简化小儿肱骨髁上骨折术后护理：取出克氏针后是否需要常规随访？
Streamlining Postoperative Care After Pediatric Supracondylar Humerus Fractures: Is Follow-up After Pin Removal Routinely Needed?
机构信息
Department of Orthopedic Surgery, University of Connecticut, Connecticut Children's Medical Center, Hartford, CT.
出版信息
J Pediatr Orthop. 2021 Jul 1;41(6):e464-e469. doi: 10.1097/BPO.0000000000001815.
BACKGROUND
Closed reduction and percutaneous pinning is the standard of care for displaced supracondylar humerus fractures (SCHFs). Although the operative management of SCHFs has achieved good consensus with low complication rates, there remains a paucity of literature on postoperative management. We hypothesized that routine office visits after pin removal can safely be avoided in uncomplicated SCHFs without compromising patient care.
METHOD
A retrospective review was conducted to query the electronic medical record for SCHFs, treated with closed reduction and percutaneous pinning. Patients with complicated SCHFs were excluded. Patients were divided into 2 cohorts: follow-up (FU) and nonfollow-up (NFU), depending on the presence or absence of after-pin removal (APR) FU visits. Demographics, surgical variables, number of x-rays, referrals for physical therapy, total FU visits, complications, and clinical events after pin removal up to 3 months were compared. Subgroup analysis was performed according to Gartland fracture types.
RESULTS
A total of 179 patients were included in the study, 111 in the FU group and 68 in the NFU group. There were no significant differences found in demographics between the 2 groups. There were no significant differences in complications and APR clinical events between 2 groups (P>0.05). An average of 1.98 additional x-rays were taken APR in FU group. None of the NFU group patients required physical therapy. Excluding patients with pin site infections, 15/108 (13.9%) of FU group patients had >1 APR visits.
SUMMARY
For operatively managed uncomplicated SCHFs, patients who do not have routinely scheduled FU APR have no greater incidence of clinical events APR than patients with a scheduled FU. With a detailed discussion including expectations, timeframe for resuming activities, home exercises, and reassurance of the ease of FU if desired, routine FU APR can be safely eliminated after uncomplicated SCHFs in order to streamline postoperative care.
LEVEL OF EVIDENCE
Level III.
背景
闭合复位和经皮钢针固定是治疗移位性肱骨髁上骨折（SCHF）的标准方法。尽管 SCHF 的手术治疗已经达成了共识，且并发症发生率较低，但术后管理的文献仍然很少。我们假设，在没有并发症的情况下，安全地避免 SCHF 患者在拔除钢针后的常规门诊随访并不会影响患者的治疗效果。
方法
对接受闭合复位和经皮钢针固定治疗的 SCHF 患者的电子病历进行回顾性查询。排除复杂 SCHF 患者。根据是否存在拔除钢针后的随访（FU）就诊，将患者分为随访（FU）和非随访（NFU）两组。比较两组患者的人口统计学、手术变量、X 线片数量、物理治疗转诊、总 FU 就诊次数、并发症以及拔除钢针后 3 个月内的临床事件。根据 Gartland 骨折类型进行亚组分析。
结果
本研究共纳入 179 例患者，其中 111 例在 FU 组，68 例在 NFU 组。两组患者的人口统计学特征无显著差异。两组患者的并发症和拔除钢针后的 APR 临床事件无显著差异（P＞0.05）。FU 组在 APR 时平均多拍摄 1.98 张 X 线片。NFU 组无患者需要物理治疗。排除有针道感染的患者后，FU 组 15/108（13.9%）例患者需要超过 1 次 APR 就诊。
结论
对于接受手术治疗的无并发症 SCHF 患者，与有定期 FU APR 计划的患者相比，不进行常规 APR FU 就诊的患者 APR 时发生临床事件的发生率并没有更高。通过详细讨论，包括预期、恢复活动的时间框架、家庭锻炼以及如果需要 FU 的便利性的保证，可以在 SCHF 术后安全地消除无并发症 SCHF 患者的常规 FU APR，以简化术后护理。
证据等级
III 级。
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