坦桑尼亚北部治疗的小儿股骨干骨折的模式、治疗方式和放射学结果

Shindo I Kilawa, Anthony J Pallangyo, Elifuraha G Maya, Rogers J Temu, Faiton N Mandari, Frank I Olotu, Estomick K Ofunguo, Adnan M Sadiq, Honest H Massawe, Octavian Shirima, Reginald Shoo
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The approval to conduct the research was obtained from Kilimanjaro College Research Ethics and Review Committee(CRERC) with ethical clearance Reg NO PG 88/2022. In our study we used secondary data and the permission to conduct the research was obtained from KCMC, hence no formal consent was required from patients/parents. The patient’s information was traced through patient files and the hospital's electronic system. The radiological outcome; shortening, angulations in six weeks and fracture union, 12 weeks post-management were reviewed with the involvement of a consultant radiologist and the orthopaedic surgeon to obtain the precise information and were recorded on the extraction sheet. Results: This study included 230 study participants who met the inclusion criteria. The mean age of participants was 9.1 (5.1) years, 41.3%, was aged 6 – 12 years, 82.2% were males, 45.7% were involved in a MTC, and 83.5% had no health insurance. 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引用次数: 0

摘要

背景:股骨干骨折是全世界儿科住院、死亡和发病的最常见原因之一。在撒哈拉以南非洲地区,没有明确的治疗方案优于其他治疗方式,尤其是5至16岁的儿童,而且有关放射学结果的公开研究很少。研究方法:对2018年1月1日至2022年12月31日期间在乞力马扎罗基督教医疗中心接受治疗的所有股骨干骨折患儿进行横断面研究。研究获得了乞力马扎罗学院研究伦理与审查委员会(CRERC)的批准,伦理许可号为Reg NO PG 88/2022。在研究中,我们使用了二手数据,并获得了乞力马扎罗学院研究伦理审查委员会(CRERC)的研究许可,因此无需征得患者/家长的正式同意。患者信息通过患者档案和医院电子系统进行追踪。在放射科顾问和矫形外科医生的参与下,对患者的放射学结果、六周后的缩短、成角情况以及治疗后 12 周的骨折愈合情况进行了复查,以获得准确信息,并记录在提取单上。结果这项研究包括 230 名符合纳入标准的参与者。参与者的平均年龄为9.1(5.1)岁,41.3%的参与者年龄在6-12岁之间,82.2%为男性,45.7%的参与者参与了MTC,83.5%的参与者没有医疗保险。最常见的骨折类型为闭合性骨折占 92.6%,横断骨折占 48.7%,右侧骨折占 65.0%。50.9%采用非手术治疗,其中76.8%采用晚期髋关节Spica治疗。大多数患者的放射学结果良好,骨结合、成角和缩短均可接受。与接受手术治疗的患者相比,未接受手术治疗的患者获得满意放射学结果的几率要低 94%(AOR=0.06,95% CI:0.01 - 0.27,p<0.001),而其他因素则无统计学意义。结论大多数研究参与者为男性,最常见的受伤机制为 MTC。大多数人的闭合性骨折主要发生在右侧,横向骨折是最常见的类型。髋关节斯派卡是常见的非手术治疗方案,但钢板固定是最常见的手术方案。治疗方式对放射学结果有很大影响,且具有统计学意义。
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Pattern, treatment modalities and radiological outcome of pediatric femoral shaft fractures; fractures treated in Northern, Tanzania
Background: Femoral shaft fracture is among the most common causes of paediatric hospitalisation, mortality and morbidity worldwide. There is no clear option that is preferable to other treatment modalities, especially between 5 to 16 years and published studies are scarce on radiological outcomes in Sub-Saharan Africa.This study aimed to determine the pattern, treatment modalities and radiological outcome of the paediatric femoral fractures treated at KCMC. Methodology: A cross-sectional study was conducted for all children with femoral shaft fractures treated at Kilimanjaro Christian Medical Centre from 1st January 2018 to 31st December 2022. The approval to conduct the research was obtained from Kilimanjaro College Research Ethics and Review Committee(CRERC) with ethical clearance Reg NO PG 88/2022. In our study we used secondary data and the permission to conduct the research was obtained from KCMC, hence no formal consent was required from patients/parents. The patient’s information was traced through patient files and the hospital's electronic system. The radiological outcome; shortening, angulations in six weeks and fracture union, 12 weeks post-management were reviewed with the involvement of a consultant radiologist and the orthopaedic surgeon to obtain the precise information and were recorded on the extraction sheet. Results: This study included 230 study participants who met the inclusion criteria. The mean age of participants was 9.1 (5.1) years, 41.3%, was aged 6 – 12 years, 82.2% were males, 45.7% were involved in a MTC, and 83.5% had no health insurance. The commonest fracture type was 92.6% closed, 48.7% transverse, and 65.% right side. Non-operatively was used in 50.9% of which 76.8% were treated with late hip Spica. Of those treated operatively, 61.1% were plating. The majority had good radiological outcomes with acceptable solid union, angulation and shortening. Those patients who were not operated had 94% lower odds of satisfactory radiological outcomes than those who were operated ( AOR=0.06, 95% CI: 0.01 – 0.27 and p<0.001) whereas other factors were not statistically significant. Conclusion: The majority of the study participants were male and were involved in MTC as the commonest mechanism of injury. Most had closed fractures that mainly presented on the right side and transverse fractures were the most common type. The hip Spica was common non-operatively option; however, plating was the most common operative option. Treatment modality substantially affected radiological outcomes and was statistically significant.
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