肘关节脱位
肘关节脱位患者指南
介绍
When the joint surfaces of an elbow are forced apart, the elbow is dislocated. The elbow is the second most commonly dislocated joint in adults (after shoulder dislocation). Elbow dislocation can be complete or partial. A partial dislocation is referred to as a subluxation. The amount of force needed to cause an elbow dislocation is enough to cause a bone fracture at the same time. These two injuries (dislocation-fracture) often occur together.
当一个肘关节的关节面因为受到外力而相互分离，那么这个肘关节就脱位了。成年人的肘关节是仅次于肩关节的最容易脱位的关节。肘关节脱位可以是完全性的或者部分性的。部分性的脱位也叫做半脱位。可以引起肘关节脱位的外力也足以同时导致骨折。这两种损伤（脱位-骨折）常常同时发生。
This guide will help you understand
这个指南将帮助你理解
· how the condition develops
· how doctors diagnose the condition
· what treatment options are available
· 这种病症是如何发生的
· 医生如何诊断这种病症
· 治疗上有什么样的选择
解剖
The bones of the elbow are the humerus (the upper arm bone), the ulna (the larger bone of the forearm, on the opposite side of the thumb), and the radius(the smaller bone of the forearm on the same side as the thumb).
组成肘关节的骨骼包括肱骨（上臂的骨），尺骨（前臂较大的骨，位于大拇指的对侧），和桡骨（前臂较小的骨，位于大拇指的同侧）。
The elbow itself is essentially a hinge joint, meaning it bends and straightens like a hinge. But there is a second joint where the end of the radius (the radial head) meets the humerus. This joint is complicated because the radius has to rotate so that you can turn your hand palm up and palm down. At the same time, it has to slide against the end of the humerus as the elbow bends and straightens. The joint is even more complex because the radius has to slide against the ulna as it rotates the wrist as well. As a result, the end of the radius at the elbow is shaped like a smooth knob with a cup at the end to fit on the end of the humerus. The edges are also smooth where it glides against the ulna.
肘关节本身本质上属于一种铰链关节，就是说它像铰链一样做屈伸动作。但是，还有桡骨顶端（桡骨头）与肱骨接触的第二个关节。这个关节比较复杂。当上下转动手掌时，桡骨需要旋转。同时，在肘关节屈伸时，桡骨还需要相对于肱骨末端滑动。另外，转动手腕时，桡骨还要相当于尺骨滑动。因此，位于肘关节内的桡骨末端外形就像一个光滑的旋钮，其盘状的顶端适应了肱骨末端的形状，与尺骨接触的边缘同样也是光滑的。
Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage can be up to one-quarter of an inch thick in the large, weight-bearing joints. It is a bit thinner in joints such as the elbow, which don’t support weight. Articular cartilage is white, shiny, and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. In the elbow, articular cartilage covers the end of the humerus, the end of the radius, and the end of the ulna.
关节软骨是某些关节里覆盖着骨骼的末端材料。在大的负重的关节里，关节软骨可以厚达1/4英寸，而在肘关节这样不负重的小关节里则相对较薄。关节软骨洁白，有光泽，整体如橡胶般坚韧。它是如此光滑，以至于关节面相对滑动时可以不留下任何损伤。在肘关节里，关节软骨覆盖了肱骨、桡骨和尺骨的末端。
There are several important ligaments in the elbow. Ligaments are soft tissue structures that connect bones to bones. The ligaments around a joint usually combine together to form a joint capsule. A joint capsule is a watertight sac that surrounds a joint and contains lubricating fluid called synovial fluid.
肘关节里有一些重要的韧带。韧带是连接骨与骨之间的软组织结构。关节周围的韧带常常组合构成关节囊。关节囊是一个水密的囊，包裹着关节，内含有润滑作用的液体，也叫滑膜液。
In the elbow, two of the most important ligaments are the medial collateral ligament and the lateral collateral ligament. The medial collateral is on the inside edge of the elbow, and the lateral collateral is on the outside edge. Together these two ligaments connect the humerus to the ulna and keep it tightly in place as it slides through the groove at the end of the humerus. These ligaments are the main source of stability for the elbow. They can be torn when there is an injury to or dislocation of the elbow. If they do not heal correctly the elbow can be too loose, or unstable.
肘关节里有两条重要的韧带，分别是内侧副韧带和外侧副韧带。内侧副韧带位于肘关节的内侧，而外侧副韧带位于外侧。这两条韧带一起将肱骨与尺骨连接，并在尺骨沿着肱骨远端的沟滑动时，紧紧地维持着结构的稳定。这些韧带是肘关节稳定性的主要来源。当肘关节发生损伤或脱位时，这些韧带可能发生撕裂。如果没有良好地愈合，肘关节可能会过于松弛，或者不稳定。
There is also an important ligament called the annular ligament that wraps around the radial head and holds it tight against the ulna. The word annular means ring-shaped. The annular ligament forms a ring around the radial head as it holds it in place. This ligament can be torn when the entire elbow or just the radial head is dislocated.
另一条重要的韧带叫做环状韧带，包裹着桡骨头，将其紧紧地靠在尺骨上。环状这个词意味着像指环的形状。环状韧带像一个戒指一样包围了桡骨头并将其控制在位。在肘关节发生完全性脱位或者单纯桡骨头脱位时，这条韧带可能被撕裂。
病因
What causes this condition?
哪此原因可以导致这种病症？
Elbow dislocation is often the result of trauma. The most common trauma resulting in an elbow dislocation is a fall onto an outstretched hand and arm. When the hand hits the ground, the force is transmitted through the forearm to the elbow. This force pushes the elbow out of its socket.
肘关节脱位通常是创伤的结果。可以导致肘关节脱位的创伤最常见的是在手臂外伸时跌倒。当手接触到地面，力量经前臂传到肘部，这个力将肘推出了它的窠臼。
This can also result in a fracture/dislocation. About half of all elbow dislocations in teens and young adults occur as a result of a sports activity. The most common elbow dislocations are associated with sports such as gymnastics, cycling, roller-blading, or skateboarding.
这也可以导致骨折/脱位。有大约一半的青少年和年轻成年人的肘关节脱位是在体育运动时发生的。最常见的相关运动有体操、自行车、轮滑、或滑板运动。
Dislocation can also occur from a sideswipe injury. This type of injury occurs when the driver of an automobile has the elbow out the open window during a car accident. The force of the impact causes a severe fracture-dislocation of the elbow.
脱位也可以发生在侧击损伤。当汽车驾驶员把肘部伸出打开的车窗外时如果发生事故，就会造成这种损伤。撞击的外力可以造成肘关节严重的骨折-脱位。
症状
What are the symptoms?
肘关节脱位有什么样的症状？
If the elbow is fully dislocated, it will look out of joint. There may be dimples or indentations of the skin over the dislocation where the bones have shifted position. Pain can be intense until the arm is relocated. The pain is often relieved immediately after the joint is put back in place. There may be some residual tenderness around the joint.
如果肘关节发生完全性脱位，它会变得不像一个关节。因为骨骼错位了，表面的皮肤会出现或大或小的凹陷。直到被复位之前，疼痛都会很剧烈。而当关节被复回原位，疼痛往往立即就缓解了。但关节周围可能还有些疼痛。
If ligaments or other soft tissues are torn, there can be swelling and bruising around the elbow. Bruising is not immediately obvious but appears several days after the injury. Injury to any of the three nerves that cross the elbow (median, ulnar, radial nerves) can cause neurologic symptoms such as numbness, tingling, and/or weakness of the forearm, wrist, and hand. If a bone fracture is also involved the fracture can cut or damage a nerve causing temporary or permanent paralysis.
如果韧带或者其他软组织被撕裂了，肘关节周围可能会出现肿胀和淤青。淤青要在受伤几天后出现，而不会马上就很明显。有3条神经跨越了肘关节，即正中神经、尺神经和桡神经。伤到其中任何一条神经，都可能导致神经症状，比如前臂、腕部和手的麻木、刺痛和/或无力。如果还发生了骨折，那么骨折端可以切割或损伤神经，导致暂时的或永久的瘫痪。
Pain and an inability to straighten the elbow or pain when turning the hand the palm up (supination) is typical. There is often tenderness along the lateral aspect of the elbow (side of the elbow away from the body).
典型的症状是肘关节疼痛和不能伸直，或者转动手掌向上（旋后）时疼痛。在肘关节的外侧（肘部远离身体的那一侧）往往会有疼痛。
How do doctors diagnose this condition?
医生如何诊断这种病症？
The history and physical examination are probably the most important tools the physician uses to guide his or her diagnosis. Moving the elbow passively is painful, especially extension and supination. The doctor will check for any signs of injury to the nerves or blood vessels.
病史和查体可能是医生做出诊断最重要的工具。肘关节做被动活动会非常疼痛，尤其是做伸肘和旋后动作时。医生会检查任何神经或血管受损的征象。
X-ray is the best way to look for dislocation or fracture-dislocation.
X光片是检查脱位或是骨折-脱位最好的方法。
After the joint is relocated, other imaging studies may be ordered to look for damage to the joint cartilage, bone, ligaments, and other soft tissues. If bone detail is difficult to identify on an X-ray, a computed tomography (CT) scan may be done. If it is important to evaluate the ligaments, a magnetic resonance image (MRI) can be helpful.
在关节复位后，可以用其他影像学检查来检查是否存在关节软骨、骨骼、韧带和其他软组织的损伤。如果在X光片上难以辨认骨骼的细节，那么可以做CT扫描。如果评估韧带很重要，那么磁共振（MRI）检查会有所帮助。
What treatment options are available?
治疗上有哪些选择？
It is possible for the elbow to relocate by itself. This is more likely when there is a subluxation, rather than a complete dislocation. Sometimes the elbow can be reduced or put back in place by a trained medical person applying a quick motion to the forearm. There are several different methods used for manual (closed) reduction. Closed reduction refers to the fact that the elbow can be put back in joint without surgery. An open incision is not needed.
肘关节可能自动复位。相对于完全性脱位，自动复位更容易发生在半脱位的情况下。有时候一个经过训练的医务人员对前臂施以一个快速的动作，即可将肘关节复位。手法（闭合）复位有多种不同的方法。闭合复位指的是不需要通过开放手术的切口来复位肘关节。
Manual reduction can be done in an emergency on site (e.g., at an athletic event or car accident) by a trained medical person but usually the procedure is done in a clinic or hospital setting. You would be given medications first to help with the pain.
手法复位可以在现场（比如，在运动场或车祸现场）由经过训练的医务人员紧急施行，但是这个过程往往在诊所或者医院的环境里进行。先给你用一些药物来镇痛。
If there is too much swelling, it may be necessary to delay surgery for a few days up to a week. The elbow will be reduced right away and the arm immobilized while waiting for the swelling to subside.
如果肿胀过于剧烈，那么有必要延迟手术数天到一星期。肘关节会被立即复位，然后手臂被固定起来，等待肿胀消退。
If there has been damage to the bones and/or ligaments, surgery may be needed to restore alignment and function. The type of surgery depends on the extent of the damage. Wires, pins, or even an external fixation device may be needed to hold everything together until healing occurs.
如果合并有骨骼和/或韧带的损伤，那么需要进行手术来恢复对位和功能。手术的类型因损伤的内容而不同。钢丝、钢针、甚至外固定架可能被用于维持复位直到愈合。
What should I expect after treatment?
治疗之后应该有什么样的期待？
Simple elbow dislocations heal well with few (if any) problems. You may notice a slight loss of elbow motion, especially when trying to straighten the arm. This should not affect your overall motion and function. X-rays may be taken while the elbow heals. This will show if the bones of the elbow joint are healing in a reduced position with good alignment.
单纯肘关节脱位愈合良好，很少会有问题。肘关节活动度可能有轻度的丧失，尤其是在伸肘动作时。但这不会影响你的整体动作和功能。在愈合过程中，可能需要拍摄X光片，用来观察肘关节的骨骼是否在复位良好的情况下愈合。
The arm may be immobilized for 10 to 14 days to allow the ligament to heal. Gentle range of motion may be allowed during that time but you should rely on your physician to advise you. Type of activities and movements allowed are determined according to the type of injury that’s present.
肘关节可能需要固定10到14天来允许韧带愈合。在此期间允许有轻柔的活动度，但是必须在你的医生的指导下进行。活动的类型和允许的动作要根据存在的损伤类型来决定。
After immobilization, physical therapy may begin. The goal is to restore normal motion, joint proprioception (sense of position), and motor control. The program will progress to include strengthening.
在解除固定后，可以开始物理治疗。其目标是恢复正常活动、关节本体觉（对位置的感知）和运动控制力。随着计划的进展，将加入力量训练。
Rehabilitation for the athlete includes sport-specific training is part of the rehab program. Your physical therapist will guide you through this process. Most athletes can resume sports participation three to six weeks after an elbow dislocation. The timing of return to sports depends on the type of sport (e.g., throwing sports may require a longer rehab). Dislocation of the dominant hand may require longer rehab before full motion and strength are restored.
包含了运动专项训练的运动员康复是康复计划的一部分。你的物理治疗师会在此过程中给你指导。大多数运动员可以在发生肘关节脱位的3到6周后重返运动场。这个时间与运动的类型有关（比如，投掷类运动可能需要更长的康复期）。优势手一侧的脱位可能需要更长的康复期来恢复完全活动度和力量。
Some athletes continue to wear a protective splint and/or use taping to stabilize the joint during the transition back into action. This can help protect the joint during motion and activity during the final phase of healing.
一些运动员需要在恢复运动的过渡期继续佩戴保护性支具和/或使用扎带来稳定关节。在愈合的终末期，这可以在运动时帮助保护关节。
It’s best to avoid any further traction on the elbow until healing has occurred. Pulling a heavy door open, carrying a heavy purse, or lifting a heavy backpack are a few examples of activities and movements that put a traction force through the elbow. These kinds of movements should be avoided until healing occurs
在愈合之前，最好不要施加任何牵拉。例如拉开沉重的门、拿沉重的提包、或者举起沉重的背包，这些活动里都有对肘关节施加的牵引力。这些类型的动作在愈合之前都要避免。
Post-operative immobilization is often required, especially for complex injuries. This could be a cast, dynamic splint, or postoperative range-of-motion (ROM) brace. The adjustable ROM brace is used to improve elbow motion gradually while allowing soft tissue healing. It helps minimize scar tissue formation and may contribute to fewer complications (such as arthritis) later on.
手术后常常需要固定，尤其是对于复杂性损伤。可以是石膏、动力夹板、或者术后的关节活动度（ROM）功能支具。可调节的ROM支具用来在允许软组织愈合的同时改善肘关节的活动度。这可以有利于产生最少的瘢痕和减少远期并发症（例如关节炎）。
After immobilization, physical therapy may begin. The goal is to restore normal motion, joint proprioception (sense of position), and motor control. The program will progress to include strengthening. Rely on your doctor and therapist to guide you through the healing process.
在解除固定后，可以开始物理治疗。其目标是恢复正常活动、关节本体觉（对位置的感知）和运动控制力。随着计划的进展，将加入力量训练。在康复的过程中，你需要依靠你的医生或治疗师的指导。
As in conservative care, some athletes continue to wear a protective splint and/or use taping to stabilize the joint during the transition back into action. This can help protect the joint during motion and activity during the final phase of healing.
与保守治疗类似，一些运动员需要在恢复运动的过渡期继续佩戴保护性支具和/或使用扎带来稳定关节。在愈合的终末期，这可以在运动时帮助保护关节。
It’s best to avoid any further traction on the elbow until healing has occurred. Pulling a heavy door open, carrying a heavy purse, or lifting a heavy backpack are a few examples of activities and movements that put a traction force through the elbow. These kinds of movements should be avoided until healing occurs. Your doctor and/or therapist will advise you as you progress through the healing process.
在愈合之前，最好不要施加任何牵拉。例如拉开沉重的门、拿沉重的提包、或者举起沉重的背包，这些活动里都有对肘关节施加的牵引力。这些类型的动作在愈合之前都要避免。你的医生和/或治疗师会在你的康复过程中对你作出建议。
Scar tissue can cause a stiff elbow. Recurrent dislocation is also possible. If either of these problems develops, additional reconstructive surgery may be needed. For some patients, arthritis is a long-term result of elbow injury. This is more likely if there is a history of recurrent elbow dislocations.
瘢痕组织可以导致肘关节僵硬。复发性脱位也有可能发生。如果产生这两种问题，可能需要进一步的重建手术。对于一些患者，关节炎是肘关节脱位的一个远期结果，如果有反复肘关节脱位者则更容易发生。
（张弛 译）
张弛，主治医师，本科毕业于温州医科大学。曾在上海长征医院和德国哈雷大学医院进修学习。
技术专长：四肢与脊柱骨折创伤的微创治疗，关节病变与运动损伤的诊治。
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