Bretland P M
Watford General Hospital, Herts, UK.
Br J Radiol. 1994 Dec;67(804):1176-85. doi: 10.1259/0007-1285-67-804-1176.
In this injury, a sudden pull on the pronated, extended arm of a child up to 5 years of age is followed by refusal to use the arm. After a simple flexion, supination and extension manoeuvre the child starts using the arm in minutes. Radiographs are said to be normal. At least 13 theories of the mechanism have been advanced. Anterior subluxation of the radial head has never been proved radiographically or experimentally. Available evidence favours momentary distraction of the radiocapitellar joint in pronation which allows upward slip of the annular ligament upon the radial head at its shortest diameter and interposition of part of the anterior capsule between the two bones. Radiography is difficult, usually producing oblique views in pronation which are not easy to interpret. The main differential diagnosis is from epiphyseal rotation. In any doubtful case early repeat radiography is essential taking matched views of both elbows, even if non-standard. A collection of 28 radiographs has been analysed, two recent typical contrasting cases are presented, two signs to identify an oblique view of a normal elbow are described and the literature is reviewed. If the best radiograph available in an injured elbow in a child is a normal oblique view in pronation, pulled elbow is a likely diagnosis.
在这种损伤中，突然牵拉5岁以下儿童处于旋前、伸展位的手臂后，孩子会拒绝使用该手臂。经过简单的屈曲、旋后和伸展动作后，孩子几分钟内就会开始使用该手臂。X线片据说正常。关于其机制至少提出了13种理论。桡骨头前半脱位从未在X线片或实验中得到证实。现有证据支持在旋前时桡尺关节瞬间牵张，这使得环状韧带在桡骨头最短直径处向上滑过桡骨头，并使部分前关节囊夹在两骨之间。X线摄影很难，通常会产生旋前位的斜位片，不易解读。主要鉴别诊断是与骨骺旋转相鉴别。在任何可疑病例中，早期重复X线摄影至关重要，即使是非标准的，也要对双肘进行匹配的投照。分析了一组28张X线片，展示了两个近期典型的对比病例，描述了识别正常肘部斜位片的两个征象，并对文献进行了综述。如果儿童受伤肘部所能获得的最佳X线片是旋前位的正常斜位片，那么牵拉肘很可能是诊断结果。
