何时放射,何时停止?小儿锁骨骨骺骨折非手术治疗期间的放射监测时机。

IF 1.4 3区 医学 Q3 ORTHOPEDICS
Robert W Gomez, David Jessen, Morgan Storino, Zachary J Lamb, Nigel K Wang, Neil Jain, Dustin A Greenhill
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引用次数: 0

摘要

介绍:保守治疗是大多数小儿锁骨骨折的标准治疗方法。尽管非手术治疗的疗程是可预测的,但关于愈合的及时性却缺乏证据。本研究的目的是确定在对闭合性小儿锁骨骺骨折进行常规保守治疗时,应在何时出现愈合的影像学征象:方法:对一家大型学术性多专科骨科诊所 5 年来收治的 18 岁或以下急性锁骨骺骨折患者进行回顾性研究。研究对象包括在放射学和临床证据显示骨折愈合前完成非手术治疗的患者,并将其分为三个年龄组:婴幼儿(0 到 2 岁)、学龄儿童(3 到 9 岁)和青少年(10 到 18 岁)。在每2至4周的时间间隔内对放射学愈合情况进行分析:结果:在 390 名患者中,有 303 人符合纳入标准。总体缩短率和移位率分别为(0.3±0.6)厘米和(42.6%±43.0%)。骨科医生平均随访 50±24 天,儿童健康检查平均随访 16.3±14.8 个月。在婴幼儿中,4周后(平均受伤后20.4±4.3天),学龄儿童中,8周后(平均受伤后39.7±7.9天),青少年中,12周后(平均受伤后66.4±8.1天),均未观察到与临床相关或具有统计学意义的皮质桥接数量改善:这项研究提供了一个与年龄相关的时间轴,在这个时间轴上,非手术治疗的小儿锁骨骨骺骨折可望获得充分的放射学愈合。婴幼儿在4周前、学龄儿童在8周前、青少年在12周前均可通过X光片观察到充分愈合:证据等级:三级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
When to Radiate and When to Stop? Timing Radiographic Surveillance During Nonoperative Treatment of Pediatric Diaphyseal Clavicle Fractures.

Introduction: Conservative management of most pediatric clavicle fractures is standard. Despite a predictable nonoperative course, evidence about the timeliness of healing is lacking. The goal of this study was to identify when radiographic signs of healing should be expected during routine conservative management of closed pediatric diaphyseal clavicle fractures.

Methods: Patients 18 years or younger with an acute diaphyseal clavicle fracture treated at a large academic multispecialty orthopaedic practice over 5 years were retrospectively reviewed. Patients who completed nonoperative management until radiographic and clinical evidence of union were included and categorized into 3 age groups: infants and toddlers (0 to 2 y old), school-aged children (3 to 9 y old), and adolescents (10 to 18 y old). Radiographic healing was analyzed within each 2- to 4-week interval.

Results: Among 390 patients, 303 met inclusion criteria. Overall shortening and displacement averaged 0.3±0.6 centimeters and 42.6%±43.0%, respectively. Follow-up averaged 50±24 days with an orthopaedic physician and 16.3±14.8 months for a well-child check. No clinically relevant or statistically significant improvements in the number of cortices bridged were observed in infants/toddlers after 4 weeks (average 20.4±4.3 d from injury), in school-aged children after 8 weeks (average 39.7±7.9 d from injury), or in adolescents after 12 weeks (average 66.4±8.1 d from injury).

Conclusions: This study provides an age-dependent timeline during which adequate radiographic healing should be expected in nonoperatively managed pediatric diaphyseal clavicle fractures. Radiographic protocols can be purposefully timed to visualize sufficient healing in infants and toddlers by 4 weeks, school-aged children by 8 weeks, and adolescents by 12 weeks.

Level of evidence: Level III.

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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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