Krul Marjolein, van der Wouden Johannes C, van Suijlekom-Smit Lisette Wa, Koes Bart W
Department of General Practice, Erasmus MC, University Medical Center, PO Box 1738, Rotterdam, Zuid-Holland, Netherlands, 3000 DR.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD007759. doi: 10.1002/14651858.CD007759.pub2.
Pulled elbow (nursemaid's elbow) is a common injury in young children. It results from a sudden pull on the arm, usually by an adult or taller person, which pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. The child experiences sudden acute pain and loss of function in the affected arm. Pulled elbow is usually treated by manual reduction of the subluxed radial head. Various manoeuvres can be applied. Most textbooks recommend supination of the forearm, as opposed to pronation and other approaches. It is unclear which manoeuvre is most successful.
The objective of this review is to compare the effectiveness and painfulness of the different methods used to manipulate pulled elbow in young children.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, LILACS, PEDro, clinical trial registers and reference lists of articles. Date of last search: January 2009.
Any randomised or quasi-randomised controlled clinical trials evaluating manipulative interventions for pulled elbow were included. Our primary outcome was failure at the first attempt, necessitating further treatment.
Two review authors independently evaluated trials for inclusion and, for the included trials, independently assessed the risk of bias and extracted data.
Three trials with 313 participants, all younger than seven years old, were included. All three trials compared pronation versus supination. The methodological quality of all three trials was low because of incomplete reporting and high risk of bias resulting from lack of assessor blinding. Pronation resulted in statistically significantly less failure than supination (risk ratio 0.53, 95% confidence interval 0.32 to 0.87). Pain perception was reported by two trials but data were unavailable for pooling. Both studies concluded that the pronation technique was less painful than the supination technique.
AUTHORS' CONCLUSIONS: There is limited evidence from three small low-quality trials that the pronation method might be more effective and less painful than the supination method for manipulating pulled elbow in young children. However, only a small difference in effectiveness was found. We recommend that a high quality randomised trial be performed to strengthen the evidence.
牵拉肘（保姆肘）是幼儿常见的一种损伤。它通常由成人或较高的人突然牵拉手臂所致，这种牵拉会使桡骨穿过环状韧带，导致桡骨头半脱位（部分脱位）。患儿会感到患侧手臂突然剧痛并失去功能。牵拉肘通常通过手法复位半脱位的桡骨头来治疗。可以采用多种手法。与旋前及其他方法相比，大多数教科书推荐旋后手法。目前尚不清楚哪种手法最为成功。
本综述的目的是比较用于处理幼儿牵拉肘的不同方法的有效性和疼痛程度。
我们检索了Cochrane骨、关节与肌肉创伤组专业注册库、Cochrane对照试验中央注册库、MEDLINE、EMBASE、CINAHL、LILACS、PEDro、临床试验注册库以及文章参考文献列表。最后检索日期：2009年1月。
纳入任何评估牵拉肘手法干预的随机或半随机对照临床试验。我们的主要结局是首次尝试失败，需要进一步治疗。
两位综述作者独立评估纳入试验，对于纳入的试验，独立评估偏倚风险并提取数据。
纳入了3项试验，共313名参与者，均小于7岁。所有3项试验均比较了旋前与旋后手法。由于报告不完整以及缺乏评估者盲法导致的高偏倚风险，所有3项试验的方法学质量都较低。旋前导致的失败率在统计学上显著低于旋后（风险比0.53，95%置信区间0.32至0.87）。两项试验报告了疼痛感受，但数据无法合并。两项研究均得出结论，旋前技术比旋后技术疼痛程度更低。
三项小型低质量试验提供的证据有限，对于幼儿牵拉肘的手法复位，旋前法可能比旋后法更有效且疼痛程度更低。然而，仅发现有效性存在微小差异。我们建议开展高质量的随机试验以强化证据。
