小儿前臂中段骨折的治疗：骨科医生类型之间存在差异吗？

Treatment of pediatric forearm midshaft fractures: Is there a difference between types of orthopedic surgeon?

作者信息

Lu D, Lin Z, Zhang J-D, Chen H, Sun L-J

机构信息

Department of Orthopaedic Surgery, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 325000 Wenzhou, Zhejiang, China.

Department of Orthopaedic Surgery, Wenzhou Central Hospital, 325000 Wenzhou, Zhejiang, China.

出版信息

Orthop Traumatol Surg Res. 2017 Feb;103(1):119-122. doi: 10.1016/j.otsr.2016.11.008. Epub 2016 Nov 19.

DOI:10.1016/j.otsr.2016.11.008

PMID:27876583

Abstract

PURPOSE OF THE STUDY

The objective of this study was to compare the clinical and radiological outcomes of pediatric forearm midshaft fractures treated operatively with titanium elastic nails (TENs) by pediatric orthopedists and non-pediatric orthopedists.

MATERIAL AND METHODS

We conducted a prospective cohort study of 88 children of forearm midshaft fractures, who were randomized to operative stabilization either by pediatric orthopedists (Group A, 44 cases) or by non-pediatric orthopedists (Group B, 44 cases) from April 2013 to February 2014. At baseline, the groups were comparable with respect to age, sex, AO classification, injured side and interval from injury to surgery. We collected data on operative and radiation time, open reduction rate, length of hospitalization, bone union time, return to full physical activity time, complications, and measured clinical results using the Children's Hospital of Philadelphia (CHOP) Forearm Fracture Fixation Outcome Classification.

RESULTS

The mean follow-up period was 15.8±3.3 months for Group A and 15.2±4.2 months for Group B (P=0.491). No significant difference existed in time to union (P=0.282), the overall complication rate (P=0.750), return to activity time (P=0.408), and clinical outcomes according to CHOP classification (P=0.908) between the two groups. However, the mean operating time and radiation time was significantly longer in Group B than in Group A (P=0.001 and P=0.001, respectively). In addition, there was a trend for patients of Group B to have a higher rate of open reduction (P=0.035).

DISCUSSIONS

Our results indicated that children forearm midshaft fractures treated surgically by pediatric orthopedists offered potential advantages including a shorter operating time and radiation time, a lower rate of open reduction. However, both pediatric and non-pediatric orthopedists had achieved satisfactory clinical results in treatment of these injuries.

LEVEL OF EVIDENCE

Level II prospective randomized study.

摘要

研究目的

本研究的目的是比较小儿骨科医生和非小儿骨科医生使用钛弹性髓内钉（TENs）手术治疗小儿前臂中段骨折的临床和放射学结果。

材料与方法

我们对88例前臂中段骨折儿童进行了一项前瞻性队列研究，这些儿童在2013年4月至2014年2月期间被随机分为由小儿骨科医生手术固定组（A组，44例）和由非小儿骨科医生手术固定组（B组，44例）。在基线时，两组在年龄、性别、AO分类、受伤侧以及受伤至手术的间隔时间方面具有可比性。我们收集了手术时间、透视时间、切开复位率、住院时间、骨愈合时间、恢复完全体力活动时间、并发症的数据，并使用费城儿童医院（CHOP）前臂骨折固定结果分类法测量临床结果。

结果

A组平均随访时间为15.8±3.3个月，B组为15.2±4.2个月（P = 0.491）。两组在骨愈合时间（P = 0.282）、总体并发症发生率（P = 0.750）、恢复活动时间（P = 0.408）以及根据CHOP分类的临床结果（P = 0.908）方面均无显著差异。然而，B组的平均手术时间和透视时间显著长于A组（分别为P = 0.001和P = 0.001）。此外，B组患者有较高切开复位率的趋势（P = 0.035）。