摇晃牵抖手法治疗肱骨外髁翻转骨折机制的探讨

From June 1978 to December 1982,the authors used pulling and shaking manipulation for the first time to treat 34 children with lateral condyle humerus fracture.All but two of these patients got satisfactory reduction.One of the two unsatisfactory cases sought treatment 13 days after the fracture and the other with marked swelling.The mechanism of reduction was studied through clinical observation,fluorescopic video tape analysis and direct observation in surgical operation.The result is as follows:(1)Manipulation analysis: prone and supine pulling and shaking manipulation was employed to pull the bony fragment toward lateral elbow side.It turned the bony fragment medially and enlarged the angle to the maximum and then reduced the bony fragment to the original position by pressing it with the thumb.(2)The manipulation corrected the bony fragment position by pulling the common tendon of extensor muscles,and pulling and shaking through pronation and supination drew the bony fragment to a straight line.Pronation or supination had to be decided according to the position of bony fragment.If the pony fragment was located at elbow anterior, supination was used.If it was located at elbow posterior,pronation was used.The purpose of pulling or shaking was to widen the joint space and make the extensor muscle group have pulling action.(3)The authors proved that although the strong muscular contraction might make the bony fragment turn over,it could stimulate the contraction force to turn the bony fragment over again if the latter was wrongly placed for proper reduction.(4)Accurate and adequate thumb press was the key to success.At first,the bony fragment was fixed and drawn in a straight line,and then after pulling and shaking so as to increase the medial turn to maximum,it was pressed with the thumb to the right place for reduction.

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