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。IntheUnitedStates,theincidenceofemergencydepartmentvisitsforpulledelbowisestimatedat2.7per1000personsyoungerthan18yearsofage.Themedianageatpresentationis2years.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.相关报道的中位年龄为2岁。Theinjuryisuniquetoinfantsandyoungchildrenbecausetheradialheadislessbulbousthanitisinolderpersonsandmayeasilybecomedisplaced.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。Reductionofapulledelbowisasafeprocedurethatcanbeperformedintheoutpatientsetting.复位牵拉肘是相对安全的操作，完全可以在门诊进行。Theannularligamentencirclestheneckoftheradiusandholdsittightlyinplaceagainsttheulna),therebymaintainingthepositionoftheproximalradiusinrelationtotheulnaandthecapitellumofthedistalhumeruswhileallowing180-degreerotation.环状韧带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。Whenthereisforcefullongitudinaltraction,suchaswhenachildispulledorliftedbythearm,theradialheadispulledunderneaththeannularligament.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，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。Thechildshistorymayincludeawitnessedevent’offorcefultraction;however,othermechanismsofinjuryhavealsobeendescribed.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。Physicalexaminationshouldrevealpseudoparalysis,withthechildvoluntarilykeepingthelimbstilltominimizediscomfort.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。Therewillalsobepainwithmovement,mostoftenrelatedtosupinationandpronationratherthantoflexionandextension.活动时疼痛，旋前或旋后较屈伸更易产生。Inmostcasestherewillbetendernesstopalpationonthelateralsideoftheelbow;however,absenceofthistendernessdoesnotruleoutthediagnosis.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。Anaffectedchildholdstheelbowinaslightlyflexedposition,withthehandpronated.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。Furtherexaminationshouldalsorevealanormal-lookingelbowwithouteffusion,bruising,orobviousdeformity.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。Radiographsarealmostalwaysnormalincasesofpulledelbow,soradiographyshouldbereservedforcasesinwhichthediagnosisisnotclear.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,positioningtheelbowinpreparationforradiographyisoftentherapeuticinreducingthedisplacement.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ThecontraindicationstoperformingareductionarefewandareusuallyeasilyRecognized.复位的禁忌征很少且容易鉴别。Ifachildhasahistoryandphysicalexaminationthatareconsistentwithfracture,suchasdeformity,swelling,orbruisingoftheelboworahistoryofafallontothearmfromasubstantialheight,thenaradiographshouldbeobtainedtoevaluateforfracture.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。Iftheradiographdoesnotrevealfractureoreffusion,thenreductionmaybeconsidered...
