儿童肱骨髁上骨折（年龄小于 2 岁）：女性发病率为男性的两倍，且仅采用外侧柱固定时，发生愈合畸形的比例较高。

Infantile Supracondylar Humeral Fractures (Patients Less Than Two Years of Age): Twice as Common in Females and a High Rate of Malunion with Lateral Column-Only Fixation.

机构信息

Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Summa Health System/Western Reserve Hospital, Ohio University Heritage College of Osteopathic Medicine, Cuyahoga Falls, Ohio.

出版信息

J Bone Joint Surg Am. 2019 Jan 2;101(1):25-34. doi: 10.2106/JBJS.18.00391.

DOI:10.2106/JBJS.18.00391

PMID:30601413

Abstract

BACKGROUND

The age range for supracondylar humeral fractures spans from 1 to 14 years of age; most published studies have analyzed patients as non-age-segregated cohorts. Some isolated studies focused on the upper age range, demonstrating a male predominance and more severe fractures. The purpose of the current study was to analyze a large cohort of patients with surgically treated supracondylar humeral fractures at the low end of the age range (<2 years of age).

METHODS

Patients <2 years of age were identified from surgical billing records. Pin constructs were categorized as lateral column-only fixation or medial and lateral column fixation. All patients were followed through fracture-healing. Substantial loss of reduction was defined as a Baumann angle that changed ≥10° between surgery and healing or as a lateral rotation percentage (i.e., Gordon index) of ≥50% at the time of healing. The Fisher exact test was used for statistical analysis.

RESULTS

One hundred and three patients met our inclusion criteria. There were 69 female and 34 male patients (a 2:1 female-to-male ratio). Two patients did not have adequate follow-up radiographs. Of the 46 patients with bicolumnar fixation, 5 (11%) demonstrated loss of reduction compared with 20 (36%) of 55 patients with lateral column-only fixation. This difference between the groups was significant (p = 0.005). The group with lateral column-only fixation had 4.7-times-higher odds of loss of reduction (95% confidence interval, 1.6 to 13.8). A subset of patients had in-cast imaging that allowed calculation of the posterior sagittal cast index (a measure of cast fit). Eight of 15 patients who had a posterior sagittal cast index of ≥0.20 experienced loss of reduction, while only 1 of 19 patients with a cast index value of <0.20 had loss of reduction (p = 0.004).

CONCLUSIONS

Supracondylar humeral fractures were twice as common in females in this very young cohort. We also found a nearly 5-times-higher odds of loss of reduction when fracture fixation was of the lateral column only.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

肱骨髁上骨折的年龄范围为 1 至 14 岁；大多数已发表的研究都对非年龄分组的患者进行了分析。一些孤立的研究集中在上限年龄，表现出男性优势和更严重的骨折。本研究的目的是分析在年龄范围较低端（<2 岁）接受手术治疗的肱骨髁上骨折的大样本患者。

方法

从手术计费记录中确定年龄<2 岁的患者。针固定器分为外侧柱固定或内外侧柱固定。所有患者均通过骨折愈合进行随访。明显的复位丢失定义为手术和愈合之间 Baumann 角变化≥10°，或愈合时外侧旋转百分比（即 Gordon 指数）≥50%。Fisher 精确检验用于统计分析。

结果

103 名患者符合我们的纳入标准。其中 69 名女性和 34 名男性（女性与男性比例为 2:1）。两名患者没有足够的随访 X 线片。在 46 名接受双柱固定的患者中，有 5 名（11%）发生复位丢失，而在 55 名仅接受外侧柱固定的患者中，有 20 名（36%）发生复位丢失。两组之间的差异具有统计学意义（p = 0.005）。仅接受外侧柱固定的组发生复位丢失的几率高 4.7 倍（95%置信区间，1.6 至 13.8）。一组患者有内部铸型成像，允许计算后矢状位铸型指数（衡量铸型贴合度的指标）。15 名后矢状位铸型指数≥0.20 的患者中有 8 名发生复位丢失，而 19 名后矢状位铸型指数值<0.20 的患者中只有 1 名发生复位丢失（p = 0.004）。