Wang You-Xin, Zhang Ge, Song Bo, Li Ming
Department of Orthopedic Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
Department of Orthopedic Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
Chin J Traumatol. 2019 Dec;22(6):340-344. doi: 10.1016/j.cjtee.2019.08.004. Epub 2019 Oct 31.
To investigate the characteristics of the onset and treatment of radial head subluxation (RHS) in pediatric clinics and emergency departments.
A retrospective study was performed on 11, 404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December 2018. The patients who with history of trauma and fracture of the affected limb were excluded. The following factors were examined: the mechanisms of RHS, the type of manual reduction, the attending physician's clinical background (emergency surgeon, junior pediatric orthopedic surgeon or senior pediatric orthopedic surgeon), and the epidemiological features (gender, age, climate and location) of the injury.
The mean age of the patients was 27.93 ± 17.94 months (range 0.93-214.53 months), with a peak incidence of 10.73-44.53 months. Approximately two-thirds of RHS cases occurred in cold weather from January to March and from September to December. Females accounted for 53.81% (n = 6137) of the cases, and left injuries were predominant (56.87%, n = 6485) in all cases. Mechanisms of injury were classified as "pull" (90.57%, n = 10, 339), "fall" (1.56%, n = 178), "hit" (0.75%, n = 86) and "unknown" (7.02%, n = 801). The overall success rate of manual reduction was 99.47%, and the success rate of reduction was higher for senior pediatric orthopedic surgeons than for emergency surgeons and junior pediatric orthopedic surgeons (p < 0.05). However, there was still a recurrence rate of 12.16% in the 9827 patients.
Younger children are predisposed to RHS, and there is a possibility of recurrence. Trained emergency doctors can handle it well, but it is essential to refer patients to specialists when manual reduction failed.
探讨儿科门诊及急诊科桡骨头半脱位（RHS）的发病及治疗特点。
对2015年1月至2018年12月期间到儿科门诊及急诊科就诊的9827例儿童中的11404例RHS病例进行回顾性研究。排除患肢有创伤和骨折史的患者。检查以下因素：RHS的机制、手法复位类型、主治医生的临床背景（急诊外科医生、小儿骨科初级医生或小儿骨科高级医生）以及损伤的流行病学特征（性别、年龄、气候和地点）。
患者的平均年龄为27.93±17.94个月（范围0.93 - 214.53个月），发病高峰年龄为10.73 - 44.53个月。约三分之二的RHS病例发生在1月至3月以及9月至12月的寒冷天气。女性占病例的53.81%（n = 6137），所有病例中左侧损伤占主导（56.87%，n = 6485）。损伤机制分为“牵拉”（90.57%，n = 10339）、“跌倒”（1.56%，n = 178）、“撞击”（0.75%，n = 86）和“不明”（7.02%，n = 801）。手法复位的总体成功率为99.47%，小儿骨科高级医生的复位成功率高于急诊外科医生和小儿骨科初级医生（p < 0.05）。然而，9827例患者中仍有12.16%的复发率。
年幼儿童易患RHS，且有复发的可能性。训练有素的急诊医生可以很好地处理，但手法复位失败时将患者转诊给专科医生至关重要。
