桡骨小头半脱位91例诊治体会

　　【关键词】 桡骨小头;半脱位;手法复位

　　Diagnosis and treatment for 91 cases of radial head subluxation

　　BI Yong-hai.Hexiwu Hospital of Wuqing District, Tianjin 301714, China

　　【Abstract】 Objective To introduce the diagnosis and treatment of radial head subluxation.Methods The therapy of manipulative reduction without anesthesia was performed in 91 infantile patients with radial head subluxation.Results All the patients were confirmed none anomalous anatomic structure about elbow joint by X-ray, and the therapy of manipulative reduction was performed successfully in all of them (7 cases were noncooperation, the second time were successes after being comforted).Conclusion The diagnosis of radial head subluxation must be confirmatory, and the effect of manipulative reduction without anesthesia is good, but recurrence ought to be prevented and the manipulative reduction again still have good effect in this condition.

　　【Key words】 radial head; subluxation; manipulative reduction

　　桡骨小头半脱位常见于5岁以下小儿[1]，是门诊常见肘部损伤,诊断并不困难。笔者2001年1月-2008年6月诊治桡骨小头半脱位91例效果良好，现就诊治体会并对诊断与鉴别诊断略作讨论。

　　1 临床资料

　　1.1 一般资料 诊治桡骨小头半脱位91例，男40例，女51例，年龄最小7个月，最大7岁。其中1～3岁最多见，占81%。受伤部位：左侧62例，占68.1%;右侧26例，占28.6%;双侧3例，占0.33%。复发时间最短者未离开诊室，脱位次数最多达9次。

　　1.2 损伤原因 患儿多处于直立位、坐位、下蹲位，或穿、脱紧身袖上衣时被无意牵拉手臂所致。

　　1.3 就诊时间 伤后3h内就诊40例，3～12h 48例，12h后3例。

　　1.4 临床诊断 患儿出现耸肩，肘关节略屈，前臂略旋前贴胸，肘关节不活动，有拒绝受检表现，肘关节处无肿胀，无畸形，小头部压痛明显。拾持物实验：患肢拒绝持物。X线检查：无骨骼与关节解剖结构变异。

　　1.5 治疗方法 手法复位，无需麻醉。复位方法有3种：(1)伸直内旋复位法：术者手掌托患肘后部，并用拇指按压桡骨小头处，另手握患肢腕部稍作纵向牵引随内旋前臂[2]。(2)屈曲外旋复位法：将患儿略屈曲旋前的伤肢屈成直角，一手拇指压迫桡骨小头，另一手将前臂过度外旋[2]。(3)术者手掌托肘后部，另手握患肢手腕部稍作纵向牵引，同时用掌托患肘手拇指按压桡骨小头处，内外旋前臂并屈肘成直角。术者拇指可感到桡骨小头处轻微弹动，即可复位。用颈、臂三角巾悬吊2～5天。

　　1.6 治疗结果 疼痛随即缓解，可屈肘上举持物，患肘可自由活动。复位后部分年龄较大患儿肘部活动较健侧差，明显为患肢上举前臂内旋、外旋活动差。复发者再次手法复

[1] [2] 下一页