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

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。

Abstract:

[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 limb can reduce the operation time and obtain a good prognosis, while the operation time of high BMI children can be extended.