不同类型骨科医生治疗儿童胫骨骨干骨折的疗效比较：一项前瞻性队列研究。

Comparison of the outcomes of pediatric tibial shaft fractures treated by different types of orthopedists: A prospective cohort study.

机构信息

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

出版信息

Int J Surg. 2018 Mar;51:140-144. doi: 10.1016/j.ijsu.2018.01.035. Epub 2018 Jan 31.

DOI:10.1016/j.ijsu.2018.01.035

PMID:29407250

Abstract

BACKGROUND

The objective of this study was to compare the outcomes of pediatric tibial shaft fractures treated with titanium elastic nail (TEN) by pediatric orthopedists and non-pediatric orthopedists.

MATERIALS AND METHODS

We conducted a prospective cohort study of 90 children of tibial shaft fractures, who were randomized to operative stabilization either by pediatric orthopedists (Group A, 45 cases) or by non-pediatric orthopedists (Group B, 45 cases) from April 2010 to May 2015. Demographic data and clinical characteristics (age, sex, weight, fracture side and type, cause of injury, number of fibula fracture and time from injury to operation) were comparable between the two groups before surgery. Clinical data, complications and functional outcomes between the two groups were recorded.

RESULTS

A total of 10 patients were lost to follow-up for various reasons and each group remained 40 cases. The mean follow-up period was 14.9 ± 1.9 months for Group A and 15.3 ± 2.2 months for Group B (P = 0.451). There was no significant difference in length of hospitalization, full weight-bearing time, fracture union time and TEN outcome scores between the two groups (P = 0.917, P = 0.352, P = 0.404, P = 506, respectively). However, Group A exhibited significantly shorter operation duration and less fluoroscopy times than Group B (P < 0.001 and P < 0.001, respectively). Also, there was a trend for patients of Group A to have lower rate of open reduction than Group B (P = 0.019). When comparing the total complications, no significant difference existed between the groups (P = 0.764).

CONCLUSIONS

Our results indicated that pediatric tibial shaft fractures treated surgically by pediatric orthopedists offered potential advantages including a shorter operating time, less times of fluoroscopy and a lower rate of open reduction. However, both pediatric and non-pediatric orthopedists could achieve satisfactory clinical results in treatment of these injuries.

摘要

背景

本研究旨在比较儿童骨科医生和非儿童骨科医生治疗儿童胫骨骨干骨折的治疗效果。

材料与方法

我们进行了一项前瞻性队列研究，纳入了 90 例胫骨骨干骨折的儿童患者，他们于 2010 年 4 月至 2015 年 5 月期间随机接受儿童骨科医生（A 组，45 例）或非儿童骨科医生（B 组，45 例）手术固定治疗。两组患者的一般资料和临床特征（年龄、性别、体重、骨折侧别和类型、受伤原因、腓骨骨折数量及受伤至手术时间）在术前均无显著差异。记录两组患者的临床资料、并发症及功能结局。

结果

由于各种原因，共有 10 例患者失访，每组各剩 40 例。A 组的平均随访时间为 14.9±1.9 个月，B 组为 15.3±2.2 个月（P=0.451）。两组患者的住院时间、完全负重时间、骨折愈合时间及钛镍记忆合金弹性钉治疗结局评分均无显著差异（P=0.917、P=0.352、P=0.404、P=506）。然而，A 组的手术时间和透视次数明显少于 B 组（P＜0.001 和 P＜0.001）。此外，A 组的患者切开复位率也有低于 B 组的趋势（P=0.019）。在比较总并发症发生率时，两组间无显著差异（P=0.764）。