Rider Carson M, Hong Victor Y, Westbrooks Timothy J, Wang Jiajing, Sheffer Benjamin W, Kelly Derek M, Spence David D, Flynn John M, Sawyer Jeffrey R
Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's Hospital.
University of Tennessee Health Sciences Center College of Medicine.
J Pediatr Orthop. 2018 Jul;38(6):e343-e348. doi: 10.1097/BPO.0000000000001171.
Despite an 88% increase in the number of pediatric fractures treated in ambulatory surgery centers (ASCs) over a 10-year period, few studies have compared outcomes of fracture treatment performed in a freestanding ASC compared with those performed in the hospital (HOSP) or hospital outpatient department (HOPD). The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of Gartland type II supracondylar humeral (SCH) fracture in the ASC, HOSP, and HOPD.
Retrospective review identified pediatric patients with isolated Gartland type II SCH fractures who had closed reduction and percutaneous pinning (CRPP) by board-certified orthopaedic surgeons from January 2012 to September 2016. On the basis of the location of their treatment, patients were divided into 3 groups: HOSP, HOPD, and ASC. All fractures were treated with CRPP under fluoroscopic guidance using 2 parallel or divergent smooth Kirschner wires. Radiographs obtained before and after CRPP and at final follow-up noted the anterior humeral line index (HLI) and Baumann angle. Statistical analysis compared all 3 groups for outcomes, complications, treatment time/efficiency, and charges.
Record review identified 231 treated in HOSP, 35 in HOPD, and 50 in ASC. Radiographic outcomes in terms of Baumann angle and HLI did not differ significantly between the groups at any time point except preoperatively when the HLI for the HOSP patients was lower (P=0.02), indicating slightly greater displacement than the other groups. Overall complication rates were not significantly different among the groups, nor were occurrences of individual complications. The mean surgical time was significantly shorter (P<0.0001) in ASC patients than in HOPD and HOSP patients, and total charges were significantly lower (P<0.001).
Gartland type II SCH fractures can be safely treated in a freestanding ASC with excellent clinical and radiographic outcomes equal to those obtained in the HOSP and HOPD; treatment in the ASC also is more efficient and cost-effective.
Level III-retrospective comparative study.
尽管在10年期间，门诊手术中心（ASC）治疗的小儿骨折数量增加了88%，但很少有研究比较独立ASC与医院（HOSP）或医院门诊部（HOPD）进行骨折治疗的结果。本研究的目的是比较ASC、HOSP和HOPD治疗Gartland II型肱骨髁上（SCH）骨折的临床和影像学结果、治疗时间及费用。
回顾性分析2012年1月至2016年9月期间由获得委员会认证的骨科医生进行闭合复位和经皮穿针固定（CRPP）的孤立性Gartland II型SCH骨折小儿患者。根据治疗地点，患者分为3组：HOSP、HOPD和ASC。所有骨折均在透视引导下使用2根平行或发散的光滑克氏针进行CRPP治疗。CRPP前后及最终随访时获得的X线片记录了肱骨前线指数（HLI）和鲍曼角。统计分析比较了3组的结果、并发症、治疗时间/效率及费用。
记录回顾发现，HOSP治疗231例，HOPD治疗35例，ASC治疗50例。除术前HOSP患者的HLI较低（P=0.02），表明其移位略大于其他组外，在任何时间点，各组间鲍曼角和HLI的影像学结果均无显著差异。各组总体并发症发生率无显著差异，各单项并发症的发生率也无显著差异。ASC患者的平均手术时间显著短于HOPD和HOSP患者（P<0.0001），总费用显著低于HOPD和HOSP患者（P<0.001）。
Gartland II型SCH骨折可在独立的ASC中安全治疗，其临床和影像学结果与HOSP和HOPD相当；在ASC治疗也更高效且具成本效益。
III级——回顾性比较研究。
