Tuomilehto N, Sommarhem A, Salminen P, Nietosvaara A Y
Helsinki University, Helsinki, Finland.
Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
J Child Orthop. 2018 Jun 1;12(3):288-293. doi: 10.1302/1863-2548.12.170144.
To assess if postponing surgery of paediatric supracondylar humerus fractures (SCHF) without compromised blood circulation to office hours can improve the quality of reduction and pin fixation and decrease complications.
In 2004, night-time (0am to 7am) surgery was allowed only for children with compromised blood circulation. Number of open reductions, surgeons experience, operation time, quality of reduction (Baumann angle, anterior humeral line crossing point with capitellum) and pin fixation as well as the number of complications were compared in 100 children before (A) and 100 after (B) the new protocol. Surgery was commenced during office hours (8am to 3pm) in 27% (A) 55% (B) and delay to surgery from admission exceeded six hours in 25% (A) 52% (B) of the children.
Open reduction was performed in eight (A) 11 (B) children. In group A, 40% were operated on by a registrar alone compared with 14% in group B. Mean operation room time decreased by 11 minutes in group B. Radiographic alignment was satisfactory at fracture union in 68% (A) 68% (B) and radiologically stable pin fixation in 42% (A) 55% (B) of children (p = 0.08). The was no statistical difference in admission time, re-reductions, infections, permanent iatrogenic nerve injuries or corrective osteotomies between the patient groups.
No statistical difference in quality of reduction or pin fixation or in number of complications was observed. Postponing operative treatment of SCHF without vascular compromise increased consultant attendance in operations and decreased operative room time.
III - retrospective comparative study.
评估对于小儿肱骨髁上骨折（SCHF），在不影响血液循环的情况下将手术推迟至办公时间进行，是否能提高复位和钢针固定的质量并减少并发症。
2004年，仅允许对血液循环受影响的儿童进行夜间（凌晨0点至7点）手术。比较了新方案实施前（A组）100名和实施后（B组）100名儿童的切开复位次数、外科医生经验、手术时间、复位质量（鲍曼角、肱骨前线与肱骨小头的交叉点）、钢针固定情况以及并发症数量。A组27%、B组55%的手术在办公时间（上午8点至下午3点）开始，A组25%、B组52%的儿童从入院到手术的延迟时间超过6小时。
A组8名、B组11名儿童进行了切开复位。A组40%的手术仅由住院医生进行，而B组为14%。B组的平均手术室时间减少了11分钟。骨折愈合时，A组68%、B组68%的儿童影像学对线满意，A组42%、B组55%的儿童钢针固定在放射学上稳定（p = 0.08）。两组患者在入院时间、再次复位、感染、永久性医源性神经损伤或截骨矫正方面无统计学差异。
在复位质量、钢针固定或并发症数量方面未观察到统计学差异。推迟对无血管损伤的SCHF进行手术治疗增加了会诊医生参与手术的比例，并减少了手术室时间。
III级——回顾性比较研究。
