儿童胫骨干骨折手术治疗率的上升：一项2000年至2012年的全国数据库研究。
Increasing rates of surgical treatment for paediatric tibial shaft fractures: a national database study from between 2000 and 2012.
作者信息
Kleiner J E, Raducha J E, Cruz A I
机构信息
Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Orthopaedics Division of Pediatric Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
出版信息
J Child Orthop. 2019 Apr 1;13(2):213-219. doi: 10.1302/1863-2548.13.180163.
PURPOSE
Tibia fractures are the third most common long bone fracture in children. Because of the remodelling potential of the tibial diaphysis, nonoperative treatment has historically been advocated for most tibial shaft fractures in children. The purpose of this study was to estimate the rate of surgical treatment of tibial shaft fractures over time and identify demographic factors associated with surgical treatment, utilizing a large, publicly available, national database.
METHODS
The Healthcare Cost and Utilization Project Kids' Inpatient Database was evaluated for the years between 2000 and 2012. Tibial shaft fractures and surgically treated patients were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes. Univariable and multivariable logistic regression were used to determine variables associated with a greater proportion of surgical treatment. Statistical analyses were performed utilizing SAS statistical software v.9.4. Statistical significance was set at p < 0.05.
RESULTS
In all, 24 166 tibial shaft fracture admissions were identified, with 15 621 (64.7%) treated surgically. The percentage of patients receiving surgery to treat tibial shaft fractures increased from 57.3% in 2000 to 74.3% in 2012 (p < 0.001). Multivariable regression showed that increasing age was associated with increased rate of surgical treatment (p < 0.001). The greatest increase in surgical treatment was seen in children aged five to nine years, increasing from 23.0% in 2000 to 46.2% in 2012.
CONCLUSION
The rate of operative treatment of paediatric tibial shaft fractures increased over time. The largest increase was seen in children aged five to nine years. Increased proportion of surgical treatment was associated with older age, concurrent femur fracture and non-Medicaid insurance status.
LEVEL OF EVIDENCE
Level III - Retrospective comparative study.
目的
胫骨骨折是儿童中第三常见的长骨骨折。由于胫骨干具有重塑潜力，过去一直主张对大多数儿童胫骨干骨折进行非手术治疗。本研究的目的是利用一个大型的、公开可用的全国性数据库，评估随时间推移胫骨干骨折的手术治疗率，并确定与手术治疗相关的人口统计学因素。
方法
对2000年至2012年期间的医疗保健成本和利用项目儿童住院数据库进行评估。使用国际疾病分类第九版临床修订版编码确定胫骨干骨折和接受手术治疗的患者。单变量和多变量逻辑回归用于确定与更高比例手术治疗相关的变量。使用SAS统计软件v.9.4进行统计分析。统计学显著性设定为p<0.05。
结果
总共确定了24166例胫骨干骨折入院病例，其中15621例（64.7%）接受了手术治疗。接受手术治疗胫骨干骨折的患者百分比从2000年的57.3%增加到2012年的74.3%（p<0.001）。多变量回归显示，年龄增加与手术治疗率增加相关（p<0.001）。手术治疗增加最多的是5至9岁的儿童，从2000年的23.0%增加到2012年的46.2%。
结论
儿童胫骨干骨折的手术治疗率随时间增加。增加最多的是5至9岁的儿童。手术治疗比例增加与年龄较大、并发股骨骨折和非医疗补助保险状态相关。
证据水平
III级——回顾性比较研究。
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