Snyder H S
Department of Emergency Medicine, Albany Medical Center Hospital, NY 12208.
J Emerg Med. 1990 May-Jun;8(3):265-9. doi: 10.1016/0736-4679(90)90003-e.
Radial head subluxation (RHS) produces no radiographic abnormalities according to most experts. However, recent anecdotal case reports have identified displacement of the radiocapitellar line (RCL) in pediatric patients with RHS. To verify this finding, we retrospectively reviewed all patients less than 5 years of age who received elbow and forearm radiographs in our emergency department. From January 1988 through April 1989, we identified 20 cases of RHS. Of the 20 radiographs, 5 (25%) were read by the attending radiologist as abnormal due to RCL displacement indicating subluxation of the radiocapitellar articulation. All 5 of these radiographs had RCL displacement greater than 3 mm. The remaining normal radiographs had RCL displacement less than or equal to 3 mm. The presence of RCL displacement without disruption of the radiocapitellar articulation confirms the diagnosis of RHS, but does not appear to change treatment or outcome in this subset of patients. In addition, radiographs may not be mandatory when the diagnosis of RHS is certain. We suggest obtaining radiographs if the history (i.e., fall) or physical examination is atypical or if reduction is unsuccessful to rule out more serious injuries such as radial head dislocation or fracture.
多数专家认为桡骨头半脱位（RHS）不会产生影像学异常。然而，近期的个案报道发现患有RHS的儿科患者存在桡骨小头对线（RCL）移位。为证实这一发现，我们回顾性分析了在我院急诊科接受肘部和前臂X光检查的所有5岁以下患者。从1988年1月至1989年4月，我们共确诊20例RHS。在这20张X光片中，有5张（25%）经主治放射科医生阅片后判定为异常，原因是RCL移位，提示桡骨小头关节半脱位。这5张X光片中的RCL移位均大于3毫米。其余正常X光片的RCL移位小于或等于3毫米。RCL移位但桡骨小头关节未脱位可确诊RHS，但在这类患者中似乎不影响治疗或预后。此外，如果RHS诊断明确，X光检查可能并非必需。我们建议，如果病史（如跌倒）或体格检查不典型，或复位未成功，应进行X光检查，以排除更严重的损伤，如桡骨头脱位或骨折。
