Goldman Vladimir, Weiss Patrice L, Weil Yehuda, Eylon Sharon
Department of Orthopaedic Surgery, Hadassah Hebrew University Medical Center.
ALYN H o spital Children's and Adolescent Rehabilitation Center.
J Pediatr Orthop. 2023 Mar 1;43(3):187-191. doi: 10.1097/BPO.0000000000002341. Epub 2023 Jan 10.
Surgery to achieve long bone lengthening and deformity correction in skeletally immature patients is traditionally performed through external fixators. The incidence of infection during treatment is high. Hydrotherapy is highly beneficial during external fixation management, but the infection rates may impact its utilization. The objective of this paper is to document the incidence and duration of infection in patients who participated in a full hydrotherapy program when performed under medical supervision and in accordance with strict follow-up protocols.
In this retrospective study, we documented the key characteristics of patients who participated in hydrotherapy after lower limb external fixation surgery including age, sex, diagnosis and surgery site, the incidence and duration of pin site infections, and the percentage of cases, which were able to comply with a full hydrotherapy protocol.
The hydrotherapy pool met all daily water quality metrics. Thirty-four children (19 males and 15 females) had a mean±SD age of 10.9±4.6 years. Of the cases, 80% were unilateral and 20% were bilateral. Diagnoses included congenital hereditary (eg, achondroplasia), congenital nonhereditary conditions (eg, fibular hemimelia), and acquired conditions (eg, traumatic). The location of osteotomy site was quite evenly spread between the femur and the tibia/fibula. Three out of the 34 patients were unable to receive hydrotherapy due to continuous secretions; 2 patients did not miss any sessions. The mean number of treatments was 3 per week. During the entire period, a total of 1200 treatments were performed for these patients with only 32 cancellations (about 3%) due to secretions or other signs of infection. Spearman correlation coefficients showed significantly high correlations between the duration of external fixation and the duration of hydrotherapy. There are no significant correlations between infections and other factors (sex, age segment, whether the problem is unilateral or /bilateral, diagnosis, and duration of treatment).
This is the first report, to our knowledge, that documents the low prevalence of infectious events during hydrotherapy treatment and demonstrates its feasibility.
Level III; retrospective, comparative study.
在骨骼未成熟患者中，传统上通过外固定器进行长骨延长和畸形矫正手术。治疗期间感染发生率很高。水疗在外固定治疗管理中非常有益，但感染率可能会影响其应用。本文的目的是记录在医疗监督下并按照严格的随访方案进行全面水疗计划的患者的感染发生率和持续时间。
在这项回顾性研究中，我们记录了下肢外固定手术后接受水疗的患者的关键特征，包括年龄、性别、诊断和手术部位、针道感染的发生率和持续时间，以及能够遵守全面水疗方案的病例百分比。
水疗池符合所有每日水质指标。34名儿童（19名男性和15名女性）的平均年龄为10.9±4.6岁。其中，80%为单侧病例，20%为双侧病例。诊断包括先天性遗传性疾病（如软骨发育不全）、先天性非遗传性疾病（如腓骨半肢畸形）和后天性疾病（如创伤）。截骨部位在股骨和胫腓骨之间分布较为均匀。34名患者中有3名因持续分泌物而无法接受水疗；2名患者没有错过任何一次治疗。平均每周治疗次数为3次。在整个期间，为这些患者共进行了1200次治疗，仅有32次（约3%）因分泌物或其他感染迹象而取消。Spearman相关系数显示外固定持续时间与水疗持续时间之间存在显著的高相关性。感染与其他因素（性别、年龄段、问题是单侧还是双侧、诊断和治疗持续时间）之间无显著相关性。
据我们所知，这是第一份记录水疗治疗期间感染事件发生率低并证明其可行性的报告。
III级；回顾性比较研究。
