桡骨小头半脱位 ppt

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。
桡骨头半脱位
邢台县医院 骨科 许浈铖 1
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What‘s 桡骨头半脱
位？
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• 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.相关报道的中位年龄为2岁。
专业回答
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大多数孩子的病史中
可能有过被牵拉的情
况
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• 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
环状韧带
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嵌压的环状韧带 6
首先，明确孩子的病史及体检与诊断一致。 The child’s 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 keeping 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 elbow; 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 effusion, 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.
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。
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。
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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 preparation for radiography is
often therapeutic in reducing the displacement.
Reduction of a pulled elbow is a safe procedure that can be performed in the outpatient 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 源自文库he distal humerus while allowing 180-degree rotation. 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。