Lin Ji,Pan Yuancheng,Lin Ran,et al.Risk factors for avascular necrosis after lateral humeral condyle fracture[J].Journal of Clinical Pediatric Surgery,2024,(11):1029-1034.[doi:10.3760/cma.j.cn101785-202405048-006]
儿童肱骨外髁骨折手术后外髁缺血性坏死的危险因素分析
- Title:
- Risk factors for avascular necrosis after lateral humeral condyle fracture
- Keywords:
- Lateral Humeral Condyle Fracture; Avascular Necrosis; Risk Factors; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨儿童肱骨外髁骨折手术后肱骨外髁缺血性坏死的危险因素。方法 回顾性分析2018年1月至2021年12月在福州市第二总医院采用手术治疗的337例儿童肱骨外髁骨折患者临床资料。随访过程中通过X线片评估是否发生肱骨外髁缺血性坏死(avascular necrosis,AVN),并以其作为因变量,以年龄、性别、侧别、BMI、Weiss分型、初始位移、骨折块是否翻转、术后移位程度、受伤至手术时间、手术时长、术中造影以及复位方式作为自变量,进行单因素Logistic回归分析。针对单因素Logistic回归分析中P≤0.1的自变量,再采用多因素Logistic回归分析进一步筛选AVN的危险因素,绘制受试者操作特征(receiver operator characteristic,ROC)曲线评价模型,并得出最佳截断值。结果 337例患儿中,7例(2.1%,7/337)术后发生AVN。单因素分析结果提示,AVN组与无AVN组患儿的年龄、初始移位距离、AVN患儿骨折块翻转率(6/7比76/330)比较,差异有统计学意义(P≤0.1);两组性别、侧别、BMI、Weiss分型、术后移位程度、受伤至手术时间、手术时长、术中关节腔造影以及复位方式比较,差异均无统计学意义(P＞0.05)。多因素Logistic 回归分析结果提示,AVN的独立危险因素包括:年龄偏小(OR=1.953,95%CI:1.065~3.571)、骨折块翻转(OR=29.413,95%CI:1.138~760.015)。ROC曲线下面积为0.7766,年龄2.5岁是该预测模型的最佳截断值;年龄＜2.5岁组和年龄≥2.5岁组患儿的AVN发生率(7.0%比1.1%)差异有统计学意义(P=0.017)。结论 年龄偏小、骨折块翻转是儿童肱骨外髁骨折术后肱骨外髁缺血性坏死的独立危险因素。年龄2.5岁可以作为最佳截断值用于预测AVN的发生。
- Abstract:
- Objective To explore the risk factors for avascular necrosis (AVN) after surgery for lateral humeral condyle fracture in children. Methods From January 2018 to December 2021,retrospective analysis was conducted for the relevant clinical data of 337 children with lateral humeral condyle fractures.Follow-up radiography was performed for assessing the occurrence of AVN of lateral humeral condyle.Univariate Logistic analysis was performed for age,gender,sideness of fracture,body mass index (BMI),Weiss classification,initial displacement,fracture fragment rotation,degree of postoperative displacement,time from injury to surgery,duration of surgery,intraoperative arthrography and reduction mode.Variables with P≤0.1 in univariate analysis were further examined.And multivariate Logistic regression was utilized for identifying independent risk factors for AVN.Receiver operator characteristic (ROC) curve analysis was employed for validating the model and determining the optimal predictive cutoff value. Results AVN occurred postoperatively in 2.1%(7/337).Univariate analysis indicated that statistically significant inter-group differences (P≤0.1) existed in age, initial displacement distance and fracture fragment rotation rate (6/7 vs.76/330).No statistically significant differences existed in gender,sideness of fracture,BMI,Weiss classification,degree of postoperative displacement,time from injury to surgery,operative duration,intraoperative imaging or reduction mode (P>0.05).Multivariate Logistic regression analysis revealed that younger age (OR=1.953,95%CI:1.065-3.571) and fracture fragment rotation (OR=29.413,95%CI:1.138-760.015) were independent risk factors for the occurrence of AVN.The area under the ROC curve (AUC) was 0.7766 and 2.5 years of age was an optimal cutoff value for this predictive model.Chi-square test showed a statistically significant difference (P=0.017) in the incidence of AVN between children aged <2.5 year and those aged 2.5 year or above (7.0% vs.1.1%). Conclusions Younger age and fragment rotation are independent risk factors for AVN after surgery for lateral humeral condyle fracture.An age of 2.5 year may be used as an optimal cutoff for predicting the occurrence of AVN.
参考文献/References:
[1] Zhang SY,Tan SHS,Lim AKS,et al.Surgical outcomes in paediatric lateral condyle non-union:a systematic review and meta-analysis[J].Orthop Traumatol Surg Res,2022,108(1):102933.DOI:10.1016/j.otsr.2021.102933.
[2] Abzug JM,Dua K,Kozin SH,et al.Current concepts in the treatment of lateral condyle fractures in children[J].J AmAcad Orthop Surg,2020,28(1):e9-e19.DOI:10.5435/jaaos-d-17-00815.
[3] 林凤飞,陈顺有.儿童肘部损伤的诊治[J].中华创伤骨科杂志,2023,25(2):104-107.DOI:10.3760/cma.j.cn115530-20230206-00069. Lin FF,Chen SY.Diagnosis and treatment of elbow injury in children[J].Chin J Orthop Trauma,2023,25(2):104-107.DOI:10.3760/cma.j.cn115530-20230206-00069.
[4] Milch H.Fractures and fracture dislocations of the humeral condyles[J].J Trauma,1964,4:592-607.DOI:10.1097/00005373-196409000-00004.
[5] Jakob R,Fowles JV,Rang M,et al.Observations concerning fractures of the lateral humeral condyle in children[J].J Bone Joint Surg Br,1975,57(4):430-436.
[6] Song KS,Waters PM.Lateral condylar humerus fractures:which ones should we fix?[J].J Pediatr Orthop,2012,32(Suppl 1):S5-S9.DOI:10.1097/BPO.0b013e318257642a.
[7] Weiss JM,Graves S,Yang S,et al.A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures[J].J Pediatr Orthop,2009,29(6):602-605.DOI:10.1097/BPO.0b013e3181b2842c.
[8] Cates RA,Mehlman CT.Growth arrest of the capitellar physis after displaced lateral condyle fractures in children[J].J Pediatr Orthop,2012,32(8):e57-e62.DOI:10.1097/BPO.0b013e31826bb0d5.
[9] Morgan SJ,Beaver WB.Nonunion of a pediatric lateral condyle fracture without ulnar nerve palsy:sixty-year follow-up[J].J Orthop Trauma,1999,13(6):456-458.DOI:10.1097/00005131-199908000-00011.
[10] Sanders J,Goldstein RY.Open reduction and pin fixation of pediatric lateral humeral condylar fractures[J].JBJS Essent Surg Tech,2020,10(4):e19.00066.DOI:10.2106/JBJS.ST.19.00066.
[11] Bridges CS,Taylor TN,Pang LK,et al.Infection and nonunion following operative treatment of lateral humeral condyle fractures[J].J Pediatr Orthop,2023,43(7):e502-e507.DOI:10.1097/BPO.0000000000002438.
[12] Pace JL,Arkader A,Sousa T,et al.Incidence,risk factors,and definition for nonunion in pediatric lateral condyle fractures[J].J Pediatr Orthop,2018,38(5):e257-e261.DOI:10.1097/BPO.0000000000001153.
[13] Shabtai L,Lightdale-Miric N,Rounds A,et al.Incidence,risk factors and outcomes of avascular necrosis occurring after humeral lateral condyle fractures[J].J Pediatr Orthop B,2020,29(2):145-148.DOI:10.1097/BPB.0000000000000698.
[14] Yang Z,Wang Y,Gilula LA,et al.Microcirculation of the distal humeral epiphyseal cartilage:implications for post-traumatic growth deformities[J].J Hand Surg Am,1998,23(1):165-172.DOI:10.1016/S0363-5023(98)80107-X.
[15] Kimball JP,Glowczewskie F,Wright TW.Intraosseous blood supply to the distal humerus[J].J Hand Surg Am,2007,32(5):642-646.DOI:10.1016/j.jhsa.2007.02.019.
[16] Silva M,Cooper SD.Closed reduction and percutaneous pinning of displaced pediatric lateral condyle fractures of the humerus:a cohort study[J].J Pediatr Orthop,2015,35(7):661-665.DOI:10.1097/BPO.0000000000000376.
[17] Silva M,Paredes A,Sadlik G.Outcomes of ORIF >7 days after injury in displaced pediatric lateral condyle fractures[J].J Pediatr Orthop,2017,37(4):234-238.DOI:10.1097/BPO.0000000000000640.
[18] 袁悦,管之也,孙军,等.切开复位与闭合复位经皮克氏针固定治疗儿童Song Ⅲ型肱骨外髁骨折的对比研究[J].临床小儿外科杂志,2022,21(6):540-545.DOI:10.3760/cma.j.cn101785-202108034-008. Yuan Y,Guan ZY,Sun J,et al.A comparative study of open reduction versus closed reduction plus percutaneous Kirschner wire fixation for Song Ⅲ lateral humeral condylar fractures in children[J].DOI:10.3760/cma.j.cn101785-202108034-008.
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备注/Memo
收稿日期:2024-5-23。
基金项目:福建省创伤骨科急救与康复临床医学研究中心(2020Y2014);福建省福州市临床重点专科(20220104)
通讯作者:陈顺有,Email:csy508@163.com