小兒牽拉肘病例報告

Pulled Elbow : A Case Report

這是一位1 歲的小兒牽拉肘病例，1 天前男童過馬路時被母親突然拉一把後，右手就變得疼痛無力，手臂下垂，拒絕別人碰觸，一直不肯用右手使力或拿東西。經我們詢問男童母親得知男童最近並無碰撞跌倒外傷史，手臂外觀亦無腫脹、瘀血。藉由理學檢查發現男童右手橈骨頭部有明顯壓痛。我們初步診斷為右側橈骨頭半脫位，因此向男童母親解釋病情及手法復位過程後，採用旋後復位法治療。術後，男童的右手疼痛消失，立即可以伸手取物。我們予以男童右肘局部外敷如意金黃散，囑咐不可再過度牽拉患側手臂。3 個月後隨訪，右手疼痛未再復發。本案例的治療結果，令人滿意。雖然許多文獻提到用旋後加屈伸手法復位牽拉肘，亦有越來越多的回顧性文獻支持過度旋前手法應為治療小兒橈骨小頭半脫位的基本首選手法，但詳細的復位機制仍需更多的研究加以證實。

This is a case of one-year-old boy who had suffered elbow pain for one day. He was pulled up by his mother when walking, and then he felt pain and weakness over his right arm. He stopped using his right arm afterward. We knew that he had no other history of trauma or injury. There was neither bruising nor swelling over the affected arm. The tentative diagnosis of radial head subluxation was suspected. Meanwhile, we performed the supination- flexion maneuver. After the reduction, the symptoms relieved and the boy could hold things by his arm. We also applied the topical patch ( 如意金黃散) and educated the patient do not overuse the arm. There was no recurrence after three months. Although majority of text books recommend supination-flexion reduction, more and more review articles take the hyperpronation method as priority. The clear mechanism need to be studied more.