Barbier D, N'Dele D, Bennis M, Thevenin-Lemoine C, De Gauzy J Sales, Accadbled F
Paediatric Orthopaedic Department, CHU Toulouse, Toulouse, France.
Anesthesia Department, CHU Toulouse, Toulouse, France.
J Child Orthop. 2019 Feb 1;13(1):100-106. doi: 10.1302/1863-2548.13.180064.
PURPOSE: To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure. METHODS: A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy. The main failure criterion was the inability to return home the day of surgery or the need for rehospitalization during the first week after discharge. Secondary evaluation parameters were the rate of postoperative complications, postoperative pain, quality of life (QOL) and patients' satisfaction outcome questionnaire (PSOQ) at postoperative day 1, 7 and 31. RESULTS: Of the 20 patients included, only one failed the ambulatory mode. The mean PSOQ score was, respectively for children and parents, 91.4% and 90.7% at day 7 and 94.6% and 95.7% at one month. Postoperative QOL at day 7 was very satisfying for all patients. Two minor early complications were reported. Both of the late complications, which included one partial wound dehiscence and one persistent knee swelling, resolved spontaneously. CONCLUSION: This study indicates that, in a targeted and well-informed population, day surgery for children ACLR yields high level of patient and family satisfaction in a safely manner. LEVEL OF EVIDENCE: IV, prospective case series.
目的:评估儿童日间手术前交叉韧带重建术(ACLR)的可行性。我们的假设是,通过适当的患者选择、充分的信息告知和简化的临床路径,可以实现安全且令人满意的手术。 方法:本单机构前瞻性病例系列纳入了20例患者,其中7名女孩和13名男孩,平均年龄为14岁(8至16岁),均接受了门诊ACLR手术。手术在单纯全身麻醉下进行,镇痛方案包括局部麻醉、术后口服镇痛药和加压冷冻疗法。主要失败标准是无法在手术当天回家或出院后第一周内需要再次住院。次要评估参数包括术后并发症发生率、术后疼痛、生活质量(QOL)以及术后第1天、7天和31天的患者满意度结果问卷(PSOQ)。 结果:在纳入的20例患者中,只有1例未成功实现日间手术模式。儿童和家长的PSOQ平均得分在第7天时分别为91.4%和90.7%,在1个月时分别为94.6%和95.7%。所有患者术后第7天的生活质量都非常令人满意。报告了2例轻微的早期并发症。2例晚期并发症,包括1例部分伤口裂开和1例持续性膝关节肿胀,均自行缓解。 结论:本研究表明,对于目标明确且信息充分的人群,儿童ACLR日间手术能够安全地实现患者和家庭的高度满意度。 证据级别:IV,前瞻性病例系列。
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