Liebs Thoralf R, Rompen Ingmar, Berger Steffen M, Ziebarth Kai
Department of Pediatric Orthopaedics and Traumatology, Clinic for Pediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland.
J Child Orthop. 2021 Jun 1;15(3):204-214. doi: 10.1302/1863-2548.15.210054.
The health-related quality of life (HRQoL) after conservatively surgically treated paediatric proximal humeral fractures is poorly understood. We assessed the HRQoL after this injury and asked if HRQoL was associated with age, radiological classification or treatment chosen.
We identified 228 patients who were treated for proximal humeral fractures between 2004 and 2017. These patients completed the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) (primary outcome), the Paediatric Quality of Life Inventory (PedsQL) and questions regarding patient satisfaction. Fractures were classified radiologically following the Paediatric Comprehensive AO Classification.
We were able to follow-up on 190 children; 147 (mean age 8.7 years (0.8 to 15.7)) sustained a metaphyseal and 43 (mean age 11.6 years (3.7 to 15.8)) sustained a Salter Harris type I or II injury. Most fractures (90%) were simple, 10% were multifragmentary. In total, 137 children (72%) were treated nonoperatively, 51 (27%) were treated by elastic stable intramedullary nailing (ESIN). After a median follow-up of 7.6 years (0.8 to 14.3) there was an overall mean Quick-DASH of 4.3 (SD 9.3) for girls and 1.2 (SD 3.1) for boys. The mean function score of the PedsQL was 94.7 (SD 11.1) for girls and 98.0 (SD 6.0) for boys. The mean psychosocial score of the PedsQL was 92.0 (SD 11.1) for girls and 94.1 (SD 11.6) for boys. Most children (79%) were very satisfied with the cosmetic result and 74% were very satisfied with the treatment overall. Surgery and female sex were associated with lower satisfaction.
In this cohort of 190 patients, where immobilization for mildly displaced fractures, and closed reduction and ESIN was used for displaced fractures, there was equally excellent mid- and long-term HRQoL when assessed by the Quick-Dash and the PedsQL.
Therapeutic, Level IV.
对于保守手术治疗的小儿近端肱骨骨折后与健康相关的生活质量（HRQoL），人们了解甚少。我们评估了该损伤后的HRQoL，并询问HRQoL是否与年龄、放射学分类或所选择的治疗方法相关。
我们确定了2004年至2017年间接受近端肱骨骨折治疗的228例患者。这些患者完成了上肢、肩部和手部快速功能障碍量表（Quick-DASH）（主要结局指标）、儿童生活质量量表（PedsQL）以及关于患者满意度的问题。骨折按照小儿综合AO分类进行放射学分类。
我们能够对190名儿童进行随访；147例（平均年龄8.7岁（0.8至15.7岁））为干骺端骨折，43例（平均年龄11.6岁（3.7至15.8岁））为Salter Harris I型或II型损伤。大多数骨折（90%）为简单骨折，10%为多段骨折。总共137名儿童（72%）接受了非手术治疗，51名（27%）接受了弹性稳定髓内钉固定术（ESIN）。中位随访7.6年（0.8至14.3年）后，女孩的总体平均Quick-DASH评分为4.3（标准差9.3），男孩为1.2（标准差3.1）。PedsQL的平均功能评分为女孩94.7（标准差11.1），男孩98.0（标准差6.0）。PedsQL的平均心理社会评分为女孩92.0（标准差11.1），男孩94.1（标准差11.6）。大多数儿童（79%）对美容效果非常满意，74%对总体治疗非常满意。手术和女性性别与较低的满意度相关。
在这190例患者的队列中，对于轻度移位骨折采用固定治疗，对于移位骨折采用闭合复位和ESIN治疗，通过Quick-Dash和PedsQL评估时，中长期HRQoL同样出色。
治疗性，IV级。
