Department of Trauma Surgery, University Clinic of Orthopaedics and Trauma Surgery, Medical University of Vienna.
Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria.
J Pediatr Orthop. 2022 Feb 1;42(2):e181-e187. doi: 10.1097/BPO.0000000000002013.
The study purpose was to assess: (1) the complication rate of osteodistraction in the pediatric upper extremity, its severity and relation to patient-specific and treatment-specific parameters, and (2) dedicated patient-reported outcome scores after these procedures.
This retrospective study analyzed a chart of patients undergoing osteodistraction of the upper limb between 2003 and 2020. Demographics, distraction-specific parameters, healing index, and any complications graded according to the Sink grading scale (grades 1 to 5) were extracted. An additional phone interview was performed to assess patient satisfaction and functionality of the elongated limb using the Quick-DASH (Disabilities of Arm, Shoulder, and Hand) score.
This study included 61 cases from 48 individual patients. The mean age at the start of distraction was 11.5±3.6 years. The ulna was the most frequently lengthened bone, with 21 (34.4%) cases. Ninety-four complications were observed, with an average complication rate of 77.0%. Based on the Sink grading scale (1 to 5), grade 3 complications were most common (n=29; 47.5%) followed by grade 1 (n=14; 23.0%), 2 (n=14; 23.0%), and 4 (n=4; 6.6%). A significantly lower and thus better bone healing index was observed for the age category less than 10 years compared with the 14 to 18 years group (P=0.006). The average satisfaction was 4.2±1.0 points of 5. The mean Quick-DASH score was 14.1±12.5, indicating very good clinical outcomes.
Despite the occurrence of numerous complications, high patient satisfaction and good daily life functionality of the treated limb was observed. An age of more than 14 years at the beginning of therapy had a negative prognostic effect on bone healing during distraction. Thus, osteodistraction in the upper extremity may preferably be performed less than 10 years of age because of enhanced bone regeneration.
Level IV-retrospective case series.
本研究旨在评估：（1）儿童上肢骨延长术的并发症发生率、严重程度及其与患者特定和治疗特定参数的关系；（2）这些手术后专门的患者报告结果评分。
本回顾性研究分析了 2003 年至 2020 年期间接受上肢骨延长术的患者的图表。提取了人口统计学、延长特定参数、愈合指数以及根据 Sink 分级量表（1 至 5 级）分级的任何并发症。还进行了额外的电话访谈，使用 Quick-DASH（手臂、肩部和手残疾）评分评估延长肢体的患者满意度和功能。
本研究纳入了 48 名患者的 61 例病例。开始延长时的平均年龄为 11.5±3.6 岁。尺骨是最常延长的骨骼，有 21 例（34.4%）。观察到 94 例并发症，平均并发症发生率为 77.0%。根据 Sink 分级量表（1 至 5 级），3 级并发症最常见（n=29；47.5%），其次是 1 级（n=14；23.0%）、2 级（n=14；23.0%）和 4 级（n=4；6.6%）。年龄小于 10 岁组的骨愈合指数明显较低，因此愈合较好，与 14 至 18 岁组相比（P=0.006）。平均满意度为 5 分中的 4.2±1.0 分。平均 Quick-DASH 评分为 14.1±12.5，表明临床结果非常好。
尽管发生了许多并发症，但观察到治疗肢体的患者满意度高，日常生活功能良好。治疗开始时年龄超过 14 岁对延长过程中的骨愈合有负面影响。因此，由于增强了骨再生，上肢骨延长术最好在 10 岁以下进行。
四级——回顾性病例系列。
