儿童移位肱骨髁上骨折手术时间的多中心分析  

A multicenter analysis on operation time for displaced supracondylar humeral fractures in children

作　　者：沈濬 徐大鹏 王晓东[2] 郭志雄[2] 戴进[3] 甄允方[2] 张爱国 孙海涛 SHEN Jun;XU Dapeng;WANG Xiao-dong;GUO Zhi-xiong;DAI-Jin;ZHEN Yun-fang;ZHANG Ai-guo;SUN Hai-tao(Children's Hospital,Jiangnan University,Wuxi 214000,China;Children's Hospital,Suzhou University,Suzhou 215000,China;Wujiang Branch,Children's Hospital,Suzhou University,Suzhou215000,China;Huishan District People's Hospital of Wuxi City,Wuxi214000,China)

机构地区：[1]江南大学附属儿童医院,江苏无锡214000 [2]苏州大学附属儿童医院,江苏苏州215000 [3]苏州大学附属儿童医院吴江分院,江苏苏州215000 [4]无锡市惠山区人民医院,江苏无锡214000

出　　处：《中国矫形外科杂志》2024年第4期308-313,共6页Orthopedic Journal of China

基　　金：江苏省卫健委科研基金项目(编号:Z2022059);无锡市卫健委科研基金项目(编号:202261);无锡市科技局“太湖之光”科技攻关项目支持项目(编号:Y20212043)。

摘　　要：[目的]分析影响儿童严重移位肱骨髁上骨折手术时间的因素。[方法]回顾性分析2018年4月—2023年4月在无锡、苏州地区4家三级医院住院治疗的严重移位的儿童肱骨髁上骨折。手术时间与术前和术后其他计量资料行Pearson相关分析。以手术时间为因变量,分析年龄、体质指数(BMI)、Baumann角、骨折旋转程度、急诊室闭合复位恢复患肢长度、术前等待时间为自变量,行多元逐步回归分析,根据偏回归系数的大小,评价相关因素的作用大小。[结果]所有患儿均顺利手术,无严重术中并发症。随时间推移,患儿VAS评分、最大肘屈曲ROM、最大肘伸直ROM和MEPS均显著改善(P<0.05)。Pearson相关分析显示急诊室复位恢复患肢长度与手术时间呈显著负相关(r=-0.433,P=0.001)。此外,手术时间与术后8周ROM呈显著负相关(r=-0.324,P=0.031),与术后6周(r=-0.356,P=0.020)、8周(r=-0.320,P=0.037)和6个月(r=-0.301,P=0.045)的MEPS均呈显著负相关。多元线性逐步回归分析结果显示手术时间(Y)与急诊室复位恢复患肢长度(X1)和BMI(X2)相关,回归方程为Y=54.6-24.5X1+14.09X2。[结论]急诊闭合复位恢复患肢长度和患者BMI是影响手术时间的因素,急诊室复位恢复患肢长度能减少手术时间,获得良好的预后,而高BMI患儿的手术时间会延长。[Objective]To analyze the factors affecting the operation time of severely displaced humeral supracondylar fractures in children.[Methods]A retrospective analysis was performed on severely displaced supracondylar fractures of humerus in 4 tertiary hospitals in Wuxi and Suzhou from April 2018 to April 2023.Pearson correlation analysis was performed between operation time and other measurement data before and after operation.With operation time as the dependent variable,and other data as independent variables,including age,BMI(body mass index),Baumann angle,degree of fracture rotation,length of the injured limb recovered from closed reduction in the emergency room,and preoperative waiting time,a multiple stepwise regression analysis was performed,and the effects of related factors were evaluated according to the size of the partial regression coefficient.[Results]All the patients were successfully operated without serious intraoperative complications.VAS scores for pain,maximum elbow flexion range of motion(ROM),maximum elbow extension ROM and Mayo elbow performance score(MEPS)were significantly improved over time(P<0.05).In term of Pearson correlation analysis,there was a significant negative correlation between the operation time and the length of the injured limb recovered from emergency room reduction(r=-0.433,P=0.001).In addition,the operation time was significantly negatively correlated with the ROM at 8 weeks after surgery(r=-0.324,P=0.031),and significantly negatively correlated with MEPS at 6 weeks(r=-0.356,P=0.020),8 weeks(r=-0.320,P=0.037)and 6 months(r=-0.301,P=0.045).As results of multiple linear stepwise regression,the operation time(Y)was correlated with the length(X1)of the affected limb recovered from the emergency room reduction,and BMI(X2),with the regression equation of Y=54.6-24.5X1+14.09X2.[Conclusion]The length of the affected limb restored by emergency closed reduction and the patient's BMI are factors that affect the operation time.Emergency reduction to restore the length of the affected l

关 键 词：儿童 严重移位肱骨髁上骨折 急诊闭合复位恢复患肢长度 体质指数 手术时间 

分 类 号：R683.41[医药卫生—骨科学]