对于手术治疗的小儿肱骨髁上骨折,无需进行术后照相。

IF 2.2 4区 医学 Q2 SURGERY
Canadian Journal of Surgery Pub Date : 2024-06-06 Print Date: 2024-05-01 DOI:10.1503/cjs.009323
George Zhao, Eliane Rioux Trottier, Kelvin Ng, Anne Murphy, Stanley Moll, Steven A Morrison, Daniel Pincus, Unni Narayanan, Mark Camp
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引用次数: 0

摘要

背景:对肱骨髁上骨折(SCH)进行手术治疗后,术后X光片的使用往往基于生搬硬套的做法,而非证据。本研究的目的是确定对闭合复位和经皮置入钢钉(CRPP)后术中稳定的小儿肱骨髁上骨折患者,在拔除钢钉时进行术后3周X线摄片以改变治疗方案的频率:我们前瞻性地招募了2020年6月至2022年6月在我院接受CRPP治疗的小儿SCH骨折患者,并回顾了2008年4月至2015年3月在我院接受手术治疗的小儿SCH骨折患者的回顾性数据。我们对患者进行了 CRPP 术后骨折对位和稳定性评估。对于前瞻性患者,我们要求临床医生在评估术后X光片之前,在3周随访时记录他们的处理决定。我们的主要结果是因影像学检查结果而改变治疗方案:共有 1066 名回顾性数据患者和 446 名前瞻性数据患者符合纳入标准。在前瞻性研究组中,2 名患者(0.4%)的放射学检查结果改变了治疗方案。一名患者胼胝形成缓慢,一名患者被确定为肘关节屈曲。改变的处理方法包括延长固定时间或进行额外的放射学随访。175例II型骨折中有0例(0%)、221例III型骨折中有2例(0.9%)、44例IV型骨折中有0例(0%)因放射学检查结果而改变了治疗方案。我们从回顾性数据中获得了类似的结果:结论:对术中稳定的SCH骨折进行手术治疗后,术后3周照相的作用微乎其微。在不影响患者预后的情况下,取消对 SCH 骨折进行术后常规拍片检查可减少家庭和医疗系统的时间和经济负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Eliminating rote postoperative radiographs for surgically managed pediatric supracondylar humerus fractures.

Background: Use of postoperative radiographs after surgical management of supracondylar humerus (SCH) fractures is often based on rote practice rather than evidence. The purpose of this study was to determine the frequency with which 3-week postoperative radiographs at the time of pin removal altered management plans in pediatric SCH fractures that were intraoperatively stable after closed reduction and percutaneous pinning (CRPP).

Methods: We prospectively recruited pediatric patients with SCH fractures managed by CRPP at our institution from June 2020 until June 2022, and reviewed retrospective data on pediatric SCH fractures managed surgically at our institution between April 2008 and March 2015. Patients were assessed for post-CRPP fracture alignment and stability. For prospective patients, we asked clinicians to document their management decision at the 3-week follow-up visit before evaluating the postoperative radiographs. Our primary outcome was change in management because of radiographic findings.

Results: Overall, 1066 patients in the retrospective data and 446 prospectively recruited patients met the inclusion criteria. In the prospective group, radiographic findings altered management for 2 patients (0.4%). One patient had slow callus formation and 1 patient was identified as having cubitus varus. Altered management included prolonged immobilization or additional radiographic follow-up. Radiographic findings altered management in 0 (0%) of 175 type II fractures, in 2 (0.9%) of 221 type III fractures, and in 0 (0%) of 44 type IV fractures. We obtained similar findings from retrospective data.

Conclusion: Rote use of 3-week postoperative radiographs after surgical management of SCH fractures that are intraoperatively stable has minimal utility. Eliminating rote postoperative radiographs for SCH fractures can decrease the time and financial burdens on families and health care systems without affecting patient outcomes.

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来源期刊
CiteScore
3.00
自引率
8.00%
发文量
120
审稿时长
6-12 weeks
期刊介绍: The mission of CJS is to contribute to the meaningful continuing medical education of Canadian surgical specialists, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.
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