Hilgersom Nick F J, Nagel Myrthe, The Bertram, van den Bekerom Michel P J, Eygendaal Denise
Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
Arthrosc Sports Med Rehabil. 2024 May 24;6(4):100952. doi: 10.1016/j.asmr.2024.100952. eCollection 2024 Aug.
To assess the applicability and safety of elbow arthroscopy in the pediatric population at our institution by analyzing the indications and complications in a large pediatric patient series.
We retrospectively identified all patients who underwent elbow arthroscopy at age 18 years or younger from 2006 to 2017 performed by a single fellowship-trained surgeon. The exclusion criteria were follow-up shorter than 8 weeks and open surgical procedures (not fully arthroscopic). Medical records were reviewed for baseline characteristics, indications for elbow arthroscopy, range of motion, complications, and reoperations.
In total, 191 patients (64 boys and 127 girls) were included, with a median age of 15.5 years (interquartile range, 14.0-16.7 years). Indications for arthroscopic surgery were grouped into treatment of osteochondritis dissecans (60%), debridement for bony or soft-tissue pathology (35%), contracture release (3%), and diagnostic arthroscopy (3%). The complication rate was 3.7%, including 4 minor complications (3 superficial wound problems and 1 case of transient ulnar neuropathy) and 3 major complications (1 case of manipulation under anesthesia for stiffness, 1 deep infection, and 1 [unplanned] reoperation for persistent locking within 1 year of the index procedure). Subsequent surgery was required in 23 patients (12%) because of newly developed, persisting or recurring elbow problems. Of the patients, 86% were able to return to sports.
Pediatric elbow arthroscopy performed by an experienced surgeon using a standardized technique for a wide variety of elbow conditions has an acceptable complication rate that is similar to rates in the previously published literature on elbow arthroscopy in the pediatric and adult populations; however, a significant proportion of patients needed subsequent surgery in the following years.
Level IV, therapeutic case series.
通过分析大量儿科患者系列中的适应症和并发症，评估肘关节镜检查在我院儿科人群中的适用性和安全性。
我们回顾性确定了2006年至2017年间由一位接受过 fellowship 培训的外科医生为18岁及以下患者进行肘关节镜检查的所有患者。排除标准为随访时间短于8周和开放性手术（非完全关节镜手术）。查阅病历以了解基线特征、肘关节镜检查的适应症、活动范围、并发症和再次手术情况。
总共纳入了191例患者（64例男孩和127例女孩），中位年龄为15.5岁（四分位间距，14.0 - 16.7岁）。关节镜手术的适应症分为剥脱性骨软骨炎的治疗（60%）、骨或软组织病变的清创（35%）、挛缩松解（3%）和诊断性关节镜检查（3%）。并发症发生率为3.7%，包括4例轻微并发症（3例表浅伤口问题和1例短暂性尺神经病变）和3例严重并发症（1例因僵硬在麻醉下进行手法操作、1例深部感染和1例在初次手术1年内因持续锁定进行[非计划]再次手术）。23例患者（12%）因新出现、持续或复发的肘部问题需要后续手术。其中86%的患者能够恢复运动。
由经验丰富的外科医生采用标准化技术为各种肘部疾病进行的儿科肘关节镜检查，其并发症发生率可接受，与先前发表的关于儿科和成人肘关节镜检查的文献中的发生率相似；然而，相当一部分患者在随后几年需要进行后续手术。
IV级，治疗性病例系列。
