Yang J, Wang T, Tian N-F, Yu X-Bin, Chen H, Wu Y-S, Sun L-J
Department of Orthopaedic Surgery, Zhuji Central Hospital, Zhuji, Zhejiang, China.
Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, Zhejiang, China.
J Child Orthop. 2019 Aug 1;13(4):404-408. doi: 10.1302/1863-2548.13.190081.
The objective of this study was to explore whether there were any differences between the theoretical recommendations for children's supracondylar humeral fractures (CSHF) according to the American Academy of Orthopaedic Surgeons (AAOS) guidelines and the treatments they actually received in our institution.
We retrospectively reviewed the medical charts and radiographs of all CSHFs at our hospital between January 2015 and December 2018. In all, 301 children meeting our inclusion criteria were identified and evaluated using the AAOS-Appropriate Use Criteria (AUC) application for supracondylar humerus fractures. Actual treatment was then compared with the treatment recommended by the AUC.
Actual operative management was undertaken in 0/58 (0%) Gartland type I fractures, 61/108 (56.5%) type II fractures and 98/135 (72.6%) type III fractures. Actual nonoperative management was undertaken in 58/58 (100%) Gartland type I fractures, 47/108 (43.5%) type II fractures and 37/135 (27.4%) type III fractures. Surgeon decisions for nonoperative treatment were in agreement with the AUC recommendations 100% of the time, whereas surgeon decisions for surgery matched the AUC recommendations 65.4% of the time. Predictors of actual operative management were age (p =0.003), fracture classification (p =0.000), associated orthopaedic injury requiring surgery (p =0.025) and anterior humeral line (AHL) not intersecting the capitellum (p =0.008).
We found low agreement between actual treatments and the AUC-recommended 'appropriate' treatments. The AUC favoured operative intervention more frequently largely on the basis of fracture classification while we emphasized age, fracture classification, associated orthopaedic injury requiring surgery and alignment of the AHL with the capitellum in our operative decision-making process.
Therapeutic Level II.
本研究的目的是探讨根据美国矫形外科医师学会（AAOS）指南对儿童肱骨髁上骨折（CSHF）的理论建议与他们在我们机构实际接受的治疗之间是否存在差异。
我们回顾性分析了2015年1月至2018年12月期间我院所有CSHF的病历和X线片。总共确定了301名符合纳入标准的儿童，并使用AAOS髁上肱骨骨折的适当使用标准（AUC）应用程序进行评估。然后将实际治疗与AUC推荐的治疗进行比较。
在58例（0%）Gartland I型骨折中，实际进行手术治疗的为0例；在108例II型骨折中，有61例（56.5%）；在135例III型骨折中，有98例（72.6%）。在58例（100%）Gartland I型骨折、47例（43.5%）II型骨折和37例（27.4%）III型骨折中进行了实际非手术治疗。外科医生非手术治疗的决策与AUC建议的符合率为100%，而外科医生手术决策与AUC建议的符合率为65.4%。实际手术治疗的预测因素包括年龄（p =0.003）、骨折分类（p =0.000）、需要手术的相关骨科损伤（p =0.025）以及肱骨前线（AHL）未与肱骨小头相交（p =0.008）。
我们发现实际治疗与AUC推荐的“适当”治疗之间的一致性较低。AUC更倾向于手术干预，主要基于骨折分类，而我们在手术决策过程中强调年龄、骨折分类、需要手术的相关骨科损伤以及AHL与肱骨小头的对线情况。
治疗性II级。
