Zhu Ting, Shi Yu, Yu Qun, Zhao Yan-Jun, Dai Wen, Chen Yan, Zhang Shun-Sheng
Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Zunran Hospital, Shanghai 200366, China.
World J Clin Cases. 2020 Dec 6;8(23):5926-5934. doi: 10.12998/wjcc.v8.i23.5926.
Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome, which is an emergency condition.
To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.
This retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017. The outcome was poor limb perfusion, which is defined as the postoperative use of mannitol. The children were divided into two groups: The normal perfusion group and the poor perfusion group. Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.
A total of 161 patients were included in the study: 85 in the normal perfusion group and 76 in the poor perfusion group. There were no significant differences in age, sex, body mass index, ethnicity, cause of fracture, fixation, or site of fracture between the two groups. After surgery, the skin temperature ( = 0.048) and skin color ( < 0.001) of the affected limb were significantly different between the two groups. The relative risk and 95% confidence interval for skin temperature of the affected limb, skin color, and range of motion of the affected limb are 2.18 (1.84-2.59), 2.89 (2.28-3.66), and 2.16 (1.83-2.56), respectively. The grading scale was established based on those three factors (score range: 0-3 points). Forty-one patients (32.5%) with score 0 had poor limb perfusion; all patients with scores 1 ( = 32) and 2 ( = 3) had poor limb perfusion (both 100%).
In children undergoing surgery for limb fracture, a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion. A prospective study is required for validation.
评估儿童肢体骨折后的血管状况对于评估骨筋膜室综合征的风险很重要，骨筋膜室综合征是一种紧急情况。
建立一种简单有效的儿童肢体骨折手术患者肢体灌注分级量表。
这项回顾性研究纳入了2017年2月至2017年8月在新华医院小儿骨科住院的肢体骨折并术后石膏固定的儿科患者。结局为肢体灌注不良，定义为术后使用甘露醇。将患儿分为两组：正常灌注组和灌注不良组。通过单因素分析选择关键危险因素以建立血管状况分级量表。
本研究共纳入161例患者：正常灌注组85例，灌注不良组76例。两组在年龄、性别、体重指数、种族、骨折原因、固定方式或骨折部位方面无显著差异。术后，两组患侧肢体的皮肤温度（P = 0.048）和皮肤颜色（P < 0.001）有显著差异。患侧肢体皮肤温度、皮肤颜色和患侧肢体活动范围的相对风险及95%置信区间分别为2.18（1.84 - 2.59）、2.89（2.28 - 3.66）和2.16（1.83 - 2.56）。基于这三个因素建立了分级量表（评分范围：0 - 3分）。41例（32.5%）评分为0分的患者肢体灌注不良；所有评分为1分（n = 32）和2分（n = 3）的患者均肢体灌注不良（均为100%）。
在接受肢体骨折手术的儿童中，血管状况分级量表评分越高，肢体灌注不良的发生率越高。需要进行前瞻性研究以验证。
