Smith Haley E, Cruz Aristides I, Mistovich R Justin, Leska Tomasina M, Ganley Theodore J, Aoyama Julien T, Ellis Henry B, Kushare Indranil, Lee Rushyuan J, McKay Scott D, Milbrandt Todd A, Rhodes Jason T, Sachleben Brant C, Schmale Gregory A, Patel Neeraj M
All authors are listed in the Authors section at the end of this article.
Investigation performed at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Orthop J Sports Med. 2022 Mar 7;10(3):23259671221078333. doi: 10.1177/23259671221078333. eCollection 2022 Mar.
The uncommon nature of tibial spine fractures (TSFs) may result in delayed diagnosis and treatment. The outcomes of delayed surgery are unknown.
To evaluate risk factors for, and outcomes of, delayed surgical treatment of pediatric TSFs.
Cohort study; Level of evidence, 3.
The authors performed a retrospective cohort study of TSFs treated surgically at 10 institutions between 2000 and 2019. Patient characteristics and preoperative data were collected, as were intraoperative information and postoperative complications. Surgery ≥21 days after injury was considered delayed based on visualized trends in the data. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounders.
A total of 368 patients (mean age, 11.7 ± 2.9 years) were included, 21.2% of whom underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF at ≥1 weeks after injury (95% CI, 1.1-14.3; = .04), 2.1 times higher odds of having seen multiple clinicians before the treating surgeon (95% CI, 1.1-4.1; = .03), 5.8 times higher odds of having magnetic resonance imaging (MRI) ≥1 weeks after injury (95% CI, 1.6-20.8; < .007), and were 2.2 times more likely to have public insurance (95% CI, 1.3-3.9; = .005). Meniscal injuries were encountered intraoperatively in 42.3% of patients with delayed surgery versus 21.0% of patients treated without delay ( < .001), resulting in 2.8 times higher odds in multivariate analysis (95% CI, 1.6-5.0; < .001). Delayed surgery was also a risk factor for procedure duration >2.5 hours (odds ratio, 3.3; 95% CI, 1.4-7.9; = .006). Patients who experienced delayed surgery and also had an operation >2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI, 1.1-12.5; = .03).
Patients who underwent delayed surgery for TSFs were found to have a higher rate of concomitant meniscal injury, longer procedure duration, and more postoperative arthrofibrosis when the surgery length was >2.5 hours. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery.
胫骨棘骨折（TSF）较为少见，可能导致诊断和治疗延迟。延迟手术的疗效尚不清楚。
评估小儿TSF延迟手术治疗的危险因素及疗效。
队列研究；证据等级，3级。
作者对2000年至2019年期间在10家机构接受手术治疗的TSF患者进行了一项回顾性队列研究。收集了患者特征和术前数据，以及术中信息和术后并发症。根据数据的可视化趋势，将伤后≥21天进行的手术视为延迟手术。先进行单因素分析，然后进行有目的纳入的多因素回归分析以调整混杂因素。
共纳入368例患者（平均年龄11.7±2.9岁），其中21.2%的患者在伤后≥21天接受手术。经历延迟手术的患者在伤后≥1周被诊断为TSF的几率高3.8倍（95%可信区间，1.1 - 14.3；P = 0.04），在治疗外科医生之前看过多个临床医生的几率高2.1倍（95%可信区间，1.1 - 4.1；P = 0.03），伤后≥1周进行磁共振成像（MRI）检查的几率高5.8倍（95%可信区间，1.6 - 20.8；P < 0.007），并且拥有公共保险的可能性高2.2倍（95%可信区间，1.3 - 3.9；P = 0.005）。延迟手术的患者术中半月板损伤发生率为42.3%，而未延迟治疗的患者为21.0%（P < 0.001），在多因素分析中几率高2.8倍（95%可信区间，1.6 - 5.0；P < 0.001）。延迟手术也是手术时间>2.5小时的危险因素（比值比，3.3；95%可信区间，1.4 - 7.9；P = 0.006）。经历延迟手术且手术时间>2.5小时的患者发生关节纤维性变的几率高3.7倍（95%可信区间，1.1 - 12.5；P = 0.03）。
发现接受TSF延迟手术的患者半月板损伤合并率更高，手术时间更长，且当手术时长>2.5小时时术后关节纤维性变更多。那些诊断或MRI延迟、看过多个临床医生且拥有公共保险的患者更有可能延迟手术。
