbow is estimated at 2.7 per 1000 persons younger than 18 years of age.The median age at presentation is 2 years. 在美国，未成年人急诊就诊中牵拉肘的发生率大约在2.7/1000.相关

2、报道的中位年龄为2岁。 The injury is unique to infants and young children because the radial head is less bulbous than it is in older persons and may easily become displaced. 牵拉肘特别常见于婴幼儿和青少年，因为幼儿的桡骨头还未发育像成人那样的圆球状桡骨头，所以很容易移位。 Reduction of a pulled elbow is a safe procedure that can be performed in the outpatien

3、t setting. 复位牵拉肘是相对安全的操作，完全可以在门诊进行。 The annular ligament encircles the neck of the radius and holds it tightly in place against the ulna), thereby maintaining the position of the proximal radius in relation to the ulna and the capitellum of the distal humerus while allowing 180-degree rotation. 环状韧带

4、包绕桡骨颈使其紧邻尺骨，从而维持桡骨与毗邻尺骨以及肱骨远端肱骨小头的相对位置，同时可以完成180旋转。 When there is forceful longitudinal traction, such as when a child is pulled or lifted by the arm, the radial head is pulled underneath the annular ligament. 在强大的纵向（轴向）牵拉下，比如提拉幼儿手臂或用手臂引体向上时，桡骨头会被牵拉至环状韧带下方。,大多数孩子的病史中可能有过被牵拉的情况,环状韧带 嵌压的环状韧带,环状韧带包绕桡骨颈

5、，并维持桡骨紧邻尺骨,轴向牵拉时，桡骨头包埋在环状韧带下,首先，明确孩子的病史及体检与诊断一致。 The childs history may include a witnessed event of forceful traction; however, other mechanisms of injury have also been described. 孩子的病史中可能有过被牵拉的情况；然而，其它的损失机制也有描述过。 Physical examination should reveal pseudoparalysis, with the child voluntarily keepi

6、ng the limb still to minimize discomfort. 体格检查会发现假性神经麻痹，而孩子为了减少不适会自主保持上肢制动。 There will also be pain with movement, most often related to supination and pronation rather than to flexion and extension. 活动时疼痛，旋前或旋后较屈伸更易产生。 In most cases there will be tenderness to palpation on the lateral side of the e

7、lbow; however, absence of this tenderness does not rule out the diagnosis. 多数情况下触诊肘关节外侧可及虚空感，即使未及虚空感也不能排除该诊断。 An affected child holds the elbow in a slightly flexed position, with the hand pronated. 受伤的孩童将被迫保持肘关节轻微屈曲位并维持手掌旋前位。 Further examination should also reveal a normal-looking elbow without eff

8、usion, bruising, or obvious deformity. 更进一步的检查则会发现肘关节外形正常，无突出，无挫伤或明显的畸形。 Radiographs are almost always normal in cases of pulled elbow, so radiography should be reserved for cases in which the diagnosis is not clear.,牵拉肘的影像学检查几乎都是正常的，所以只有在诊断不明确时才考虑进行影像学检查。 However, positioning the elbow in preparati

9、on for radiography is often therapeutic in reducing the displacement. 然而，在放置体位来进行影像学检查时，往往对复位移位有帮助。 Contraindications 禁忌征 The contraindications to performing a reduction are few and are usually easily Recognized. 复位的禁忌征很少且容易鉴别。 If a child has a history and physical examination that are consistent wi

10、th fracture, such as deformity, swelling, or bruising of the elbow or a history of a fall onto the arm from a substantial height, then a radiograph should be obtained to evaluate for fracture. 如果孩子的病史或体格检查与骨折吻合，比如畸形，肿胀或肘关节挫伤或有高处摔落手臂着地的外伤史，则应行影像学检查来判断是否骨折。 If the radiograph does not reveal fracture o

11、r effusion, then reduction may be considered. 如果影像学检查未发现骨折或突出，则可以考虑手法复位。,In one study, reduction was achieved on the first attempt in 95% of patients who underwent randomization to hyperpronation as compared with 77% of patients who underwent randomization to supination. 在一项研究中，随机予以过度旋前手法首次复位成功的比例是9

12、5%，而旋后手法则为77%。 Supination Technique 旋后手法 To perform the supination technique, seat the child on the parent or caregivers lap, with the child facing you. Clasp both the hand and elbow of the affected arm (图. 3). 采用旋后手法时，让孩子坐在家长或监护人的大腿上面对着操作者。扣住患肢的手和肘。 Your fingers or thumb should overlie the radial h

13、ead. Neither the positioning of your fingers or thumb nor the starting position of the affected arm is critical to the success of the procedure. 操作者的手指后大拇指应压在桡骨头上。无论是操作者的手指或大拇指位置或患肢的初始位置对于复位成功都至关重要。,Supinate and flex the forearm until you feel the ligament move back into position (图. 4). You may fee

14、l or hear a click as the ligament is reduced. 旋前屈曲前臂直到感觉环状韧带移回至正常位置。环状韧带复位时操作者可以感觉或听到轻微的咔哒声。 If the reduction is successful, the child should be pain free and able to move the arm normally in 5 to 30 minutes, including being able to reach for an object above the head. 如果复位成功，孩子便会不痛并能在5-30分钟内自如活动，包括碰

15、触高过头顶的物体。 Hyperpronation Technique 过度旋前法 Hyperpronation can be the primary method used to reduce a pulled elbow, or it can be used if the supination technique has failed. Seat the child on the parents or caregivers lap, with the child facing you. However, if any other abnormalities are present, such

16、 as evidence of infection, reduction should not be attempted and immediate evaluation of the cause and appropriate treatment should be initiated. 但是，如果合并其它任何疾病，比如感染，则不能予以复位而应立即评估造成疾病的原因同时立即予以适当的治疗。,Preparation准备 No equipment is required for the reduction of a pulled elbow. The clinicians hands shoul

17、d be washed thoroughly as part of standard precautions. 复位肘关节无需准备任何设备。临床医生彻底洗手应该是标准注意事项的一部分。 Procedure 操作 To prepare the parent or caregiver, explain that some discomfort may be associated with the procedure. 操作前告知家长或监护人，操作过程中可能会造成一些不适。 The child may cry or scream for several minutes after the radia

18、l head has been relocated to its proper position. 桡骨头复位至正常位置后孩子可能会哭或喊叫一会。 Two techniques can be used to correct a pulled elbow. 二种手法可以用来纠正牵拉肘。 The supination technique has typically been used for reduction of pulled elbow; however, some studies comparing the supination with the hyperpronation techni

19、que have shown that hyperpronation is more successful. 旋后法早已被用作为经典的牵拉肘复位手法；然而，一些研究比较了旋后手法与过度旋前手法发现过度旋前法效果更好。,复位肘关节可以首选过度旋前法或在旋后手法未能复位时再选择过度旋前手法。让孩子坐在家长或监护人的大腿上，面对着操作者。 Clasp the hand of the affected arm as you would in a handshake (图. 5). Use your free hand to support the patients elbow. 握住患肢像握手那样。用

20、另一只手拖住患者的肘部。 Hyperpronate the patients wrist (图. 6). You may feel or hear a click as the ligament is reduced. 旋前患者手腕。韧带复位时可以感觉或听到轻微的咔哒声。 If the reduction is successful, the child should be pain free and able to move the arm normally in 5 to 30 minutes, including being able to lift the affected arm a

21、bove the head. 如果复位成功，孩子便会不痛并能在5-30分钟内自如活动，包括碰触高过头顶的物体。 Troubleshooting 处理难题 Most reductions of a pulled elbow will be successful after a single attempt. 大多数的牵拉肘都能一次复位成功。,If an initial attempt fails, the procedure may be repeated or the alternate technique may be used. 如果初次复位失败，可以再次尝试复位或换一种复位手法。 If

22、the elbow has not been reduced after three or four attempts, reexamine the arm carefully from shoulder to fingertips and obtain a radiograph to rule outfracture. 如果尝试3-4次后仍无法复位肘关节，则应再次仔细检查从肩膀至手指并予以行影像学检查来排除骨折。 However, when the cause of the injury or displacement is a fall, when the circumstances of

23、 the injury are unclear, or when it is difficult to perform a thorough examination because the child is uncooperative, it is prudent to obtain a radiograph before the third or fourth attempt at reduction. 然而，当造成损伤或移位的原因是摔落，或损伤的周围环境不清楚或则是因为孩子不配合而无法进行彻底的体格检查时，在尝试进行第三或第四次复位前为谨慎起见应进行影像学检查。 After obtaini

24、ng a radiograph, splint the elbow at an angle of approximately 90 degrees (even if the child presents with the arm more fully extended) and refer the child to an orthopedic surgeon. 影像学检查后，用夹板固定肘关节在大约90的位置（即使孩子开始的手臂是过伸位的），然后将孩子转诊至骨科医生。,In the majority of such cases, the affected elbow will reduce spontaneously during the period of immobilization. 对于多数此类情况，受伤的肘关节会在制动期间自发复位。 Aftercare 操作后护理 When a pulled elbow