【作者】 刘铮；

【导师】 韩大为；

【作者基本信息】 福建中医学院 ， 中医骨伤科学， 2007， 硕士

【摘要】 目的：通过对幼儿肘关节解剖学研究和旋前、旋后复位法治疗桡骨小头半脱位的临床疗效观察，探讨桡骨小头半脱位的最佳复位手法。方法：基础选择6具小儿尸体标本，共12例肘关节，进行相关的解剖研究。对小儿肘关节桡骨头、颈和环状韧带进行解剖观察测量。临床收集临床上首次被确诊为桡骨小头半脱位，小于6岁的患者。随机运用旋前复位法和旋后复位法2种复位方法中的一种对患者进行治疗，每隔5分钟检查患肢功能恢复情况。15分钟后如果肘关节功能未能恢复正常则重复第一次复位方法，30分钟后患者仍未恢复肘关节功能，则此复位方法失败。再采取另一种复位方法。假如患者两种复位方法均失败，建议用x线进行检查。对复位过程中疼痛程度进行Mops评分，由患者家属进行评分。结果：基础桡骨头明显大于桡骨颈，桡骨头与桡骨颈矢状径比为1.26±0.021，桡骨头与桡骨颈横径比值1.25±0.016，环状韧带上、下缘比值1.01±0.10。临床临床共收治76例桡骨小头半脱位患者，其中旋前复位组39例复位成功39例(复位成功率为100％)，而旋后复位组中37例复位成功29例(复位成功率为78.4％)，旋前复位组疼痛评分为4.17±1.35，旋后复位组疼痛评分为7.05±1.60。结论：通过小儿肘关节解剖学研究，结合临床的桡骨小头半脱位复位方法比较研究结果，我们认为旋前复位法是桡骨小头半脱位的首选复位方法。更多还原

【Abstract】 Objective: according to anatomic research the infant elbow joint andclinical observation of hyperpronation and supination treatment radialhead subluxation, to explore the best reduction method of radial headsubluxation.Methods: Basic: thought choice of six human cadacer specimens, total 12embalmed cadsver’s elbows.the radial head and neck, annular ligamentwere observed and measured. All of statistic was treated with SPSS13.0.Clinical: this study involved of children younger than 6years ofage with a clinical the first diagnosis of radial head subluxationpatients were randomized to undergo reduction by one of the two methodsabout supination and hyperpronation, followed every 5 minutes for checkof elbow function, the initial procedure was repeated if baselinefunctioning did not return 15 minutes after the initial reduction attempt.failure of that technique 30 minutes after the initial reduction attemptresulted in a cross-over to the alternate method of reduction. thealternate procedure was repeated if baseline functioning did notattempted. if the patient failed toth techniques, radiaography of theelbow was perforemed. at the same time, we will let patient’ s familymembers used the modifle objective pain score to evaluated pain in thereduction processed.Results: Basic: the sagittal and transverse diameter of the radial headwere large than the diameters of the radial neck. ratio about 1.26±0.021 and 1.25±0. 016. the superior and inferior lengths of the annular ligamentwere approximately similar, ratio about 1.01±0.10.Clinical: a total of 76 patients were enrolled in the study.Demographic characteristics of each groph were similar. 39 of 39 patientsrandomized to hyperpronation were reduced successfully (100％) versus 29of 37 patients randomized to supination (78.4％).in the grouphyperpronation the assessment of pain about 4.17±1.35. in the groupsupination the assessment of pain about 7.05±1.60.Conclusions: in the reduction of radial head subluxations, thehyperpronation technique was successful more often than supination. sowe think the hyperpronation is best reduction method.更多还原