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BMJ：摔倒后手腕疼痛是咋回事？-案例报道

2017-04-24 xing.T MedSci原创

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手腕环状骨折通常使用石膏、夹板、绷带固定四周。多数情况下手术是没有必要的，一般预后良好。

患者为一名13岁的男孩，因摔倒后手腕疼痛而就诊于骨科。体格检查时，该患者右侧手腕肿胀疼痛，没有发现肢体畸形。拍摄手腕前后位和侧位X片（图1）。诊断是什么？


图1右侧手腕（a）前后位和（b）侧位片

回答
手腕环状骨折。


讨论
X线片示右侧尺骨和桡骨的典型环状骨折改变。在右侧尺骨和桡骨一侧可见骨皮质扣带和成角畸形。皮质的另一面是完整的（图2）。没有看到明显的骨折线。


图2右侧腕部X线片显示右侧尺骨（a）和桡骨（b）局部皮质褶皱，可见右侧桡骨（c）和尺骨（d）可见成角畸形。皮质的另一面是完整的。

环状骨折通常发生在儿童桡骨远端，特别是在摔伤后。需要与青枝骨折进行鉴别诊断。这些骨折通常发生在儿童患者中。环状骨折中没有明显的骨折线。青枝骨折是一种不完全骨折，由于皮质中断只发生在骨的一侧。前后位和侧位X线摄片可以对这一状况进行及时诊断。

手腕环状骨折通常使用石膏、夹板、绷带固定四周。多数情况下手术是没有必要的，一般预后良好。

原始出处：

Yong -Hai Zhou, et al. A painful w rist after a fall.BMJ 2017; http://www.bmj.com/content/357/bmj.j1642

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    2017-09-14 gaoxiaoe

    #BMJ#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1848290, encodeId=41cb1848290cd, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Sep 14 17:46:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1662794, encodeId=44941662e9492, content=<a href='/topic/show?id=af80569586f' target=_blank style='color:#2F92EE;'>#摔倒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56958, encryptionId=af80569586f, topicName=摔倒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eec125505991, createdName=ms9476844295372110, createdTime=Fri Jun 23 01:46:00 CST 2017, time=2017-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195756, encodeId=aebc195e561a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160821/IMG57B96E626B5FA2505.jpg, createdBy=ed841862466, createdName=风起时9736, createdTime=Tue May 09 08:26:22 CST 2017, time=2017-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190722, encodeId=0e7b190e22f7, content=很好的知识点，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAbAss3ANsjUWZKUgN2n3JyJDHOJJAxibetNCiaEh70YckbPPTELyyStMZ8T3Q340icNSXgj72MowgTC/0, createdBy=188f1666747, createdName=1de00086m73(暂无匿称), createdTime=Wed Apr 26 09:29:25 CST 2017, time=2017-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190171, encodeId=b8c11901e10f, content=学习了很多先进水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Mon Apr 24 14:58:09 CST 2017, time=2017-04-24, status=1, ipAttribution=)]
    2017-06-23 ms9476844295372110

    #摔倒#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1848290, encodeId=41cb1848290cd, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Sep 14 17:46:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1662794, encodeId=44941662e9492, content=<a href='/topic/show?id=af80569586f' target=_blank style='color:#2F92EE;'>#摔倒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56958, encryptionId=af80569586f, topicName=摔倒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eec125505991, createdName=ms9476844295372110, createdTime=Fri Jun 23 01:46:00 CST 2017, time=2017-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195756, encodeId=aebc195e561a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160821/IMG57B96E626B5FA2505.jpg, createdBy=ed841862466, createdName=风起时9736, createdTime=Tue May 09 08:26:22 CST 2017, time=2017-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190722, encodeId=0e7b190e22f7, content=很好的知识点，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAbAss3ANsjUWZKUgN2n3JyJDHOJJAxibetNCiaEh70YckbPPTELyyStMZ8T3Q340icNSXgj72MowgTC/0, createdBy=188f1666747, createdName=1de00086m73(暂无匿称), createdTime=Wed Apr 26 09:29:25 CST 2017, time=2017-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190171, encodeId=b8c11901e10f, content=学习了很多先进水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Mon Apr 24 14:58:09 CST 2017, time=2017-04-24, status=1, ipAttribution=)]
    2017-05-09 风起时9736

    学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1848290, encodeId=41cb1848290cd, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Sep 14 17:46:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1662794, encodeId=44941662e9492, content=<a href='/topic/show?id=af80569586f' target=_blank style='color:#2F92EE;'>#摔倒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56958, encryptionId=af80569586f, topicName=摔倒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eec125505991, createdName=ms9476844295372110, createdTime=Fri Jun 23 01:46:00 CST 2017, time=2017-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195756, encodeId=aebc195e561a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160821/IMG57B96E626B5FA2505.jpg, createdBy=ed841862466, createdName=风起时9736, createdTime=Tue May 09 08:26:22 CST 2017, time=2017-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190722, encodeId=0e7b190e22f7, content=很好的知识点，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAbAss3ANsjUWZKUgN2n3JyJDHOJJAxibetNCiaEh70YckbPPTELyyStMZ8T3Q340icNSXgj72MowgTC/0, createdBy=188f1666747, createdName=1de00086m73(暂无匿称), createdTime=Wed Apr 26 09:29:25 CST 2017, time=2017-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190171, encodeId=b8c11901e10f, content=学习了很多先进水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Mon Apr 24 14:58:09 CST 2017, time=2017-04-24, status=1, ipAttribution=)]
    2017-04-26 1de00086m73(暂无匿称)

    很好的知识点，学习了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1848290, encodeId=41cb1848290cd, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Thu Sep 14 17:46:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1662794, encodeId=44941662e9492, content=<a href='/topic/show?id=af80569586f' target=_blank style='color:#2F92EE;'>#摔倒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56958, encryptionId=af80569586f, topicName=摔倒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eec125505991, createdName=ms9476844295372110, createdTime=Fri Jun 23 01:46:00 CST 2017, time=2017-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195756, encodeId=aebc195e561a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160821/IMG57B96E626B5FA2505.jpg, createdBy=ed841862466, createdName=风起时9736, createdTime=Tue May 09 08:26:22 CST 2017, time=2017-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190722, encodeId=0e7b190e22f7, content=很好的知识点，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAbAss3ANsjUWZKUgN2n3JyJDHOJJAxibetNCiaEh70YckbPPTELyyStMZ8T3Q340icNSXgj72MowgTC/0, createdBy=188f1666747, createdName=1de00086m73(暂无匿称), createdTime=Wed Apr 26 09:29:25 CST 2017, time=2017-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190171, encodeId=b8c11901e10f, content=学习了很多先进水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Mon Apr 24 14:58:09 CST 2017, time=2017-04-24, status=1, ipAttribution=)]
    2017-04-24 雅文博武

    学习了很多先进水平

    0

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