Agarwal Anil, Kant Kumar Shashi, Verma Indreshwar
Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalya, Geeta Colony, Delhi-31, India.
Hand Surg. 2013;18(3):407-10. doi: 10.1142/S0218810413720258.
A linear constricting scar around the wrist in the presence of a discharging sinus raises clinical suspicion of a forgotten band around the wrist. A 3-year-old girl presented with an encircling scar, swelling and discharging sinus over the right wrist since last three months. There were no trophic ulcers and gross sensations were intact. Wrist radiographs showed the "constriction" sign in the radial epiphysis. MRI confirmed the diagnosis of encircling band inside wrist abutting the bone. A coloured rubber band was surgically extracted lying deep to restored and continuous tendons and neurovascular structures. Wound healing was uneventful. Examination at 14 months revealed residual ulnar nerve palsy. If aware, the clinical diagnosis is fairly accurate in rubber band syndrome. MRI aids in establishing diagnosis preoperatively. The reparative potential of a child's tissues is amazing. Although the lesion heals well after extraction of encircling band, the clinician should be wary of residual neurological changes.
手腕处出现线性收缩瘢痕且伴有排脓窦道，临床上应怀疑存在被遗忘的手腕束带。一名3岁女童自三个月前起出现右腕部环形瘢痕、肿胀及排脓窦道。无营养性溃疡，大体感觉完好。腕部X线片显示桡骨骨骺处有“收缩”征。磁共振成像（MRI）证实腕部存在紧贴骨骼的环形束带。手术取出一条彩色橡皮筋，其位于修复后连续的肌腱和神经血管结构深部。伤口愈合顺利。14个月时检查发现残留尺神经麻痹。如果有所警觉，橡皮筋综合征的临床诊断相当准确。MRI有助于术前确诊。儿童组织的修复潜力惊人。虽然取出环形束带后病变愈合良好，但临床医生应警惕残留的神经学改变。
