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Letter to Editor regrading "Predictors for operative treatment in pediatric proximal third both-bone diaphyseal forearm fractures in children include age and translation, but not initial angulation". 致编辑的关于“儿童前臂近端第三双骨干骨折手术治疗的预测因素包括年龄和平移,但不包括初始成角”的信。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-11-01 eCollection Date: 2023-12-01 DOI: 10.1177/18632521231205602
Vishal Kumar, Sitanshu Barik, Vikash Raj
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引用次数: 0
Effect of tranexamic acid on intraoperative blood loss in pediatric osteotomies around the hip: Study protocol for a double-blind randomized placebo-controlled trial. 氨甲环酸对小儿髋关节周围截骨术中失血的影响:一项双盲随机安慰剂对照试验的研究方案。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-10-02 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231199518
Hilde W van Kouswijk, Jaap J Tolk, Christian Pe van Bommel, Max Reijman, Dagmar Rj Kempink, Pieter B de Witte

Background: Proximal femoral and/or pelvic osteotomies (PFPOs) can be indicated for a multitude of hip pathologies in (often asymptomatic) children, to prevent future hip problems. These procedures can result in significant blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent routinely administered in adult trauma and joint reconstruction surgery to reduce blood loss. TXA is also registered for use in children and reported safe and beneficial for pediatric trauma, cardiac, and spinal surgery. However, for pediatric orthopedics, particularly for PFPOs, the available evidence is limited. Therefore, the current trial will investigate the potential reducing effect of preoperative TXA on intraoperative blood loss in pediatric PFPOs.

Methods: In this single-center, double-blind, randomized placebo-controlled trial, we aim to include 180 participants aged from 1 to 18 years undergoing PFPOs for any indication at our institution. Participants will be randomized to receive either TXA or placebo (saline) during anesthetic induction. The primary outcome is intraoperative estimated blood loss (mL/kg), which is determined gravimetrically. Secondary outcomes include the percentage of patients with excessive blood loss (>20 mL/kg), procedure time and hospital stay, and postoperative hemoglobin level changes.

Discussion: This will be the first prospective study investigating the effect of preoperative TXA on intraoperative blood loss in pediatric PFPOs. Its results will help to determine whether it would be advisable to adopt preoperative TXA as a standard medication to minimize blood loss and prevent complications in this vulnerable population.

Trial registration: EudraCT: 2022-002384-30. Prospectively registered on September 26, 2022.

背景:股骨近端和/或骨盆截骨术(PFPO)可用于(通常无症状)儿童的多种髋关节病变,以预防未来的髋关节问题。这些程序可能导致大量失血。氨甲环酸(TXA)是一种抗纤溶剂,在成人创伤和关节重建手术中常规使用,以减少失血。TXA也被注册用于儿童,据报道对儿童创伤、心脏和脊柱手术安全有益。然而,对于儿科骨科,特别是PFPO,可用的证据是有限的。因此,目前的试验将研究术前TXA对儿科PFPO术中失血的潜在减少作用。方法:在这项单中心、双盲、随机安慰剂对照试验中,我们的目标是包括180名年龄在1至18岁的参与者 在我们机构接受PFPO的年数。参与者将在麻醉诱导期间随机接受TXA或安慰剂(生理盐水)。主要结果是术中估计的失血量(mL/kg),通过重力测定。次要结果包括失血过多(>20 mL/kg)、手术时间和住院时间以及术后血红蛋白水平变化。讨论:这将是第一项研究术前TXA对儿科PFPO术中失血影响的前瞻性研究。其结果将有助于确定术前采用TXA作为标准药物是否可取,以最大限度地减少失血并预防这一弱势人群的并发症。试验注册:EudraCT:2022-02384-30。预计于2022年9月26日注册。
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引用次数: 0
Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg-Calvé-Perthes. Legg Calvé-Perthes的流行病学、自然进化、发病机制、临床谱和管理。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-09-25 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231203009
Benjamin Joseph, Hitesh Shah, Daniel C Perry

Background: Legg-Calvé-Perthes disease is a self-limiting disorder that develops in children following interruption of the blood supply to the capital femoral epiphysis. This review outlines the current knowledge on the epidemiology, natural evolution, clinical spectrum, and management of the disease.

Methods: The literature pertaining to these aspects of the disease were studied and summarized in this review.

Results: Epidemiological studies suggest that environmental factors contribute to the causation of the disease. Incidence rates monitored over time indicate that the incidence of Legg-Calvé-Perthes disease is declining. The natural evolution followed on sequential plain radiographs enables division of the disease into Stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV. Reversible deformation of the capital occurs in Stages Ia-IIa simply on standing while irreversible deformation may occur in Stages IIb and IIIa. Treatment of Legg-Calvé-Perthes disease in Stages Ia-IIa aims to prevent the femoral head from getting deformed by containment and avoidance of weight-bearing. In Stages IIb and IIIa, treatment aims to remedy the effects of early irreversible deformation of the femoral head. In Stage IIIb and IV, treatment is directed to correcting the altered shape of the femoral head. The impression that these treatment methods are helpful is based on poor quality evidence.

Conclusion: There is an urgent need to undertake Level I studies to establish the efficacy of currently treatment.

Level of evidence: level V.

背景:Legg-Calvé-Perthes病是一种自限性疾病,在儿童股骨干骺供血中断后发生。这篇综述概述了该疾病的流行病学、自然进化、临床谱和管理方面的最新知识。方法:对与该病这些方面有关的文献进行研究和总结。结果:流行病学研究表明,环境因素是导致该疾病的原因之一。随着时间的推移,监测到的发病率表明Legg-Calvé-Perthes病的发病率正在下降。根据连续平片的自然演变,可以将疾病分为Ia、Ib、IIa、IIb、IIIa、IIIb和IV阶段。Ia、IIb阶段仅在站立时发生资本的可逆变形,而IIb和IIIa阶段可能发生不可逆变形。Ia-IIa期Legg-Calvé-Perthes病的治疗旨在通过控制和避免负重来防止股骨头变形。在IIb和IIIa阶段,治疗旨在补救股骨头早期不可逆变形的影响。在第IIIb和IV阶段,治疗旨在矫正股骨头形状的改变。这些治疗方法有帮助的印象是基于低质量的证据。结论:迫切需要进行I级研究,以确定目前治疗的疗效。证据级别:五级。
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引用次数: 0
Elective musculoskeletal surgery is associated with postoperative weight changes in pediatric and adolescent patients. 选择性肌肉骨骼手术与儿童和青少年患者术后体重变化有关。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-09-19 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231198250
Sharon G Huang, Philip L Wilson, Hannah M Worrall, Brandon A Ramo, Ami Kapadia, Henry B Ellis

Purpose: Patients of elective orthopedic surgeries often reduce activity levels during postoperative recovery. It is unclear whether these extended periods of modified activities lead to weight changes. The purpose of this study was to evaluate changes in body mass index percentile in pediatric patients over 2.5 years following primary musculoskeletal surgeries.

Methods: Institutional records for utilized current procedural terminology codes were used to identify patients aged 21 years or younger who underwent elective surgery at a single pediatric orthopedic institution between October 2016 and December 2018. Non-primary surgeries and patients without preoperative body mass index measurements were excluded. Demographic characteristics, height, weight, and body mass index within 30 months of surgery were collected. Body mass index relative to age was calculated. Analysis of body mass index changes at follow-up intervals of 3-7, 9-18, and 24-30 months after surgery was performed for the overall sample, within surgical categories, and within preoperative weight classifications.

Results: A total of 1566 patients (53.1% female, average age 12.4 years) were included. Over one-third of patients were overweight or obese at presentation. The average change in body mass index percentile relative to baseline was increased at all follow-up intervals. Values reached significance at 9-18 months (p = .002) and 24-30 months (p = .001). While underweight and normal-weight patients had increased body mass index at all three timepoints, overweight or obese patients decreased.

Conclusions: Patients undergoing elective orthopedic procedures may experience significant changes in body mass index percentile postoperatively. At extremes of weight, patients experience improvement toward the mean, but most patients may undergo body mass index increases beyond what would be expected during normal growth.

Level of evidence: Retrospective level III.

目的:选择性骨科手术的患者在术后恢复期间通常会降低活动水平。目前尚不清楚这些长时间的改良活动是否会导致体重变化。本研究的目的是评估2.5岁以上儿童患者体重指数百分位数的变化 初级肌肉骨骼手术后数年。方法:使用现行程序术语代码的机构记录来识别21岁的患者 2016年10月至2018年12月期间在一家儿科骨科机构接受选择性手术的年龄在岁或以下的患者。排除非原发性手术和术前未测量身体质量指数的患者。人口统计学特征、身高、体重和体重指数在30以内 收集了数月的手术。计算了与年龄相关的体重指数。3-7、9-18和24-30随访期间的体重指数变化分析 手术后数月,在手术类别内和术前体重分类内对整个样本进行检查。结果:共有1566名患者(53.1%为女性,平均年龄12.4岁) 年)。超过三分之一的患者在就诊时超重或肥胖。在所有随访间隔中,体重指数百分位数相对于基线的平均变化都有所增加。9-18时数值达到显著值 月(p = .002)和24-30 月(p = .001)。体重不足和体重正常的患者在所有三个时间点的体重指数都有所增加,而超重或肥胖的患者则有所下降。结论:接受选择性骨科手术的患者术后体重指数百分位数可能会发生显著变化。在极端体重下,患者的体重会向平均水平改善,但大多数患者的体重指数可能会增加,超过正常生长过程中的预期。证据级别:回顾性三级。
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引用次数: 0
Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires. 可分解镁螺钉固定治疗骨骼发育不全患者上髁内侧撕脱骨折:与克氏针的比较。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-09-13 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231192470
Marco Baldini, Valentino Coppa, Danya Falcioni, Giuseppe Cusano, Daniele Massetti, Mario Marinelli, Antonio Pompilio Gigante
NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). https://doi.org/10.1177/18632521231192470 Journal of Children’s Orthopaedics 2023, Vol. 17(5) 499 –501 © The Author(s) 2023 DOI: 10.1 77/186325 1231 924 journals.sagepub.com/home/cho JOURNAL OF CHILDREN’S ORTHOPAEDICS Response to Letter to the Editor
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引用次数: 0
Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires. 可分解镁螺钉固定治疗骨骼发育不全患者上髁内侧撕脱骨折:与克氏针的比较。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-09-13 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231192466
Andreas Rehm, Rachael Clegg, Pinelopi Linardatou Novak, Elizabeth Ashby
NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). https://doi.org/10.1177/18632521231192466 Journal of Children’s Orthopaedics 2023, Vol. 17(5) 497 –498 © The Author(s) 2023 DOI: 10.1 77/186325 1231 924 journals.sagepub.com/home/cho JOURNAL OF CHILDREN’S ORTHOPAEDICS Letter to the Editor
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引用次数: 0
Hip reconstruction in cerebral palsy: Lessons from a single center and 137 hips. 脑瘫的髋关节重建:来自单一中心和137个髋关节的经验教训。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-09-05 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231196846
Anoushka Ayub, Christy Graff, Lajos Maurovich Horvat, Claudia Maizen

Background: This large, retrospective, single-center study aimed to compare the outcomes of unilateral hip reconstruction and bilateral hip reconstruction in children with non-ambulatory cerebral palsy and ascertain risk factors for recurrent instability and reoperation.

Method: We performed a retrospective review of 137 hip reconstructions performed for patients with cerebral palsy. Preoperative and postoperative clinical and radiological parameters were documented, including hip migration percentage, acetabular index, the Gross Motor Function Classification System, the Melbourne Cerebral Palsy Hip Classification System, hip abduction, and pelvic obliquity.

Results: Overall, 49 patients underwent bilateral hip reconstruction, and 37 patients underwent unilateral hip reconstruction. In the unilateral hip reconstruction group, the reconstructed hip remained stable (with a migration percentage < 33%) in 59% of patients compared to 74.4% of the more affected hips in the bilateral hip reconstruction group (p = 0.02). Of the unreconstructed hip in the unilateral hip reconstruction group, 74.4% remained stable (with a migration percentage < 33%), compared to 78.8% of the less affected hips in the bilateral hip reconstruction group. A level pelvis was maintained at final follow-up in significantly more patients in the bilateral hip reconstruction group than the unilateral hip reconstruction group (p = 0.002). Further surgical intervention was performed in 41% of the unilateral hip reconstruction group, compared with 11.5% in the bilateral hip reconstruction group (p = 0.001). Surgery performed under the age of 8 years and not performing an acetabular osteotomy were found to be risk factors for recurrent instability in all groups.

Conclusion: Our series suggests that in terms of recurrent instability after hip reconstruction in cerebral palsy, protective factors against this complication include bilateral hip reconstruction, hip reconstruction after 8 years of age, and the use of an acetabular osteotomy.

背景:这项大型、回顾性、单中心研究旨在比较非活动性脑瘫儿童单侧髋关节重建和双侧髋关节重建的结果,并确定复发性不稳定和再次手术的风险因素。方法:我们对137例脑瘫患者的髋关节重建进行了回顾性分析。记录了术前和术后的临床和放射学参数,包括髋关节移位率、髋臼指数、总运动功能分类系统、墨尔本脑瘫髋关节分类系统、髋关节外展和骨盆倾斜度。结果:49例患者接受了双侧髋关节重建,37例患者接受单侧髋关节重建。在单侧髋关节重建组中,重建的髋关节保持稳定(具有迁移百分比 结论:我们的系列研究表明,就脑瘫髋关节重建后复发性不稳定而言,预防这种并发症的保护因素包括双侧髋关节重建、8 年龄和髋臼截骨的使用。
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引用次数: 0
Spinal osteoid osteoma in the pediatric population: A management algorithm and systematic review. 儿科人群中的脊柱骨样骨瘤:一种管理算法和系统综述。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-30 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231192477
Alexander R Farid, David S Liu, Mary M Morcos, Grant D Hogue

Purpose: The purpose of this study is to develop an accessible step-wise management algorithm for the management of pediatric spinal osteoid osteomas (OOs) based on a systematic review of the published literature regarding the diagnostic evaluation, treatment, and outcomes following surgical resection.

Methods: A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric spinal OOs. Data extraction of clinical presentation, management strategies and imaging, and treatment outcomes were performed.

Results: Ten studies reporting on 85 patients under the age of 18 years presenting with OOs were identified. Back pain was the most common presenting symptom, and scoliosis was described in 8 out of 10 studies, and radicular pain in 7 out of 10 studies. Diagnostic, intraoperative, and postoperative assessment included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), bone scans, and frozen section. Treatment options varied, including conservative management, open surgical resection with or without intraoperative imaging, and percutaneous image-guided treatment. All included studies described partial or complete resolution of pain in the immediate postoperative period.

Conclusions: The proposed algorithm provides a suggested framework for management of pediatric spinal OOs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a step-wise approach should be utilized in the management of pediatric spinal OOs.

目的:本研究的目的是在系统回顾已发表的关于手术切除后诊断评估、治疗和结果的文献的基础上,开发一种可访问的分级管理算法,用于儿童脊柱骨样骨瘤(OOs)的管理。方法:在PubMed上对文献进行系统回顾,以查找有关儿童脊髓OOs管理的英语研究报告。对临床表现、管理策略、影像学和治疗结果进行数据提取。结果:10项研究报告了85名18岁以下出现OOs的患者。背痛是最常见的表现症状,10项研究中有8项描述了脊柱侧弯,7项研究描述了神经根疼痛。诊断、术中和术后评估包括射线照片、计算机断层扫描(CT)、磁共振成像(MRI)、骨骼扫描和冷冻切片。治疗方案多种多样,包括保守治疗、带或不带术中影像学的开放手术切除和经皮图像引导治疗。所有纳入的研究都描述了术后即刻疼痛的部分或完全缓解。结论:基于现有证据(证据水平:3,4),所提出的算法为儿童脊柱OOs的管理提供了一个建议的框架。这篇文献综述表明,应采用循序渐进的方法来管理儿童脊柱OOs。
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引用次数: 0
Hip Impingement of severe SCFE patients after in situ pinning causes decreased flexion and forced external rotation in flexion on 3D-CT. 严重SCFE患者原位钉扎后的髋关节撞击导致3D-CT上屈曲减少和强迫外旋。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-29 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231192462
Till D Lerch, Young-Jo Kim, Ata Kiapour, Adam Boschung, Simon D Steppacher, Moritz Tannast, Klaus A Siebenrock, Eduardo N Novais

Introduction: In situ pinning is an accepted treatment for stable slipped capital femoral epiphysis. However, residual deformity of severe slipped capital femoral epiphysis can cause femoroacetabular impingement and forced external rotation.

Purpose/questions: The aim of this study was to evaluate the (1) hip external rotation and internal rotation in flexion, (2) hip impingement location, and (3) impingement frequency in early flexion in severe slipped capital femoral epiphysis patients after in situ pinning using three-dimensional computed tomography.

Patients and methods: A retrospective Institutional Review Board-approved study evaluating 22 patients (26 hips) with severe slipped capital femoral epiphysis (slip angle > 60°) using postoperative three-dimensional computed tomography after in situ pinning was performed. Mean age at slipped capital femoral epiphysis diagnosis was 13 ± 2 years (58% male, four patients bilateral, 23% unstable, 85% chronic). Patients were compared to contralateral asymptomatic hips (15 hips) with unilateral slipped capital femoral epiphysis (control group). Pelvic three-dimensional computed tomography after in situ pinning was used to generate three-dimensional models. Specific software was used to determine range of motion and impingement location (equidistant method). And 22 hips (85%) underwent subsequent surgery.

Results: (1) Severe slipped capital femoral epiphysis patients had significantly (p < 0.001) decreased hip flexion (43 ± 40°) and internal rotation in 90° of flexion (-16 ± 21°, IRF-90°) compared to control group (122 ± 9° and 36 ± 11°). (2) Femoral impingement in maximal flexion was located anterior to anterior-superior (27% on 3 o'clock and 27% on 1 o'clock) of severe slipped capital femoral epiphysis patients and located anterior to anterior-inferior (38% on 3 o'clock and 35% on 4 o'clock) in IRF-90°. (3) However, 21 hips (81%) had flexion < 90° and 22 hips (85%) had < 10° of IRF-90° due to hip impingement and 21 hips (81%) had forced external rotation in 90° of flexion (< 0° of IRF-90°).

Conclusion: After in situ pinning, patient-specific three-dimensional models showed restricted flexion and IRF-90° and forced external rotation in 90° of flexion due to early hip impingement and residual deformity in most of the severe slipped capital femoral epiphysis patients. This could help to plan subsequent hip preservation surgery, such as hip arthroscopy or femoral (derotation) osteotomy.

引言:原位钉扎是治疗稳定滑脱的股骨干骺的一种公认的治疗方法。然而,严重滑脱的股骨头骨骺的残余畸形会导致股骨髋臼撞击和强迫外旋。目的/问题:本研究的目的是评估(1)髋关节屈曲时的外旋和内旋,(2)髋关节撞击位置,以及(3)严重滑动的股骨干骺患者原位钉扎后早期屈曲时的撞击频率。患者和方法:一项由机构审查委员会批准的回顾性研究,评估了22例(26髋)严重股骨头骨骺滑脱(滑脱角 > 60°)。诊断为股骨头骨骺滑脱的平均年龄为13岁 ± 2. 年(58%为男性,4例为双侧,23%为不稳定,85%为慢性)。将患者与单侧股骨头骺滑脱的对侧无症状髋关节(15髋)(对照组)进行比较。原位钉扎后的骨盆三维计算机断层扫描用于生成三维模型。使用特定的软件来确定运动范围和撞击位置(等距法)。22个髋关节(85%)接受了后续手术。结果:(1)严重滑脱型股骨头骨骺患者有显著性差异(p 结论:原位钉扎后,患者特异性三维模型显示,大多数严重股骨干骺滑脱患者由于早期髋关节撞击和残余畸形,屈曲受限,IRF-90°,90°屈曲时被迫外旋。这可能有助于计划后续的髋关节保护手术,如髋关节镜检查或股骨(旋转)截骨。
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引用次数: 0
Plate fixation versus flexible intramedullary nails for management of closed femoral shaft fractures in the pediatric population: A systematic review and meta-analysis of the adverse outcomes. 在儿科人群中,钢板内固定与柔性髓内钉治疗闭合性股骨干骨折:不良结果的系统综述和荟萃分析。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-28 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231190713
Abhinav Singh, William Bierrum, Justin Wormald, Manoj Ramachandran, Gregory Firth, Deborah Eastwood

Purpose: Fractures of the femoral diaphysis are associated with a risk of morbidity in children. Various fixation methods have been developed, but with only limited evidence to support their use. This systematic review assesses the evidence regarding clinical outcomes of closed femoral diaphyseal fractures in children treated with plate fixation or flexible intramedullary nails.

Methods: A PROSPERO-registered, PRISMA-compliant systematic review and meta-analysis were conducted. MEDLINE, Embase, and Web of Science (WoS) databases were searched from inception to February 2023. Inclusion criteria included clinical studies reporting adverse outcomes following surgical treatment of pediatric closed femoral diaphyseal fractures using plate fixation and flexible intramedullary nails. The ROBINS-I and RoB 2 tools evaluated the risk of bias.

Results: Thirteen papers (2 prospective randomized controlled trials and 11 retrospective cohorts) reported 805 closed diaphyseal femoral fractures in 801 children (559 males, 242 females). There were 360 plate fixations and 445 flexible intramedullary nails. Two cases of osteomyelitis and one nonunion were reported. Meta-analysis showed that plate fixation had a lower risk of soft tissue infection (relative risk 0.26 (95% confidence interval 0.07-0.92)). There was no difference in the following outcomes: malunion (relative risk 0.68 (95% confidence interval 0.32-1.44)); unplanned reoperation (relative risk 0.59 (95% confidence interval 0.31-1.14)), and leg-length difference (relative risk 1.58 (95% confidence interval 0.66-3.77)). The risk of bias was high in all studies.

Conclusions: An analysis of 805 fractures with minimal differences in meta-analyses is considered high quality even when the quality of the evidence is low. The findings are limited by important flaws in the methodology in the published literature. Well-designed multicentre prospective studies using standardized core outcomes are required to advise treatment recommendations.

Level of evidence: III.

目的:儿童股骨骨干骨折与发病风险相关。已经开发了各种固定方法,但只有有限的证据支持它们的使用。本系统综述评估了使用钢板内固定或柔性髓内钉治疗儿童闭合性股骨干骨折的临床结果。方法:进行PROSPERO注册、符合PRISMA的系统回顾和荟萃分析。MEDLINE、Embase和Web of Science(WoS)数据库从成立到2023年2月进行了搜索。纳入标准包括临床研究报告使用钢板固定和柔性髓内钉手术治疗儿童闭合性股骨干骨折后的不良结果。ROBINS-I和RoB2工具评估了偏倚的风险。结果:13篇论文(2项前瞻性随机对照试验和11个回顾性队列)报道了801名儿童(559名男性,242名女性)的805例闭合性股骨干骨折。共有360个钢板固定器和445个柔性髓内钉。报告两例骨髓炎和一例骨不连。荟萃分析显示,钢板内固定术发生软组织感染的风险较低(相对风险0.26(95%置信区间0.07-0.92))。以下结果无差异:畸形愈合(相对风险0.68(95%可信区间0.32-1.44));非计划性再手术(相对风险0.59(95%置信区间0.31-1.14))和腿长差异(相对风险1.58(95%可信区间0.66-3.77))。所有研究中偏倚的风险都很高。结论:即使证据质量较低,对805例骨折的荟萃分析差异最小的分析也被认为是高质量的。研究结果受到已发表文献中方法论的重要缺陷的限制。需要使用标准化核心结果进行精心设计的多中心前瞻性研究,以提出治疗建议。证据级别:三。
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引用次数: 0
期刊
Journal of Childrens Orthopaedics
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