肥胖儿童经闭合复位和经皮克氏针固定治疗肱骨髁上骨折后的患者报告结局是否较差？

Do Obese Children Have Poor Patient-reported Outcomes After Closed Reduction and Percutaneous Pin Fixation of Supracondylar Humerus Fractures?

机构信息

Department of Orthopaedics, The Ohio State University Wexner Medical Center.

Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.

出版信息

J Pediatr Orthop. 2021 Apr 1;41(4):e337-e341. doi: 10.1097/BPO.0000000000001761.

DOI:10.1097/BPO.0000000000001761

PMID:33481479

Abstract

BACKGROUND

Nearly 1 in 5 American children are obese. The primary purpose of this study is to evaluate the relationship between childhood obesity and perioperative complications, patient-reported outcomes (PRO), and functional recovery after closed reduction and percutaneous pinning (CRPP) of type II and III supracondylar humerus fractures.

METHODS

Retrospective review of patients treated operatively with CRPP of Wilkins modification of the Gartland classification type II and III supracondylar humerus fractures was performed over a 1-year timeframe (July 1, 2016 to July 1, 2017). One hundred forty-four patients under the age of 16 treated were identified. Obesity was defined as body mass index (BMI) at or above the 95th percentile for age. Obesity as a risk factor for poor outcomes was assessed. The primary outcome measure was postoperative PRO [quick-DASH, Patient Reported Outcomes Measurement Information System (PROMIS)-UE, PROMIS Global Health, and PROMIS Pain scores].

RESULTS

Mean age at surgery was 5.9 years (SD=2.1, 1.07 to 12.2) and mean age at final follow-up (3.3 y) was 8.8 (SD=2.14, 4 to 16). Mean patient BMI was 17.2 (SD=4.48, 12.4 to 56.2). Sixty-six patients were female (45.8%) and 78 patients were male (54.2%). In all, 31 of 144 patients (21.5%) met criteria for obesity. Obesity (95th percentile for BMI or above) was not associated with a higher rate of complications overall (χ2=1.29, P=0.256), range of motion loss (χ2=0.2, P=0.655) or requirement of postoperative physical therapy (χ2=0.17, P=0.678). Seventy-five patients were available and willing to participate in the outcomes score assessments. Mean follow-up for this cohort of 75 patients was 3.3 years (SD=0.31, 2.85 to 3.88). There were no differences in PROMIS pain, PROMIS upper extremity function, PROMIS general health, or quick-DASH scores when comparing obese with nonobese patients.

CONCLUSIONS

Obesity is a growing concern in the United States and its effect on long-term outcomes after CRPP of supracondylar humerus fractures is unknown. The present study demonstrates no difference in complications or PRO among obese patients compared with nonobese patients.

LEVEL OF EVIDENCE

Level IV-retrospective cohort study.

摘要

背景

近五分之一的美国儿童肥胖。本研究的主要目的是评估儿童肥胖与围手术期并发症、患者报告的结果（PRO）以及经闭合复位和经皮克氏针固定（CRPP）治疗的 II 型和 III 型肱骨髁上骨折的功能恢复之间的关系。

方法

对 1 年内（2016 年 7 月 1 日至 2017 年 7 月 1 日）接受 Wilkins 改良 Gartland 分类 II 型和 III 型肱骨髁上骨折 CRPP 治疗的患者进行回顾性研究。共确定了 144 名 16 岁以下的患者。肥胖定义为体重指数（BMI）等于或高于年龄的第 95 百分位。评估肥胖作为不良预后的危险因素。主要观察指标为术后 PRO[快速-DASH、患者报告的结果测量信息系统（PROMIS）-UE、PROMIS 总体健康和 PROMIS 疼痛评分]。

结果

手术时的平均年龄为 5.9 岁（SD=2.1，1.07 至 12.2），最终随访（3.3 岁）的平均年龄为 8.8（SD=2.14，4 至 16）。平均患者 BMI 为 17.2（SD=4.48，12.4 至 56.2）。66 名患者为女性（45.8%），78 名患者为男性（54.2%）。共有 31 名患者（21.5%）符合肥胖标准。肥胖（BMI 第 95 百分位或以上）与总体并发症发生率无相关性（χ2=1.29，P=0.256）、运动范围丧失（χ2=0.2，P=0.655）或术后物理治疗的需求（χ2=0.17，P=0.678）。75 名患者可获得并愿意参与结果评分评估。75 名患者的平均随访时间为 3.3 年（SD=0.31，2.85 至 3.88）。肥胖患者与非肥胖患者比较，在 PROMIS 疼痛、PROMIS 上肢功能、PROMIS 总体健康或快速-DASH 评分方面无差异。